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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 121 out of 6,867

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VAERS ID: 1637053 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-05
Onset:2021-08-17
   Days after vaccination:193
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Fatigue, Myalgia, Oropharyngeal pain, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose01/12/21 2nd dose02/05/21 Diagnosed covid positive:08/17/21 Symptom onset:08/16/21 Exposure: Symptoms:Muscle aches, fatigue, runny nose,HA, sorethroat.


VAERS ID: 1637198 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: New York  
Vaccinated:2021-01-27
Onset:2021-08-17
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Chills, Cough, Exposure to SARS-CoV-2, Fatigue, Headache, Myalgia, Oropharyngeal pain, Pyrexia, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose01/07/21 2nd dose01/27/21 Diagnosed covid positive:08/19/21 Symptom onset:08/17/21 Exposure:Travel Symptoms:fever, cough,fatigue,muscle aches, sore hroat,loss of smell/taste, chills,runny nose,HA


VAERS ID: 1637241 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Wisconsin  
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 FD 8448 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blindness transient, Dizziness, Loss of consciousness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: UNKNOWN. MOTHER REPORTED FLU SHOT
Other Medications: UNKNOWN
Current Illness: NONE
Preexisting Conditions: UNKNOWN
Allergies: NONE LISTED
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: CLIENT INDICATED SHE WAS NOT ABLE TO SEE WITHINS A FEW SECONDS AFTER HER SHOT AND FELT SHE WAS GOING TO FAINT. CLIENT FAINTED AFTER RECEIVING HER 1ST COVID VACCINE. CLIENT LOST CONSCIOUSNESS FOR LESS THAN A MINUTE. AFTER REGAINING CONSCIOUSNESS, CLIENT THOUGHT SHE COULD WALK BUT THEN LOST CONSCIOUSNESS AGAIN. CLIENT WAS ASSISTED TO THE FLOOR AND DID NOT RECEIVE AN INJURY TO THE HEAD OR OTHER BODY PARTS. AFTER A MINUTE, THE CLIENT CAME TO AND REMAINED ON THE FLOOR TO REST. AFTER A FEW MINUTES, SHE QSS ABLE TO SIT AND DRINK WATER, SHORTLY AFTER HE WALKED AND LAID DOWN ON A COT FOR 10 MINUTES UNTIL SHE FELT SHE COULD WALK. PLANS TO VACCINATE LAYING DOWN ON NEXT DOSE. CLIENT SMOTHER REPORTS SHE HAS FAINTED TWICE WITH PREVIOUS VACCINES.


VAERS ID: 1637300 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-02-19
Onset:2021-08-17
   Days after vaccination:179
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fully vaccinated. Diagnosed and hospitalized with COVID 19 from 8/17-8/24/2021


VAERS ID: 1637604 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: North Carolina  
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 2F21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: prednisone 5mg, omeprazole 20mg, atenolol 50mg,
Current Illness: Sinus/bronchial bacterial
Preexisting Conditions: RA, neuropathy, hypertension, sinus,
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache- moderate with some dizziness


VAERS ID: 1637822 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: New Hampshire  
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 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

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

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

Write-up: PATIENT FELT LIGHT HEADED AFTER GETTING THE VACCINE DUE TO ANTICIPATION. WE CHECKED THEIR BLOOD PRESSURE WHICH WAS NORMAL.


VAERS ID: 1638065 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: California  
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 (JANSSEN)) / JANSSEN 207A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Dizziness, Fatigue, Headache, Influenza like illness, Malaise
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin, Omega 3 vitamin, Peach detox tea
Current Illness: None
Preexisting Conditions: Hypothyroid, Adrenal Fatigue,
Allergies: Penicillin, Sulfa
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Headache onset within 30 min, malaise within 90 min; 2nd day onset of flu-like symptoms (headache, fatigue, painful joints, mild dizziness). Headache and joint pain lasted 4 days.


VAERS ID: 1638252 (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 (MODERNA)) / MODERNA 017E21A / 1 LA / SYR

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

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

Write-up: Soreness at the injection site lasting approximately 2 days Itchy red rash at the injection site - ongoing (approximately 10 days so far) What feels like a bump under the skin at the injection site I''ve not yet sought treatment.


VAERS ID: 1638433 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066D21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Differential white blood cell count, Dyspnoea, Electrocardiogram, Eye swelling, Full blood count, Metabolic function test, Migraine, Palpitations, Tachycardia, Tinnitus, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hearing impairment (narrow), Hypersensitivity (narrow), 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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Oral birth control
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 4 different doctor visits over 8 days. Ekg, iv meds, iv fluids, cbc with different, bmp, multiple physical exams.
CDC Split Type:

Write-up: Right swollen eye, migraine, sob, heart palpitations, tachycardia, tinnitus of right ear, profuse vomiting. 1 er visit. 1 pcp visit and 2 urgent care visits.


VAERS ID: 1638909 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Louisiana  
Vaccinated:0000-00-00
Onset:2021-08-17
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: TADALAFIL
Current Illness: Pulmonary hypertension secondary
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210849338

Write-up: FAINTED; This spontaneous report received from a patient concerned a 53 year old male of unknown race and ethnicity. The patient''s weight was 100 kilograms, and height was not reported. The patient''s concurrent conditions included: secondary pulmonary hypertension. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported, expiry: Unknown) dose was not reported, 1 total, administered on 02-AUG-2021 for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. Concomitant medications included tadalafil. On 17-AUG-2021, the patient fainted after taking the dog outside which might have been heat related. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of fainted was not reported. This report was serious (Other Medically Important Condition). This case, involving the same patient is linked to A-NJ2020-205487.; Sender''s Comments: V0:20210849338-COVID-19 VACCINE AD26.COV2.S-Fainted. This event(s) is considered unassessable. The event(s) has a compatible/suggestive 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: 1640752 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chest discomfort, Chest pain, Chills, Dizziness, Dyspnoea, Eye swelling, Flushing, Hyperhidrosis, Mouth swelling, Pain, Pyrexia, Rash, Swelling face, Swollen tongue, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Arthritis (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: Systemic: Allergic: Difficulty Breathing-Medium, Systemic: Allergic: Rash (specify: facial area, extremeties)-Medium, Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Mild, Systemic: Body Aches Generalized-Severe, Systemic: Chest Tightness / Heaviness / Pain-Mild, Systemic: Chills-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Mild, Systemic: Fever-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Joint Pain-Medium


VAERS ID: 1641081 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-25
Onset:2021-08-17
   Days after vaccination:53
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amenorrhoea
SMQs:, Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Pending: I have been advised to visit MD if menses does return by late September.
CDC Split Type:

Write-up: Abnormal menstrual cycle: After the 1st dose the menstrual cycle was delayed by 1 week (onset July 17, 2021), was heavier than usual. It lasted 3 days, however, two days later I experienced spotting which lasted 4 days. After 2nd dose the menses has been missing. Historically my menstrual cycle has been exactly 29 days.


VAERS ID: 1641089 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-02-26
Onset:2021-08-17
   Days after vaccination:172
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Adenovirus test, Asthenia, Bordetella test negative, COVID-19, COVID-19 pneumonia, Chest X-ray normal, Chlamydia test negative, Condition aggravated, Coronavirus test negative, Dyspnoea, Enterovirus test negative, Fatigue, Human metapneumovirus test, Human rhinovirus test, Influenza A virus test negative, Influenza B virus test, Influenza virus test negative, Mental status changes, Mycoplasma test negative, Respiratory syncytial virus test negative, Respiratory viral panel, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol NORVASC Asprin Tessalon CALCIUM WITH D Celexa Vitamin B12 DECADRON ARICEPT ROBITUSSIN Melatonin Memantine MULTIVITAMIN PriLOSEC FLORASTOR ZOCOR EFFEXOR
Current Illness:
Preexisting Conditions: Dementia without behavioral disturbance; Hearing loss of left ear, unspecified hearing loss type; Cerebrovascular accident (CVA), unspecified mechanism; Chronic sinusitis; Essential hypertension; type I atrioventricular block; Ileus; Benign neoplasm of colon; Diverticular disease of colon; Gastroesophageal reflux disease; Infectious diarrhea; Acute renal failure; Mixed stress and urge urinary incontinence; Osteoarthrosis involving multiple sites but not designated as generalized; Mixed hyperlipidemia; Prediabetes; Pure hypercholesterolemia; COVID-19 virus infection; Allergic arthritis; Adjustment disorder with mixed emotional features; Memory loss; Fibroadenosis of breast; Generalized anxiety disorder; Fever, unspecified fever cause; Weakness
Allergies: Ramipril: Dermatitis, Welts, Itching Solifenacin: Itching Atorvastatin: Myalgia, Muscle Pain Bee Sting: Swelling Amoxicillin: Rash Cortisone: Itching Penicillin: Rash Prednisone: Other
Diagnostic Lab Data: On 08/17/21 1525 Respiratory virus detection panel Collected on 08/17/21 1431 Final result Specimen: Swab from Nasopharynx. Adenovirus Not Detected, Mycoplasma pneumoniae Not Detected, Chlamydophila pneumoniae Not Detected, Parainfluenza Not Detected, COVID-19 SARS-CoV-2 Overall Result Detected Critical, Enterovirus Rhinovirus Not Detected, Coronavirus Not Detected, Respiratory Syncytial Virus Not Detected, Influenza A Not Detected, Bordetella pertussis not Detected, Influenza B Not Detected, Bordetella parapertussis Not Detected, Metapneumovirus Not Detected, X-ray chest 1 view [3298219392] Resulted on 08/17/21 1354. Completed Updated: 08/17/21 1354. Narrative: AP upright portable chest radiograph at 1:40 PM. IMPRESSION: Heart size normal. No evidence for acute cardiopulmonary disease. Compared to 1/5/2021 and earlier. INDICATION: Altered mental status. Heart size normal. Lungs clear. Pulmonary vascular do not congested. No pleural fluid. No focal consolidation.
CDC Split Type:

Write-up: ED to Hospital Admission, Discharged 8/17/2021 to 8/20/2021 (3 days) Hospital COVID-19 virus infection, weakness. Patient was admitted secondary COVID-19 pneumonia picture after presenting with shortness of breath. Patient had fatigue and tiredness with however had no loss of taste or smell. He also did have COVID-19 vaccination. Patient was placed on Decadron and supportive care and IV fluids. Patient did well and was taken off of oxygen. PT and OT evaluation was done secondary to her weakness at presentation and felt the patient would benefit from placement to ECF.


VAERS ID: 1641153 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-04-02
Onset:2021-08-17
   Days after vaccination:137
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Myositis, Neck pain
SMQs:, Rhabdomyolysis/myopathy (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril 5mg
Current Illness: None
Preexisting Conditions: None
Allergies: Aspirin
Diagnostic Lab Data: Physical exams only, no labs. One of four had x-rays taken.
CDC Split Type:

Write-up: Myself and three (3) other ladies in my office got the J&J vaccine on the same date, at the same location on 4/2/21. All four of us, beginning roughly around 8/17 began having several shoulder/neck pains, with no one having done any injury. All of us continue to experience pain and have been to our respective doctors. Mine and one other''s doctors diagnosed with inflamed muscles, possibly affecting nerves and prescribed anfi-inflammatory and muscle relaxer meds. One was told could be rotator cuff and nerves and referred to an Orthopedic. One reports nerve issues and referred to a Neurologist. In my case, medication not helping, nor is heat, ice, icy hot, or electronic pulse massager. Was told NOT to go get a message for a few weeks.


VAERS ID: 1641261 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-02-10
Onset:2021-08-17
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Exposure to SARS-CoV-2, Stent removal, Urinary tract infection, Vaginal 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: Muti- Vitamin; Alendronate 70mg once a week; Levothyroxine 88mg once a day
Current Illness: No
Preexisting Conditions: Thyroid; Osteopenia
Allergies: Penicillin; Phenobarbital; Atropine; Tetracycline
Diagnostic Lab Data: Long COVID test that takes 24 hours. Quarantining . Extra medicine
CDC Split Type: vsafe

Write-up: Prior to 08/17/202 relative in the house had COVID exposer to COVID went in on 08/17/202 to have a test and it confirmed the positive COVID results. Quarantining til 08/31/2021. 08/17/2021 Urology removal of stent, UTI and Vaginal Infections.


VAERS ID: 1641265 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Feeling hot
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Shortly after second Pfizer dose, pt reported she felt a little warm with slight erythema


VAERS ID: 1641279 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-01-16
Onset:2021-08-17
   Days after vaccination:213
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014L20A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Hypoaesthesia, Oedema peripheral, Pain in extremity, Tendonitis, X-ray
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (narrow), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: No
Preexisting Conditions: Blood Clotting Disorder
Allergies: Lexapro; Terconazole; Adhesive; Latex
Diagnostic Lab Data: Xray (right arm)
CDC Split Type: vsafe

Write-up: This is a continuation of worsening symptom. The day after 1/17 had swelling on right armpit caused my arm to numb. It was extremely painful my doctor prescribed me anti inflammatory 800 mg (Ibuprofen) for 8 hrs consistently. I had started Tylenol prior to that no relief. As of today the pain is till present I have been referred to a shoulder specialist. The doctor has diagnosed me with AC Arthritis and Bicep Tendonitis. He started me on a dose pack, physical therapy. I have a follow up on 9/3 the symptoms hasn''t gotten any better will be performing CT scan.


VAERS ID: 1641354 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-10
Onset:2021-08-17
   Days after vaccination:129
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Respiratory tract congestion, Rhinorrhoea, 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: atorvastatin (LIPITOR) 20 mg tablet azithromycin (ZITHROMAX) 250 mg tablet meloxicam (MOBIC) 15 mg tablet (Expired)
Current Illness:
Preexisting Conditions: Musculoskeletal Plantar fasciitis of left foot
Allergies: No Known Allergies
Diagnostic Lab Data: COVID-19 PCR
CDC Split Type:

Write-up: cough congestion runny nose


VAERS ID: 1641385 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Patient stated that she had the normal symptoms the first couple of days. On day 10 patient received a sudden onset of joint and muscle pain. Pain made it uncomfortable to walk.


VAERS ID: 1641546 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Contusion, Malaise, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: buprenorphine, lisinopril
Current Illness: none
Preexisting Conditions: opioid dependence, htn, tinea versicolor
Allergies: nkda
Diagnostic Lab Data: none
CDC Split Type:

Write-up: she felt unwell (fever, chills, muscle aches) after the vaccine, which was not cocerning. She also developed some unexplained bruising on her upper thighs, inner arms, which have resolved. They were not painful. They completely resolved in one week. I saw her routinely today - she showed me pictures of the bruising.


VAERS ID: 1641735 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 00DTJWA (UNLEGI / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Discomfort, Dizziness, Fatigue, Hypoaesthesia, Hypoaesthesia oral, Nausea, Paraesthesia, Paraesthesia oral, SARS-CoV-2 test negative
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), COVID-19 (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No prescriptions, no over the counter medications. Equate brand prebiotic Fiber Supplement (8 grams), Vitafusion Women''s Multivitamin, Vitafusion 500 mg Calcium.
Current Illness: none
Preexisting Conditions: none
Allergies: None that I am aware of other than general anesthesia makes me vomit.
Diagnostic Lab Data: Went to urgent care on Thursday morning, 8.19.21. Notes from visit - PA Differential includes vaccine reaction, acute viral syndrome, COVID-19, vestibular neuritis, Guillon Barr? amongst others. Discussed SSX are most likely due to vaccine reaction, but due to limitations of urgent care I cannot fully evaluate for serious causes of patient''s symptoms. Discussed that general vaccine reactions may last anywhere from 2 to 7 days. For now I advised hydration, rest, p.o. meclizine as needed. Strict ER precautions given for new, unresolved, or worsening symptoms. COVID-19 in clinic was negative in clinic.
CDC Split Type:

Write-up: dizzy, equilibrium off, nausea from the dizziness/equilibrium issue. This started 23 hours after injection and lasted 42 hours. 48 hours after injection I started feeling numb and tingly in feet, hands, and tongue. 48 hours later I was feeling numb in my calves. I was able to walk and move, but it felt like circulation was cut off or those body parts were asleep - without the painful tingly feeling when you move it. No fever, no chills, body felt heavy and tired after the dizziness wore off. Didn''t feel like myself until Sunday afternoon.


VAERS ID: 1645229 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature, Flushing, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: 20210817; Test Name: Body temperature; Result Unstructured Data: High
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Flush; Body aches; Nausea; 99.5 is the highest temp; This spontaneous case was reported by a consumer and describes the occurrence of FLUSHING (Flush), MYALGIA (Body aches), NAUSEA (Nausea) and PYREXIA (99.5 is the highest temp) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 16-Aug-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 17-Aug-2021, the patient experienced FLUSHING (Flush), MYALGIA (Body aches), NAUSEA (Nausea) and PYREXIA (99.5 is the highest temp). At the time of the report, FLUSHING (Flush), MYALGIA (Body aches), NAUSEA (Nausea) and PYREXIA (99.5 is the highest temp) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 17-Aug-2021, Body temperature: 99.5 (High) High. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medication information was provided. No treatment medication information was provided. Reporter did not allow further contact


VAERS ID: 1645233 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-06-02
Onset:2021-08-17
   Days after vaccination:76
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Product dose omission issue
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Second dose has not been administered more than 2 months away from the first dose; This spontaneous case was reported by a nurse and describes the occurrence of PRODUCT DOSE OMISSION ISSUE (Second dose has not been administered more than 2 months away from the first dose) in a 38-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 02-Jun-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 17-Aug-2021, the patient experienced PRODUCT DOSE OMISSION ISSUE (Second dose has not been administered more than 2 months away from the first dose). At the time of the report, PRODUCT DOSE OMISSION ISSUE (Second dose has not been administered more than 2 months away from the first dose) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medications were reported No treatment information was reported.


VAERS ID: 1645273 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 3 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Extra dose administered, Pyrexia, Vaccination site erythema, Vaccination site warmth
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: the area around the injection site from her 3rd shot on her right arm is fairly red & hot and is 2&1/2 inches wide & 1&1/2 inches tall; the area around the injection site from her 3rd shot on her right arm is fairly red & hot and is 2&1/2 inches wide & 1&1/2 inches tall; chills; a low grade fever today of 99.5 F/She had a fever last night with shakes; Extra dose administered; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE WARMTH (the area around the injection site from her 3rd shot on her right arm is fairly red & hot and is 2&1/2 inches wide & 1&1/2 inches tall), VACCINATION SITE ERYTHEMA (the area around the injection site from her 3rd shot on her right arm is fairly red & hot and is 2&1/2 inches wide & 1&1/2 inches tall), CHILLS (chills), PYREXIA (a low grade fever today of 99.5 F/She had a fever last night with shakes) and EXTRA DOSE ADMINISTERED (Extra dose administered) in a 61-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 088D21A) for COVID-19 vaccination. No Medical History information was reported. On 17-Aug-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 17-Aug-2021, the patient experienced CHILLS (chills), PYREXIA (a low grade fever today of 99.5 F/She had a fever last night with shakes) and EXTRA DOSE ADMINISTERED (Extra dose administered). On 18-Aug-2021, the patient experienced VACCINATION SITE WARMTH (the area around the injection site from her 3rd shot on her right arm is fairly red & hot and is 2&1/2 inches wide & 1&1/2 inches tall) and VACCINATION SITE ERYTHEMA (the area around the injection site from her 3rd shot on her right arm is fairly red & hot and is 2&1/2 inches wide & 1&1/2 inches tall). At the time of the report, VACCINATION SITE WARMTH (the area around the injection site from her 3rd shot on her right arm is fairly red & hot and is 2&1/2 inches wide & 1&1/2 inches tall), VACCINATION SITE ERYTHEMA (the area around the injection site from her 3rd shot on her right arm is fairly red & hot and is 2&1/2 inches wide & 1&1/2 inches tall), CHILLS (chills) and PYREXIA (a low grade fever today of 99.5 F/She had a fever last night with shakes) outcome was unknown and EXTRA DOSE ADMINISTERED (Extra dose administered) had resolved. No concomitant medication was provided. No treatment information was provided. This case was linked to MOD-2021-290761 (Patient Link).


VAERS ID: 1645293 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-13
Onset:2021-08-17
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Headache, Limb discomfort, Malaise
SMQs:, Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: felt a tiny bit under the weather/was feeling under the weather on and off; headache/had a headache which he describes as very slight, nothing crazy; with the exact same thing happening to his big toe on his right foot; felt like gout on the back or heel of his left foot; The joint was sore and not feeling right; This spontaneous case was reported by a consumer and describes the occurrence of LIMB DISCOMFORT (felt like gout on the back or heel of his left foot), LIMB DISCOMFORT (with the exact same thing happening to his big toe on his right foot), MALAISE (felt a tiny bit under the weather/was feeling under the weather on and off), HEADACHE (headache/had a headache which he describes as very slight, nothing crazy) and ARTHRALGIA (The joint was sore and not feeling right) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 13-Aug-2021 at 5:03 PM, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 17-Aug-2021, the patient experienced LIMB DISCOMFORT (felt like gout on the back or heel of his left foot) and ARTHRALGIA (The joint was sore and not feeling right). On 18-Aug-2021, the patient experienced LIMB DISCOMFORT (with the exact same thing happening to his big toe on his right foot). On an unknown date, the patient experienced MALAISE (felt a tiny bit under the weather/was feeling under the weather on and off) and HEADACHE (headache/had a headache which he describes as very slight, nothing crazy). The patient was treated with PARACETAMOL (TYLENOL) for Adverse event, at an unspecified dose and frequency. At the time of the report, LIMB DISCOMFORT (felt like gout on the back or heel of his left foot) and ARTHRALGIA (The joint was sore and not feeling right) had resolved and LIMB DISCOMFORT (with the exact same thing happening to his big toe on his right foot), MALAISE (felt a tiny bit under the weather/was feeling under the weather on and off) and HEADACHE (headache/had a headache which he describes as very slight, nothing crazy) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant drugs were reported


VAERS ID: 1645352 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-01-15
Onset:2021-08-17
   Days after vaccination:214
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chromaturia, Haematuria, Haemorrhage urinary tract, Malaise, Urine analysis
SMQs:, Rhabdomyolysis/myopathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210819; Test Name: urine was clear; Result Unstructured Data: normal
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Feeling groggier than normal; Urine was very dark brown, with a little bit of blood, and blood clots; Their urine was totally black and had blood clots; A little bit of blood in their urine; This spontaneous case was reported by a consumer and describes the occurrence of HAEMORRHAGE URINARY TRACT (Urine was very dark brown, with a little bit of blood, and blood clots) in an 82-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 037K20A and 041L20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 15-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 12-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 17-Aug-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 17-Aug-2021, the patient experienced HAEMATURIA (A little bit of blood in their urine). On 18-Aug-2021, the patient experienced HAEMORRHAGE URINARY TRACT (Urine was very dark brown, with a little bit of blood, and blood clots) (seriousness criterion medically significant) and CHROMATURIA (Their urine was totally black and had blood clots). On an unknown date, the patient experienced MALAISE (Feeling groggier than normal). On 19-Aug-2021, HAEMORRHAGE URINARY TRACT (Urine was very dark brown, with a little bit of blood, and blood clots), HAEMATURIA (A little bit of blood in their urine) and CHROMATURIA (Their urine was totally black and had blood clots) had resolved. At the time of the report, MALAISE (Feeling groggier than normal) had not resolved. Patient was not taking any daily medications. It is reported that patient was self catheterized four times a day. It is stated that as the day went on, the blood in the urine was lessening. It is stated that the patient had not taken anything to help with the symptoms. Action taken was not applicable. This case was linked to MOD-2021-292324, MOD-2021-292304 (Patient Link).; Sender''s Comments: Based on current available information and the temporal association between product use and the start date of the events a causal relationship cannot be excluded.


VAERS ID: 1645354 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-01-15
Onset:2021-08-17
   Days after vaccination:214
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Blood urine present, Chromaturia, Extra dose administered, Haemorrhage urinary tract, Somnolence
SMQs:, Rhabdomyolysis/myopathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Ureteral catheterisation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: This spontaneous case was reported by a consumer and describes the occurrence of HAEMORRHAGE URINARY TRACT (Little bit of blood, and blood clots in urine), SOMNOLENCE (Feeling groggier than normal), BLOOD URINE PRESENT (A little bit of blood in their urine), CHROMATURIA (Their urine was brown and black) and EXTRA DOSE ADMINISTERED (patient received a 3rd dose of the Moderna COVID-19 vaccine on 17Aug2021 in the left arm.) in an 82-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 041L20A and 037K20A) for COVID-19 vaccination. Concurrent medical conditions included Ureteral catheterisation. On 15-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 12-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 17-Aug-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 17-Aug-2021, the patient experienced BLOOD URINE PRESENT (A little bit of blood in their urine) and EXTRA DOSE ADMINISTERED (patient received a 3rd dose of the Moderna COVID-19 vaccine on 17Aug2021 in the left arm.). On 18-Aug-2021, the patient experienced HAEMORRHAGE URINARY TRACT (Little bit of blood, and blood clots in urine) and CHROMATURIA (Their urine was brown and black). On an unknown date, the patient experienced SOMNOLENCE (Feeling groggier than normal). On 19-Aug-2021, HAEMORRHAGE URINARY TRACT (Little bit of blood, and blood clots in urine), BLOOD URINE PRESENT (A little bit of blood in their urine) and CHROMATURIA (Their urine was brown and black) had resolved. At the time of the report, SOMNOLENCE (Feeling groggier than normal) had not resolved and EXTRA DOSE ADMINISTERED (patient received a 3rd dose of the Moderna COVID-19 vaccine on 17Aug2021 in the left arm.) had resolved. Concomitant product was not provided by the reporter. Treatment information was not provided. Patient reported that self catheterize four times a day. Patient had not taken anything to help with the symptoms. Company Comment: This report refers to a case of Extra dose administered for mRNA-1273 (lot # 037K20A) with associated adverse events reported as BLOOD URINE PRESENT, HAEMORRHAGE URINARY TRACT, CHROMATURIA and SOMNOLENCE. Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. However, current history of Ureteral catheterisation may be a confounding factor for the case. Event HAEMORRHAGE URINARY TRACT was automatically upgraded as serious as per IME list. However, based on information available and as per medical judgement was assessed as non-serious. No further contact is possible. This case was linked to MOD-2021-292294, MOD-2021-292304 (Patient Link).; Sender''s Comments: This report refers to a case of Extra dose administered for mRNA-1273 (lot # 037K20A) with associated adverse events reported as BLOOD URINE PRESENT, HAEMORRHAGE URINARY TRACT, CHROMATURIA and SOMNOLENCE. Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. However, current history of Ureteral catheterisation may be a confounding factor for the case. Event HAEMORRHAGE URINARY TRACT was automatically upgraded as serious as per IME list. However, based on information available and as per medical judgement was assessed as non-serious. No further contact is possible.


VAERS ID: 1645924 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-29
Onset:2021-08-17
   Days after vaccination:141
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Anosmia, Arthralgia, Chest pain, Cough, Diarrhoea, Dysgeusia, Dyspnoea, Headache, Myalgia, Nausea, SARS-CoV-2 test, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Taste and smell disorders (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Outpatient Medications acetaminophen (TYLENOL) 500 mg tablet escitalopram (LEXAPRO) 20 mg tablet HUMIRA PEN 40 mg/0.8 mL pen injector kit injection lisinopriL (ZESTRIL) 20 mg tablet
Current Illness:
Preexisting Conditions: Respiratory Witnessed apneic spells Snoring OSA (obstructive sleep apnea) Circulatory Essential hypertension Digestive Crohn''s disease Symptomatic cholelithiasis Genitourinary Benign essential microscopic hematuria Musculoskeletal Arthritis Closed fracture of base of fifth metatarsal bone of left foot at metaphyseal-diaphyseal junction, initial encounter Closed fracture of base of fifth metatarsal bone of left foot at metaphyseal-diaphyseal junction with routine healing, subsequent encounter Immune Immunocompromised state due to drug therapy Other Retained stone fragments Lip swelling Daytime sleepiness
Allergies: Latex, Natural RubberRash, Other (document details in comments), Jittery / shaky LevofloxacinMyalgia / Muscle Pain LidocaineBradycardia
Diagnostic Lab Data: COVID-19 PCR
CDC Split Type:

Write-up: Chest Pain Shortness of Breath Cough Epigastric pain Nausea Vomiting Diarrhea Arthralgias Myalgias Ansomia Dysgeusia Headache


VAERS ID: 1647346 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Pain, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: none
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101064308

Write-up: Ache; Chills; sore arm; This is a spontaneous report received from a non-contactable consumer(patient). A 25-year-old female patient received BNT162B2 (solution for injection; lot number- ew0181, expiry date not reported) via an unspecified route of administration into right arm, on 16Aug2021 17:00 at the age of 25-year-old, dose 2, single for covid-19 immunisation in a pharmacy or drug Store. The patient did not have any medical history. Historical vaccine included BNT162B2 (solution for injection; lot number and expiry date not reported) via an unspecified route of administration, on unknown date, dose 1, single for covid-19 immunisation. The patient is not pregnant at the time of vaccination. The patient did not receive other vaccine in four weeks. The patient did not have prior COVID vaccination and was not tested post vaccination. On 17Aug2021 09:00, the patient experienced ache, chills,and sore arm. The patient did not receive treatment in response to the events. The outcome of the events was not recovered at the time of report. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1647369 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-16
Onset:2021-08-17
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 2 LA / OT

Administered by: Work       Purchased by: ?
Symptoms: COVID-19, Drug ineffective, Headache, Pain, Pyrexia, SARS-CoV-2 test
SMQs:, Lack of efficacy/effect (narrow), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210817; Test Name: PCR/Nasal Swab; Test Result: Positive
CDC Split Type: USPFIZER INC202101068576

Write-up: covid test date=17Aug2021, covid test result=Positive; covid test date=17Aug2021, covid test result=Positive,; Body aches; fever; Headache; This is a spontaneous report from a contactable Nurse. A 62-year-old female patient received bnt162b2 (BNT162B2, Formulation: solution for Injection, Batch/Lot number: EL3248) dose 2 via an intramuscular route of administration, administered in Left arm on 16Feb2021 1:30 (at the age of 62-years) as dose 2, single dose for covid-19 immunisation. The patient medical history were not reported the patient past drug therapy included BNT162B2 (Lot number=EL3248) dose 1 via an intramuscular route of administration, administered in Left arm for covid-19 immunisation on an unspecified date in Jan2021 01:45. The concomitant medications were not reported. The patient experienced covid test date=17Aug2021, covid test result=Positive (vaccination failure and COVID-19), body aches, fever, headache on 17Aug2021. The patient underwent lab tests and procedures which included PCR/Nasal Swab was positive on 17Aug2021. The outcome of the events experienced covid test date=17Aug2021, covid test result=Positive was unknown, body aches, fever, headache was not recovered.; Sender''s Comments: Based on the information currently available,The casual association between the reported event "Covid-19" and suspected vaccine BNT162B2 cannot be completely excluded.


VAERS ID: 1647373 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-21
Onset:2021-08-17
   Days after vaccination:118
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 2 - / OT

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: 20210817; Test Name: Abbott BinaxNow Antigen Self Test; Result Unstructured Data: Test Result:Positive; Comments: Nasal Swab
CDC Split Type: USPFIZER INC202101069110

Write-up: COVID antigen test which came out positive; COVID antigen test which came out positive; This is a spontaneous report from a contactable consumer. This consumer reported for 36-year-old female patient. A 36-year-old non-pregnant female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, formulation: Solution for injection, Batch/Lot Number: ER8734), dose 1 intramuscularly on 31Mar2021 (age at the time of vaccination was 36-year-old) as dose 1, single for COVID-19 immunization and BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, formulation: Solution for injection, Batch/Lot Number: ER8729) dose 2 intramuscularly on 21Apr2021 (age at the time of vaccination was 36-year-old) as dose 2, single for COVID-19 immunization. The patient medical history and concomitant medications were not reported. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. No other medications were received by the patient within 2 weeks of vaccination. The patient did not test COVID-19 positive prior to vaccination. The patient had been tested for COVID-19 since the vaccination. It was reported that on 17Aug2021, the patient took an at-home COVID antigen test (Abbott BinaxNow Antigen Self Test) which came out positive on 17Aug2021. Patient was experiencing COVID-19 symptoms which included fever, aches, loss of smell and taste, fatigue, congestion and cough. The patient underwent lab tests and procedures which included sars-cov-2 test: positive on 17Aug2021 (Nasal Swab). Treatment medications included OTC DayQuil and NyQuil to treat symptoms. Outcome of the event COVID-19 was reported as not recovered at this time of the report. Follow-up attempts are completed. No further information is expected.


VAERS ID: 1654014 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-07
Onset:2021-08-17
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-08-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0102 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Dysmenorrhoea, Muscle spasms, Muscular weakness, Pain in extremity, Paraesthesia, Pelvic pain, Thrombosis
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dystonia (broad), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D3, B-12, Magnesium Glycinate, Vitamin C
Current Illness:
Preexisting Conditions:
Allergies: Acyclovir
Diagnostic Lab Data: I went to my doctor on 8/20/2021 and she examined my legs. She was not able to tell what was going on and asked me to follow up if it does not improve which I will do.
CDC Split Type:

Write-up: 10 days after I received the vaccine, I began experiencing leg pain in both legs. I first experienced what felt like muscle cramps and they progressively got worse throughout the day and week. I also began experiencing what feels like pins and needles on the back of my legs from my upper thighs, calves and into my ankles at times. The pain continued so I went to my doctor 3 days after first symptoms appeared. I also began my menstrual cycle 3 days after the onset of the leg pain and had a tremendous amount of pain (cramps and sharp knife like pains) in my abdomen and pelvis for 3 days during my menstrual cycle. I also discussed this with my doctor. While pain and cramps are typical with my periods, this was nothing like I have experienced before. I also passed many clots both small and large (larger than a 50 cent piece) the entirety of my menstrual cycle. While a few clots are normal for me, the amount I was passing the entire time has never happened to me before. I am still experiencing the leg pain and pins and needles sensations in my calves. I also have experienced weakness in my left arm from time to time since receiving the vaccine.


VAERS ID: 1654141 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-08-14
Onset:2021-08-17
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dyspnoea, Fatigue, Kidney infection, Lip swelling, Pain in extremity, Pruritus, Pyrexia, SARS-CoV-2 test negative, Skin discolouration, Somnolence, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Covid 19 test
CDC Split Type:

Write-up: 8/17 I woke up to a kidney infection. I got antibiotics prescribed and took the full dose feeling better after 3 days. At the same time I started to feel exhausted every moment of the day. When I wasn?t working, I was sleeping. About 8/23 or so I started getting fevers daily. Ranging from 101.5-101.9. I had chills that I couldn?t get rid of for hours, daily. 2 of my toes turned reddish purple and ached like they were thawing from getting too cold. My breathing was bad. I couldn?t talk without being out of breath. My lips are both swollen right now. My legs developed a hive like rash. I have a scar on my knee that is red now and itching along with my sides and hips. I got a covid test that came back negative today


VAERS ID: 1654196 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-02-01
Onset:2021-08-17
   Days after vaccination:197
Submitted: 0000-00-00
Entered: 2021-08-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Fibrin D dimer increased, Pulmonary embolism
SMQs:, Haemorrhage laboratory terms (broad), Embolic and thrombotic events, venous (narrow), Pulmonary hypertension (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Pregabalin, Pristiq, diltiazem, hydrochlorothiazide, buspirone, zolpidem
Current Illness:
Preexisting Conditions: Fibromyalgia, Supraventricular tachycardia
Allergies: nitrofurantoin
Diagnostic Lab Data: Chest CTA and elevated D Dimer
CDC Split Type:

Write-up: Bilateral pulmonary emboli diagnosed 8/20/21


VAERS ID: 1655373 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Rash
SMQs:, Anaphylactic reaction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Allergic: Rash Generalized-Medium, Systemic: Chest Tightness / Heaviness / Pain-Medium


VAERS ID: 1655691 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-09
Onset:2021-08-17
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Oligomenorrhoea, Pain in extremity, Paraesthesia, Peripheral swelling, Skin warm, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Fertility disorders (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Garlic capsules; Multivitamin; Klonopin; Synthroid; Trazodone; Amitriptyline; Xyzal allergy medication
Current Illness: N/A
Preexisting Conditions: Hashimito''s autoimmune thyroid disorder; Asthma; Seasonal allergies; Generalized anxiety disorder; major depressive disorder; PAT heart disorder
Allergies: Sulfa drugs; anti-nausea medications
Diagnostic Lab Data: N/A
CDC Split Type: vsafe

Write-up: I received the shot on the 9th of August, had 2-3 days of the initial arm site swelling and pain. Then It went away and I was fine. Then the morning of the 17th of August I woke up in pain in my arm and a pins and needles sensation in my arm. I looked at it and it looked like hives, it was hot to touch and was a big, hard, red area. That lasted the 17th/18th/19th and on the 20th when I woke up and was supposed to go to the Dr., it was pretty much gone. Oh, and you know else, my menstrual cycle is very regular, and it should''ve come right after my shot, and it didn''t come then when it did come it was only two days which is very weird for me since I am never irregular like that. So, on the 20th of August I had went to the Dr., but he said it was "normal" as a reaction after the vaccine and he recommended getting the shot in the other arm for the vaccine. So, for my next vaccine, I have a Dr. appointment 3 days after my vaccine just in case. At home I had treated with Benadryl.


VAERS ID: 1655808 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Hypotension, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: VasoVagal response. Drop in BP. Paramendics evaluated and transported due to low BP


VAERS ID: 1655960 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-05
Onset:2021-08-17
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Electrocardiogram, Hypertension, Postural orthostatic tachycardia syndrome
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (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? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acitane For Acme Zoloft 50mg
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: EKG
CDC Split Type:

Write-up: Patient stated that she developed many problems due to receiving the vaccination. Postural Orthostatic Pachycargra syndrome. Hypertension, QT


VAERS ID: 1656019 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: FOLLOWING JANSSEN COVID VACCINE, PATIENT COMPLAINED OF ANXIETY AND MENTIONED HISTORY OF ASTHMA. PATIENT WAS GIVEN ALBUTEROL HFA INHALER AND ALL THE VITALS WERE NORMAL. HOWEVER, CALL 911 TO FURTHER ASSESS THE PATIENT. PARAMEDIC CONFIRMED PATIENT WAS HAVING ANXIETY BUT ALL THE VITALS WERE NORMAL . SPO2 99%, HR 90-94, BP 100/70. AFTER PARAMEDIC ASSESSMENT, PATIENT STARTED TO RELAX AND FEELING BETTER AND LEFT WITH HER HUSBAND.


VAERS ID: 1656054 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-09
Onset:2021-08-17
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angiogram, Aphasia, Blood test, Dysarthria, Hypoaesthesia oral, Magnetic resonance imaging, Urine analysis, Vasodilatation
SMQs:, Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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: Dexmethylphenidate 5mg daily Monday- Friday
Current Illness: Nasal congestion 1 week prior. Tested negative for covid at that time.
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: MRI, MRA, blood work and urine test. 8/17/2021.
CDC Split Type:

Write-up: On August 17th he experienced numbness on the right side of his body, expressive aphasia-unable to say the words he wanted to say. He was taken to the emergency room and had MRI/ MRA completed. Symptoms resolved after 2 hours. MRA revealed a notice blood vessel in the left side of the brain. Pending follow up with Neurology.


VAERS ID: 1656101 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Fatigue, Headache, Loss of personal independence in daily activities, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: singular, livalo, farxiga, triameternene/ HCTZ, omeprazole, losartan, ASA, naprosn, gabapentin, metformin, stiolto, ventolin, calcium
Current Illness: no acute illness
Preexisting Conditions: DM II, COPD, OA, HLD, HTN
Allergies: almond,morphine, PCN, blueberry, emycin, sulfa
Diagnostic Lab Data: ordered testing today
CDC Split Type:

Write-up: patient reports after the first dose of Pfizer vaccine the she felt as though she had COVID all over again, those symptoms resolved. Received her 2nd dose 2 weeks ago an in the office today due to fatigue, headache, nausea, dizziness that are interfering with daily activity. Some days feels pretty good other days are so bad that she cannot do normal activities


VAERS ID: 1656218 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-26
Onset:2021-08-17
   Days after vaccination:172
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Once a day women''s multivitamin
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: COVID at-home test on 8/19/21 was positive and second test on 8/26/21 was positive.
CDC Split Type:

Write-up: After an outbreak of COVID at my daughter''s summer camp, both her (5 yrs old - unvaccinated) and myself contracted COVID. This was on 8/17/21. I was ill for about 7 days and was unable to work for many of those days due to being sick. I definitely had more symptoms and more severity than my daughter did who is unvaccinated due to her age. We remained in quarantine for 10 days.


VAERS ID: 1656232 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Connective tissue disorder, Fatigue, Injection site reaction, Musculoskeletal stiffness, Nausea, Rash macular
SMQs:, Acute pancreatitis (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient says she started feeling nauseous the next day and was tired for a couple days. Then 1 week after injection developed a red blotchy rash all over injection site down to elbow (was still visible when pt presented to pharmacy on 8/30). Also stated she has a connective tissue disorder that has been flaring up since injection and has had increased stiffness in hands.


VAERS ID: 1656265 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-25
Onset:2021-08-17
   Days after vaccination:84
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain upper, Asthenia, Blister, Burning sensation, Fatigue, Glossodynia, Mouth ulceration, Rash, Rash macular, Viral infection
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Systemic lupus erythematosus (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: After receiving the chickenpox vaccine and shortly after I received the actual virus itself.
Other Medications: Multivitamin; Vitamin B complex; magnesium; Claritin
Current Illness:
Preexisting Conditions:
Allergies: Fluoricleterone
Diagnostic Lab Data:
CDC Split Type: vsafe

Write-up: Around August 17th I felt very tired and had a bad stomachache that lasted about two days. Also, I experienced sores all over my mouth and tongue, and blister all over my hands and feet. Going up my right leg I had small blood red spots that was accompanied by a burning sensation that comes and goes. I had absolutely no energy throughout the day. By Friday I was a lot better and on Saturday I felt completely better. I still have red spots that are slowly but surely disappearing. There were no medical test done besides the normal check in for going to the doctor''s office. They stated that it was just a virus that I had caught with not much information about what was going on.


VAERS ID: 1656387 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-08-09
Onset:2021-08-17
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Polymenorrhoea
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: Levothyroxine
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Went to obgyn and she confirmed it was in fact a period. No other issues she observed.
CDC Split Type:

Write-up: Had my usual menstrual cycle for the month of august, 9 days after receiving shot my period started again. A semi light 7 day long period. I had just had my period 12 days before the shot. I believe the shot jump started my period again.


VAERS ID: 1657256 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-18
Onset:2021-08-17
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Oxygen saturation decreased, SARS-CoV-2 test positive
SMQs:, Acute central respiratory depression (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:
Allergies:
Diagnostic Lab Data: 08/17/2021 Antigen Positive test, 08/23/2021 PCR positive test
CDC Split Type:

Write-up: Positive COVID-19 test, oxygen level dropping, hospitalization


VAERS ID: 1657800 (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: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Wrong technique in product usage process
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: mixed normal saline with Moderna COVID19 vial; This spontaneous case was reported by a consumer and describes the occurrence of WRONG TECHNIQUE IN PRODUCT USAGE PROCESS (mixed normal saline with Moderna COVID19 vial) in a 57-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 17-Aug-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 17-Aug-2021, the patient experienced WRONG TECHNIQUE IN PRODUCT USAGE PROCESS (mixed normal saline with Moderna COVID19 vial). On 17-Aug-2021, WRONG TECHNIQUE IN PRODUCT USAGE PROCESS (mixed normal saline with Moderna COVID19 vial) had resolved. No concomitant medications information was reported. No treatment medications were provided. It was reported that the patient was not experiencing any symptoms and was monitored for 15 minutes.


VAERS ID: 1657801 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053C21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Accidental overdose
SMQs:, Drug abuse and dependence (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Patient received 1ml instead of .5ml; This spontaneous case was reported by a pharmacist and describes the occurrence of ACCIDENTAL OVERDOSE (Patient received 1ml instead of .5ml) in a 55-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 053C21A) for COVID-19 vaccination. No Medical History information was reported. On 17-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 milliliter. On 17-Aug-2021, the patient experienced ACCIDENTAL OVERDOSE (Patient received 1ml instead of .5ml). On 17-Aug-2021, ACCIDENTAL OVERDOSE (Patient received 1ml instead of .5ml) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant product use was not provided by the reporter. No treatment information was provided.


VAERS ID: 1657813 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-05
Onset:2021-08-17
   Days after vaccination:134
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 LA / OT
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: She received her first 2 doses from Pfizer and her 3rd dose from Moderna; This spontaneous case was reported by a consumer and describes the occurrence of INTERCHANGE OF VACCINE PRODUCTS (She received her first 2 doses from Pfizer and her 3rd dose from Moderna) in a 47-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 002F21A) for COVID-19 vaccination. Co-suspect product included non-company product TOZINAMERAN (PFIZER BIONTECH COVID-19 VACCINE) for COVID-19 vaccination. No Medical History information was reported. On 05-Apr-2021, the patient received first dose of TOZINAMERAN (PFIZER BIONTECH COVID-19 VACCINE) (unknown route) 1 dosage form. On 25-Apr-2021, received second dose of TOZINAMERAN (PFIZER BIONTECH COVID-19 VACCINE) (unknown route) dosage was changed to 1 dosage form. On 17-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 17-Aug-2021, the patient experienced INTERCHANGE OF VACCINE PRODUCTS (She received her first 2 doses from Pfizer and her 3rd dose from Moderna). At the time of the report, INTERCHANGE OF VACCINE PRODUCTS (She received her first 2 doses from Pfizer and her 3rd dose from Moderna) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medication were provided by the reporter. No treatment medication were provided by the reporter.


VAERS ID: 1657895 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-15
Onset:2021-08-17
   Days after vaccination:155
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101091580

Write-up: Bell''s Palsy; This is a spontaneous report from a contactable consumer or other non hcp. A 44-year-old male patient received second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection) via an unspecified route of administration, administered in left arm on 15Mar2021 15:00 (Batch/Lot number was not reported, age at vaccination 44-year-old) as single for COVID-19 immunisation. Medical history was reported as none and concomitant medications were not reported. The patient previously took first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, batch/lot number was not reported) via an unspecified route of administration, administered in left arm on 22Feb2021 03:00 pm as single dose for COVID-19 immunisation. On 17Aug2021 13:00, the patient experienced bell''s palsy. He received treatment medications as prednisone and valacyclovir. The seriousness of event considered as disability. It was reported that patient had emergency room visit and physician office visit. He had no known allergies. No COVID prior vaccination and no COVID tested post vaccination. No other vaccine in four weeks and no other medications in two weeks. The outcome of event was not recovered. Follow-up attempts are completed. No further information is expected.


VAERS ID: 1658398 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-05
Onset:2021-08-17
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Cycle threshold 8/17/21 = 20.7
CDC Split Type:

Write-up: Hospitalization with COVID-19 Reported per vaccine EUA


VAERS ID: 1658405 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-25
Onset:2021-08-17
   Days after vaccination:84
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Deep vein thrombosis, Echocardiogram, Pulmonary embolism, Ultrasound Doppler abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol, Amlodipine-Atorvastatin, Ascorbic acid, Aspirin, Cetirizine, Glimepiride, Janumet, Lisinopril, Multivitamin, zinc
Current Illness: None
Preexisting Conditions: Type 2 DM, Hyperlipidemia, Hypertension, seasonal allergies
Allergies: None
Diagnostic Lab Data: Venous Duplex Scans, Chest CTA, CTD Echo
CDC Split Type:

Write-up: New onset of multiple pulmonary embolisms and DVTs.


VAERS ID: 1658412 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-02-19
Onset:2021-08-17
   Days after vaccination:179
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Cough, Dyspnoea, Pyrexia, Respiratory failure, SARS-CoV-2 test positive, Sepsis, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ergocalciferol, fluticasone-salmeterol, ipratropium, levothyro, levothyroxine, loratadine, metformin, nitrofurantoin
Current Illness:
Preexisting Conditions: diabetes, COPD
Allergies: NKDA
Diagnostic Lab Data: 8/14/21: positive for COVID at outside facility
CDC Split Type:

Write-up: 8/17/21: presents to the ED with complaints of COVID-19 symptoms. had persistent cough for the past couple of weeks and she tested positive for coronavirus on Saturday (08/14). Her PCP prescribed her po steroids, azithromycin and benzonatate on the same day, she is complaint with medications. But her cough is not getting any better and she developed fever and SOB for the past 2 days, so she decided to go to ED for further treatment. She received both doses of the Pfizer COVID-19 vaccine; First Dose: 01/29/21 Lot Number EL1283; Second Dose: 02/19/21 Lot Number EL9262 Diagnosed with: sepsis w/fever, tachycardia and COVID pneumonia, mild hypoxic resp failure 8/19/21: patient discharged


VAERS ID: 1659014 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-08-14
Onset:2021-08-17
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0Y9E218 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Headache, Laboratory test normal, Malaise, Oropharyngeal pain, SARS-CoV-2 test, SARS-CoV-2 test negative
SMQs:, Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypertension (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Thyroid medicine; cholesterol medicine
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa; Avalox; when I was younger I could not take the Polio vaccine because I was allergic to it.
Diagnostic Lab Data: Heart test- normal
CDC Split Type: vsafe

Write-up: I did not feel good after getting the shot. On 08/17/201 I started having a really bad headache. It was like a hammer was hitting my head. It made my blood pressure go up. I went to see my doctor and they said it might have been my body spiking. They did have much to tell me about it. I started feeling a little bit better because I was taking Tylenol. Then I started getting worse. I had to go to the ER. They did not tell me much either. They wanted to make sure it was not my heart because of my high blood pressure, so they did a test and it came back normal. They told me to take Tylenol. I have been having a sore throat. I have been getting tested for COVID, which have been coming back negative. Now, I am waiting for the results of a PCR. Last Saturday was the first day since I got the vaccine that I did not get the headache.


VAERS ID: 1659133 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Loss of personal independence in daily activities, Pain, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Shot on Monday. Tuesday night developed body soreness and fever between 100-101. Overnight Tuesday woke up shaking with fever over 102. Wed had a fever over 103 all day/night taking advil every 4 hours. Late Wed night, early Thursday morning, woke up shaking again with fever of 105.2. Could not function enough to go to doctor. Fever finally broke Thursday morning waking up soaking wet. Ran a temp of about 100-101 for the next few days after that but felt much better.


VAERS ID: 1659241 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-11
Onset:2021-08-17
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Polymerase chain reaction
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Cycle threshold 8/17/21 = 37.4
CDC Split Type:

Write-up: Hospitalization with COVID-19 Reported per vaccine EUA


VAERS ID: 1661054 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Minnesota  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Vaccine administered to 7 patients beyond 30 days; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Vaccine administered to 7 patients beyond 30 days) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 034C21A) for COVID-19 vaccination. No Medical History information was reported. On 17-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 17-Aug-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Vaccine administered to 7 patients beyond 30 days). On 17-Aug-2021, EXPIRED PRODUCT ADMINISTERED (Vaccine administered to 7 patients beyond 30 days) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medications was reported. No treatment medications was reported.


VAERS ID: 1661056 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-18
Onset:2021-08-17
   Days after vaccination:60
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Product dose omission issue
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: 1st dose given 18Jun2021; no 2nd dose yet; This spontaneous case was reported by a consumer and describes the occurrence of PRODUCT DOSE OMISSION ISSUE (1st dose given 18Jun2021; no 2nd dose yet) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 054C21A) for COVID-19 vaccination. No Medical History information was reported. On 18-Jun-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 17-Aug-2021, the patient experienced PRODUCT DOSE OMISSION ISSUE (1st dose given 18Jun2021; no 2nd dose yet). At the time of the report, PRODUCT DOSE OMISSION ISSUE (1st dose given 18Jun2021; no 2nd dose yet) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medication reported . No treatment medication reported . No lab data provided by reporter .


VAERS ID: 1661057 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-01-19
Onset:2021-08-17
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / 3 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Body temperature, Chills, Extra dose administered, Headache, Hyperhidrosis, Pyrexia, Vaccination site pain
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arthritis (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:
Other Medications:
Current Illness: Diabetes
Preexisting Conditions: Medical History/Concurrent Conditions: Quadruple vessel bypass graft
Allergies:
Diagnostic Lab Data: Test Date: 20210818; Test Name: Body temperature; Result Unstructured Data: 104 degrees Fahrenheit.; Test Date: 20210818; Test Name: Body temperature; Result Unstructured Data: 102 degrees Fahrenheit.; Test Date: 20210818; Test Name: Body temperature; Result Unstructured Data: 99.9 degrees Fahrenheit.
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Fever/104 degrees F/102 degrees F/99.9 degrees F; Chills; Headache; Joint pain; Arm at the injection site was a little sore; Sweating; Received third dose on 17/Aug/2021; This spontaneous case was reported by a consumer and describes the occurrence of HYPERHIDROSIS (Sweating), EXTRA DOSE ADMINISTERED (Received third dose on 17/Aug/2021), PYREXIA (Fever/104 degrees F/102 degrees F/99.9 degrees F), CHILLS (Chills) and HEADACHE (Headache) in a 74-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 042L20A, 007M20A and 054C21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Quadruple vessel bypass graft. Concurrent medical conditions included Diabetes. On 19-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 23-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 17-Aug-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 17-Aug-2021, the patient experienced EXTRA DOSE ADMINISTERED (Received third dose on 17/Aug/2021). On 18-Aug-2021, the patient experienced HYPERHIDROSIS (Sweating), PYREXIA (Fever/104 degrees F/102 degrees F/99.9 degrees F), CHILLS (Chills), HEADACHE (Headache), ARTHRALGIA (Joint pain) and VACCINATION SITE PAIN (Arm at the injection site was a little sore). On 17-Aug-2021, EXTRA DOSE ADMINISTERED (Received third dose on 17/Aug/2021) had resolved. On 18-Aug-2021, HYPERHIDROSIS (Sweating), CHILLS (Chills) and ARTHRALGIA (Joint pain) had resolved. At the time of the report, PYREXIA (Fever/104 degrees F/102 degrees F/99.9 degrees F), HEADACHE (Headache) and VACCINATION SITE PAIN (Arm at the injection site was a little sore) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 18-Aug-2021, Body temperature: 104 (High) 104 degrees Fahrenheit., 102 (High) 102 degrees Fahrenheit. and 99.9 (High) 99.9 degrees Fahrenheit.. No concomitant medication was reported. The treatment information was not reported.


VAERS ID: 1661125 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-14
Onset:2021-08-17
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Neck pain, Swelling, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LOSARTAN; VITAMINS C; VITAMIN D 2000; ESTRADIOL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure abnormal
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101064254

Write-up: neck swelling/Neck is swollen; The face and jaw are also swollen/her jaw were swollen; neck/tender to touch; This is a spontaneous report from a contactable other nurse (patient). A 47-years-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE, solution for injection, lot number and expiry date not reported), via an unspecified route of administration, administered in left deltoid on 14Aug2021 (at the age of 47 years old) as dose 1, single for covid-19 immunisation. Medical history included blood pressure (normal) from an unknown date and unknown if ongoing. The patient has no allergies. Concomitant medications included ongoing losartan at 25 mg, once a day for blood pressure; ongoing ascorbic acid (VITAMINS C) at an unknown dose once a day; ongoing calcium carbonate, colecalciferol (VITAMIN D 2000) at an unknown dose once a day; and estradiol at 2 mg, twice a day (once in the morning and once at night). Patient mentioned that she was on regular blood pressure medicine and hormones she has been taking for years (unspecified). The patient received her 1st dose of the Pfizer COVID-19 Vaccination on Saturday, 14Aug2021. She woke up the morning of 17Aug2021 with neck swelling and her face and her jaw were swollen. The patient was calling to see if this was normal side effect of the 1st dose of the Pfizer COVID-19 Vaccination. Patient further described that neck was swollen on the side the patient received the first dose Pfizer Covid Vaccine, the face and jaw were also swollen. The patient stated she was not sure if this had anything to do with the Pfizer Covid Vaccine. Patient stated that she was currently out of town and unable to seek medical care from her primary healthcare provider. She did mention seeking HCP through an urgent care system in the meantime while out of town. For the event neck was swollen, the patient stated this was the same and was also like tender to the touch. When asked serious criteria, the patient stated this was significant enough but not life threatening. This was significant and she stated she should get an anti-inflammatory or something. For the event, the face and jaw were also swollen, this was the same and was medically significant. The patient mentioned that this was the only new medication that has been injected into the caller''s body. Patient did not receive any recent vaccines for any other conditions prior to the events being reported. Patient did not receive any recent vaccines for SARS-CoV2 other than Pfizer-BioNTech COVID-19 Vaccine prior to the event being reported. Patient did not receive any other vaccines around the time of Pfizer-BioNTech COVID-19 Vaccine vaccination. The patient was not hospitalized or admitted to an intensive care unit and had not been in the emergency department. The patient was trying to see if she should go to urgent care of something. No laboratory tests or diagnostic studies performed. Therapeutic measures were taken as a result of the events reported wherein in patient took anti-histamines. The outcome of the events was not recovered (reported as ongoing and persistent). The lot number for the vaccine BNT162B2 was not provided and will be requested during follow up.; Sender''s Comments: Based on current information available and considering drug-event temporal association a possible contributory role of the suspect BNT162B2 cannot be completely excluded for the reported events of Neck swelling, Facial swelling and Neck pain. The case will be reassessed further upon receipt of additional information. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.


VAERS ID: 1661143 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Diarrhoea, Headache, Nausea, Pain, Pain in extremity
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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: Medical History/Concurrent Conditions: Hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101067562

Write-up: Woke up at midnight with severe nausea abdominal pain and diarrhea; Woke up at midnight with severe nausea abdominal pain and diarrhea; Woke up at midnight with severe nausea abdominal pain and diarrhea; Body aches; headache; arm pain; This is a spontaneous report from a contactable nurse (patient). A 50-years-old female patient received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration administered in Arm Left on 16Aug2021 16:30 (at the age of 50-years-old) (Batch/Lot Number: FC3183) as single dose for covid-19 immunisation. Medical history included HTN (hypertension). It was unknown if patient had Covid prior vaccination. The patient was not pregnant. The patient was not pregnant at time of vaccination. The patient did not receive other vaccine in four weeks. Concomitant medications included other medications received in two weeks. The patient experienced woke up at midnight with severe nausea abdominal pain and diarrhea on 17Aug2021 00:00. The patient had several bouts of diarrhea and ongoing pain up until current time of 19:00 on 17Aug2021. Body aches, headache and arm pain were also present. All events onset on 17Aug2021 00:00. No treatment received for any events. The patient had not Covid tested post vaccination. The outcome of the events was not recovered.


VAERS ID: 1661159 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Hot flush, Hyperhidrosis, Hypoaesthesia, Loss of consciousness, Paraesthesia
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101070756

Write-up: Blackouts; Hot flashes; Uncontrollable sweating; Fatigue; Dizziness/ Lightheadedness; Tingling/ Numbing in both arms; Tingling/ Numbing in both arms; This is a spontaneous report received from a contactable consumer. This 23-year-old male consumer (patient) reported for himself that who received bnt162b2 (BNT162B2, solution for injection, lot number FC3182), dose 1 via an unspecified route of administration in left arm on 17Aug2021 15:45 (at the age of 23-years-old) as DOSE 1, SINGLE for covid-19 immunisation. The patient medical history and concomitant medications were not reported. Prior to the vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient had not been tested for COVID-19. Patient had no known allergies. The patient did not receive any other vaccines within four weeks prior to the vaccination. On 17Aug2021 15:46 the patient experienced blackouts, hot flashes, uncontrollable sweating, fatigue, dizziness/light-headedness, tingling/numbing in both arms. Symptoms occurred roughly one minute after vaccination and lasted roughly 12 minutes. No treatment was given for adverse event. Outcome of the events was recovered on an 17Aug2021. Follow-up attempts are completed. No further information is expected.


VAERS ID: 1661161 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Fatigue, Oral herpes, Oropharyngeal blistering, Oropharyngeal pain
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Oropharyngeal infections (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LEXAPRO; LISINOPRIL; HYDROCHLOROTHIAZIDE; METFORMIN
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Anxiety; Blood pressure high; Depression; Insulin resistance; Polycystic ovarian syndrome; Sleep apnea
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101070840

Write-up: Sore throat with blisters in back of throat; Sore throat with blisters in back of throat; cold sore; fatigue; mild cough; This is a spontaneous report from a contactable consumer (patient). A 32-year-old non-pregnant female patient received second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Lot number was FC3181), via an unspecified route, administered in left arm on 17Aug2021 16:00 (at the age of 32-year-old) at dose 1, single for COVID-19 immunization. Medical history includes PCOS, anxiety, depression, high blood pressure, sleep apnea, insulin resistance. Concomitant medications includes escitalopram oxalate (LEXAPRO), lisinopril, hydrochlorothiazide, metformin, all drugs received within two weeks of vaccinations. The patient previously took Bactrim and had Allergies. The patient was not pregnant at time of vaccination. Patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. Since the vaccination patient was not tested for COVID-19. On 17Aug2021 16:30, the patient experienced Sore throat with blisters in back of throat, cold sore, fatigue, mild cough. The patient did not receive treatment for all events. The outcome of events was not recovered. Follow-up attempts are completed. No further information is expected.


VAERS ID: 1661198 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Michigan  
Vaccinated:0000-00-00
Onset:2021-08-17
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Drug ineffective, SARS-CoV-2 test
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: 20210817; Test Name: SARS-CoV-2 test; Test Result: Positive.
CDC Split Type: USPFIZER INC202101076687

Write-up: Had the COVID Vaccine, but tested positive for COVID; Had the COVID Vaccine but tested positive for COVID; This is a spontaneous report received from a contactable consumer. This consumer reported for patient. A female patient of an unspecified age received BNT162B2 (COVID-19 VACCINE MANUFACTURER UNKNOWN; Batch/Lot number was not reported), via an unspecified route of administration on an unspecified date as single dose for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. The patient had the COVID vaccine, but tested positive for COVID on 17Aug2021. The reported was calling about the patient who had the COVID vaccine and was not sure which one she received. The patient underwent lab tests and procedures which included SARS-CoV-2 test positive on 17Aug2021. The outcome of the events was unknown. No follow-up attempts are possible, information about batch/lot number cannot be obtained. No further information is expected.


VAERS ID: 1661215 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Diarrhoea
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Cholesterol (I have cholesterol problem); Poor peripheral circulation; Type II diabetes mellitus (Verbatim: Type II Diabetes)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101083522

Write-up: I have had Diarrhea Ever since; everything I eat I go straight to go loo.; This is a spontaneous report from a contactable consumer (patient). A 62-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/Lot number was not reported), via an unspecified route of administration, administered in left arm on 17Aug2021 (at the age 62-years-old) as dose 1, single for covid-19 immunization. Medical history included type 2 diabetes mellitus, blood cholesterol, slow blood flow and high blood. The patient''s concomitant medications were not reported. Prior to vaccination, the patient did not receive any other vaccines. On Tuesday (17Aug2021) after the first dose of vaccine patient was having diarrhea. Patient reported everything she eats go straight to loo. The outcome of the event was unknown. The lot number for the vaccine, [BNT162B2], was not provided and will be requested during follow up.


VAERS ID: 1661216 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Arizona  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / OT

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Exposure via breast milk
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Neonatal exposures via breast milk (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CITALOPRAM
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101084053

Write-up: The day after receiving my second dose of COVID-19 vaccine, my breastfed baby (4 mo) developed diarrhea.; The day after receiving my second dose of COVID-19 vaccine, my breastfed baby (4 mo) developed diarrhea.; This is a spontaneous report from a contactable consumer or other non hcp (patient''s mother). This consumer or other non hcp reported information for both mother and baby. This is a baby report. A 04-month-old patient of unspecified gender was exposed to bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for injection, Lot number: unknown), via transmammary route, administered in Left arm on 17Aug2021 as dose 2, single for covid-19 immunisation from the mother. The patient''s medical history was not reported. Concomitant medication included citalopram (CITALOPRAM) taken for an unspecified indication, start and stop date were not reported received within 2 weeks of vaccination. Facility where the most recent COVID-19 vaccine was administered was Pharmacy or Drug Store. Device Date : 20Aug2021. It was reported that the day after receiving her second dose of COVID-19 vaccine, her breastfed baby (4 mo) developed diarrhea on 18Aug2021. No treatment was received for adverse events. The reporter assessed events as non-serious with no seriousness criteria of resulting in death, Life threatening, Caused/prolonged hospitalization, Disabling/Incapacitating, Congenital anomaly/birth defect. Adverse events resulted in none of the above. The outcome of events was recovered on an unspecified date in 2021. The lot number for the vaccine,[BNT162B2], was not provided and will be requested during follow up.


VAERS ID: 1661850 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Muscular weakness, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: Demerol
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Arm was sore, but not able tonuse for 3 days. There was no strength for any movement.


VAERS ID: 1662121 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-04
Onset:2021-08-17
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Dizziness, Dyspnoea, Pain, Pneumonia, Pyrexia, Respiratory tract congestion, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

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

Write-up: Pneumonia - shortness of breath, fluid in lungs, fever, cough, congestion, body aches, dizziness, and runny nose


VAERS ID: 1662124 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-04-29
Onset:2021-08-17
   Days after vaccination:110
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin B12 ASA Metformin lasix Levemir Flex Pen Glipizide
Current Illness:
Preexisting Conditions: DM triple by pass HTN
Allergies: amoxicillin penicillin tetracycline
Diagnostic Lab Data: COVID PCR positive 8/31/21
CDC Split Type:

Write-up: 02 sats 88-89% cough SOB


VAERS ID: 1662377 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Asthenia, Chills, Fatigue, Headache, Lymph node pain, Lymphadenopathy, Malaise, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Acetaminophen, Albuterol HFA, Amlodipine, Atenolol, Magnesium, Benicar HCT, Vitamin D#
Current Illness: No
Preexisting Conditions: Hypertension, Arthritis
Allergies: Augmentin, Pineapple
Diagnostic Lab Data: Just physical examination.
CDC Split Type:

Write-up: Sick for 3 days with headache, fever, chills, and weakness/ fatigue. On day 5 woke up with left side lymph node in neck inflamed, sore, and knotted. Went to Urgent care where I was transferred to Emergency Department for further evaluation and treatment.


VAERS ID: 1662729 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Muscle spasms, Musculoskeletal discomfort, Neck pain, Pyrexia, Sleep disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Paxil 10 mg Aspirin 81mg Hormone patch 0.0375 mg Multivitamin 2 gummies daily
Current Illness: none
Preexisting Conditions: osteoarthritis in shoulders
Allergies: Highly sensitive to any medication taken
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Moderna COVID?19 Vaccine EUA Woke up during the night with 103 fever. From then until around 7 my entire body would spasm like i was stretching then relax. I got up about 3:30 and my joints felt as though they were liquid. I began taking tylenol at 7 which eased the spasming and fever. I had the headache all the next day in the back of my head and into my neck.


VAERS ID: 1662829 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Dry mouth, Dysgeusia, Fatigue, Headache, Hypoacusis, Palpitations, Respiration abnormal
SMQs:, Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Hearing impairment (narrow), Respiratory failure (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: In the morning, took Mesalamine and CBD
Current Illness:
Preexisting Conditions: Ulcerative Colitis, Anxiety
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: About 10 minutes after receiving the shot, tasted a metallic taste and then had the feeling of dry mouth. This lasted throughout the day so I did my best to stay hydrated. By the evening, my hearing was muffled and just felt off. The next day, those symptoms went away and new ones began. Each day for a week, felt heart palpitations and also a feeling of needing to take deeper breaths, but not short of breath. I also felt tired and experienced headaches for 3-4 days. I do get regular headaches, but these were more intense. After the week from when I received the shot, those daily symptoms seem to have subsided.


VAERS ID: 1662892 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Menstruation irregular
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Fertility 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: Sore, swollen, red, patchy tonsils, swollen lymph nodes
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: My period came two weeks early, the day after I got the second Pfizer dose. The bleeding was heavier and darker than usual. Today, September 1, 2021, I''m bleeding again and my period is not due until September 19.


VAERS ID: 1665450 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Ohio  
Vaccinated:0000-00-00
Onset:2021-08-17
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood test, Electrocardiogram, Syncope, Urine analysis
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210817; Test Name: Blood test; Result Unstructured Data: Normal; Test Date: 20210817; Test Name: EKG; Result Unstructured Data: Normal; Test Date: 20210817; Test Name: Urine analysis; Result Unstructured Data: Normal
CDC Split Type: USJNJFOC20210900241

Write-up: This spontaneous report received from a 34 year old African American, not Hispanic or Latino female patient. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient was not pregnant at the time of report. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 204A21A expiry: unknown) dose was not reported, administered, 1 total, to left deltoid on 17-AUG-2021 for prophylactic vaccination. No concomitant medications were reported. On 17-AUG-2021, 5-10 minutes after receiving the injection patient fainted and was rushed to the ER (Emergency room) by paramedics. Laboratory data included: Blood test (NR: not provided) normal, EKG (Electrocardiogram) (NR: not provided) normal, and Urine analysis (NR: not provided) normal. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from fainted on 17-AUG-2021. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0:20210900241-COVID-19 VACCINE AD26.COV2.S-Fainted. This event(s) is considered unassessable. The event(s) has a compatible/ suggestive 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: 1665588 (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: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Product preparation issue
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: mixed normal saline with Moderna COVID19 vial; This spontaneous case was reported by a consumer and describes the occurrence of PRODUCT PREPARATION ISSUE (mixed normal saline with Moderna COVID19 vial) in a 53-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 17-Aug-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to .5 ml. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 17-Aug-2021, the patient experienced PRODUCT PREPARATION ISSUE (mixed normal saline with Moderna COVID19 vial). On 17-Aug-2021, PRODUCT PREPARATION ISSUE (mixed normal saline with Moderna COVID19 vial) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No Concomitant drugs were reported. No treatment was reported. It was reported that when administering the Moderna COVID-19 vaccine, the medical assistant mixed normal saline with the Moderna vaccine vial. She mixed 2 mLs of normal saline into the vial of the vaccine and administered 0.5 mL to each patient. The patient was not experiencing any symptoms and was monitored for 15 minutes. This was the second dose for the patient.


VAERS ID: 1665723 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1665727 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1665750 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1665752 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1665974 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 LA / IM

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

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

Write-up: Error: Booster Given Too Early-


VAERS ID: 1665989 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Error: Improper storage (temperature).


VAERS ID: 1665991 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1666001 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1666061 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Mouth swelling, Rash, Rash macular, Throat irritation
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Dose 1 of Moderna Vaccine (1/11/21, LOT: 012L20A, intramuscular, right deltoid) The patient said after her first dose of Moderna
Other Medications: pantoprazole, pregabalin
Current Illness:
Preexisting Conditions: Anxiety disorder, GERD, Migraine, Pain in thoracic spine, History of herniated intervertebral disc
Allergies: codeine (itching, unknown), sulfacetamide (itching, rash), hydrocodone-acetaminophen (abdominal pain, sweating, nausea), gluten protein (sore throat symptom), penicillins (unknown, rash), valdecoxib (swelling and unknown)
Diagnostic Lab Data:
CDC Split Type:

Write-up: 8/17/21: 49yoF presenting with allergic reaction s/p 2nd dose of Moderna COVID-19 vaccination. Ptn reports receiving having similar symptoms after the first dose so she took Benadryl prior to receiving her second dose today. Ptn received the vaccination at 1400 today when she began to develop symptoms 10 minutes after vaccination administration reporting scratchy, irritated sensation in her throat causing her to feel like she needs to repeatedly clear it, splotchy rash on her chest, and feeling SOA. Clinic called EMS and she was brought to the ED. Ptn reports she feels the same as she did during initial symptom presentation. Ptn has not taken any medication for symptoms prior to presentation. Reports she feels she needs to keep her neck distended to prevent feeling short of air. She also reports her BP usually runs softer with systolics in the 110s. Denies lightheadedness, presyncope, N/V/D, abdominal pain. Clinical Impressions as of Aug 18 2000 Allergic reaction to COVID-19 vaccine MDM Number of Diagnoses or Management Options Allergic reaction to COVID-19 vaccine Diagnosis management comments: MS4 MD Candidate 2022 Patient is a 49-year-old woman with history of multiple drug allergies who presents to the emergency department with concerns for an reaction to the COVID-19 vaccine. Patient is hemodynamically stable and afebrile on presentation. Patient demonstrates mild facial swelling with no other concerning signs on physical exam. Patient already has taken 50 mg of by mouth Benadryl at home prior to the onset of her symptoms. I will provide the patient with IM epinephrine and IV Benadryl and IV Decadron for control of her allergic reaction. On re-evaluation of the patient she notes that her swelling has significantly improved after her by mouth Benadryl and is not requiring any IM or IV medications. Patient was re-evaluated and continues to be in the morning. Patient is comfortable with discharge. Patient was counseled on likely allergic reaction the COVID-19 vaccination. Patient was discharged in stable condition with strict return precautions. Pt is well appearing on exam. Arrives after 2nd Moderna vaccine; she had similar allergic response after 1st dose. Asymptomatic on my exam. No respiratory issues, no n/v or s/s significant allergic event. She refused meds. Pt discharged home.


VAERS ID: 1666091 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-07
Onset:2021-08-17
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Hypoaesthesia, Impaired work ability, Muscular weakness, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

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

Write-up: Numbing, burning, pain, and weakness in both hands and arms. Started on 8/17, progressed on 8/19, numbing and pain was so bad, I went to the ER on 8/22. Left hand was wrapped. Taken off work. Referred to Orthopedic specialist. Recommended therapy. Taken off work.


VAERS ID: 1666100 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1666117 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

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

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

Write-up: The patient has not identified any adverse effects, but the patient did not inform us that she had already been vaccinated with 1 dose of Pfizer before receiving the Johnson & Johnson vaccine.


VAERS ID: 1666143 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-14
Onset:2021-08-17
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050LL1A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest X-ray normal, Dyspnoea, Electrocardiogram normal, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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: Methotrexate Simponi Celebrex Chlorthalidone
Current Illness: Shingles
Preexisting Conditions: RA
Allergies:
Diagnostic Lab Data: Negative covid test on 08/26/2021 Negative chest x-ray Negative EKG Follow up with doctor on 02/09/21- chest sounds fine. Treating me for allergies.
CDC Split Type:

Write-up: Minor shortness of breath


VAERS ID: 1666364 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysgeusia, Feeling cold, Headache, Myalgia, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Chills, low-grade fever, muscle/body aches, headache experienced on 8/17/21. Recovered from these symptoms. Muscle/body aches experienced on 8/18/21. Recovered from these symptoms. Metallic taste in mouth present since 8/17/21 up until now, still currently experiencing it.


VAERS ID: 1666594 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-06
Onset:2021-08-17
   Days after vaccination:103
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032B21A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 2 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: 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? 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 following high fever


VAERS ID: 1666663 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-03-08
Onset:2021-08-17
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 UN / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chest X-ray, Cough, Dyspnoea, Fatigue
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Pt has Crohn''s disease and hypertension and has been diagnosed with interstitial Lung Disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt had lung biopsy scheduled for 8/17 at hospital due to breathing issues for several months and order of Pulmonary Dr from chest xray in April. Only symptoms cough and fatigue other than the breathing difficulty which has been ongoing. Pt has Crohn''s disease and hypertension and has been diagnosed with interstitial Lung Disease.


VAERS ID: 1666734 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: New York  
Vaccinated:2021-02-07
Onset:2021-08-17
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Cough, Fatigue, Headache, Myalgia, Nausea, Oropharyngeal pain, Pyrexia, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose01/12/21 2nd dose02/07/21 Diagnosed covid positive:08/25/21 Symptom onset:08/17/21 Exposure:Home Symptoms:fever,cough,fatigue,muscle aches, loss of smell/taste,sorethroat, nausea, runny nose,HA


VAERS ID: 1666748 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-14
Onset:2021-08-17
   Days after vaccination:125
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Dyspnoea, Fatigue, Headache, Rhinorrhoea, SARS-CoV-2 test positive
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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose03/24/21 2nd dose04/14/21 Diagnosed covid positive:08/21/21 Symptom onset:08/17/21 Exposure:Community Symptoms:SOB, fatigue,loss of smell/taste, runny nose,HA


VAERS ID: 1666759 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-11
Onset:2021-08-17
   Days after vaccination:187
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose01/14/21 2nd dose02/11/21 Diagnosed covid positive:08/23/21 Symptom onset:08/17/21 Exposure: Symptoms:sore throat, runny nose.


VAERS ID: 1666782 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-02
Onset:2021-08-17
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Appendicectomy, Appendicitis, Computerised tomogram abdomen abnormal, Scan with contrast abnormal
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Buproprion 150 mg 2xday, Escitalophram 5mg daily, Levothyroxine 0.025 mg daily, Zinc 50 mg daily, Calcium 1200 mg/Vit D-3 25mg daily, Vitamin C 1000 mg daily, Melatonin 1 mg daily
Current Illness: none
Preexisting Conditions: high cholesterol, low thyroid
Allergies: Codeine
Diagnostic Lab Data: 8/17/2021 contrasting CT scan - appendicitis
CDC Split Type:

Write-up: 08/17/2021 appendicitis - abdominal pain for 7 hours prior to going to ER. CT Scan revealed appendicitis. 8/18/2021 - Appendectomy


VAERS ID: 1666790 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 1 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Asthenia, Breast swelling, Burning sensation, Chills, Injection site erythema, Mobility decreased, Nausea, Pain, Pyrexia, Swelling, Vaccination site swelling, Vaccination site warmth
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Trulicity, glimiperide, pantoprazole, zofran, hydrocodone, AERDS, magnesium, vitamn D3, oxybutinin, xanax, ASA, butabitol, gabapentin, dulera, abuterol, reglan
Current Illness: Was diagnosed and hospitalized with severe bilateral covid pneumonia 3 months prior
Preexisting Conditions: Diabetes, macular degeneration,
Allergies: imitrex, tramadol, eggs, dairy, wheat
Diagnostic Lab Data: none
CDC Split Type:

Write-up: The day after my injection I had severe nausea, chills and throughout the day I started getting worse. my whole body hurt, I could not even sit, I felt like my body was on fire. My energy was zapped! My right side where I received the vaccine swelled up to my neck and to my right breast which was also red and warm to the touch. I ran a low grade fever. This all lasted for about a week


VAERS ID: 1666797 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Autoimmune thyroiditis, Basophil count decreased, Basophil percentage, Condition aggravated, Eosinophil count decreased, Eosinophil percentage, Extra dose administered, Fatigue, Feeling abnormal, Goitre, Haematocrit normal, Haemoglobin normal, Hangover, Headache, Impaired healing, Impaired work ability, Influenza, Lymph node pain, Lymphadenopathy, Lymphocyte count decreased, Lymphocyte percentage, Mean cell haemoglobin concentration normal, Mean cell haemoglobin increased, Mean cell volume normal, Migraine, Monocyte count decreased, Monocyte percentage increased, Myalgia, Neutrophil count decreased, Neutrophil percentage, Peripheral swelling, Photophobia, Platelet count decreased, Pyrexia, Red blood cell count normal, Red cell distribution width normal, Respiratory tract congestion, Swelling, Swelling face, Vision blurred, White blood cell count decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Agranulocytosis (broad), Angioedema (narrow), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (narrow), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious meningitis (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Lens disorders (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Hypothyroidism (broad), Hyperthyroidism (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unithyroid 50mcg Bupropion XL 150mg Iron 195mg B Complex Vitamin Vitamin D Milk Thistle Cranberry
Current Illness: None
Preexisting Conditions: Hashimoto?s Thyroids Medicated Hypothyroidism Low WBC and platelets Depression, Anxiety and ADHD. Medicated Anemia
Allergies: Azithromycin
Diagnostic Lab Data: WBC: 3.4 (3.8- 11.8) RBC: 4.6 (4- 5.3) Hemoglobin: 14.1 (11.5-15.5) Hematocrit: 41.4 (35-45) MCV: 91 (80-100) MCH: 31.3 (27-34) MCHC: 34.2 (32-35) RDW: 12.8 (11-15) Platelet ct: 144 (130-400) NEUTROS PCT: 56.5 (40-74) LYMPH%: 24.2 (19-48) MONO%: 15.3 (4-13) EOS PCT:3.5 (0-7) BASOS PCT: 0.5 (0-2) NEUTROS ABS: 1.9 (1.9-8.2) LYMPH ABS: 0.8 (1.1-3.1) MONOS ABS: 0.5 (0.2-0.9) ABSOLUTE EOSINOPHIL CT: 0.1 (0-0.5) BASOS ABS: 0 (0-0.1
CDC Split Type:

Write-up: The next morning I woke up feeling like I was hungover and had terrible flu. I had a fever of 100.5 that rose to 100.8 later in the day. I had a terrible migraine. Took 3 Tylenol later that day and felt better by the end of the day. Ever since I got the third shot though, it caused a terrible flare up of the Hashimoto?s disease. One of the worst I?ve felt. I had to leave my job partially because of it. My symptoms in order of most bothersome are: fatigue, headaches, light sensitivity, brain fog, swollen thyroid, very inflamed large and painful lymph nodes, trouble focusing my eyes, muscle soreness, swollen feet/legs, swollen neck and face, slight congestion, wounds that won?t heal.


VAERS ID: 1666830 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Blood test, Body temperature increased, Chest X-ray, Chest discomfort, Chest pain, Computerised tomogram thorax, Electrocardiogram, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal vitamin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 8/18/21 - ecg, chest X-ray, blood tests, chest ct 8/26/21- follow up appointment, feeling better
CDC Split Type:

Write-up: Sore muscles, joints, and skin 8/17/21 am. Temperature of 103F 8/17/21 pm 8/18/21 am - severe pulsing pain in chest that?s subsided in urgent care and was replaced by a feeling of pressure on the chest


VAERS ID: 1666867 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-12
Onset:2021-08-17
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 RA / IM

Administered by: School       Purchased by: ?
Symptoms: Amenorrhoea, Pregnancy test negative
SMQs:, Fertility 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: Spironolactone 50mg 1/day
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Pregnancy test 9/01 (negative)
CDC Split Type:

Write-up: Menstrual period was due by 8/17/21, and as of 9/02/21 it has still not occurred. No history of irregular periods, not on any hormonal contraceptives, not pregnant or at risk of becoming pregnant. Currently taking 50mg once per day of Spiro for acne since February 2021, and no other medications.


VAERS ID: 1667405 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-17
Onset:2021-08-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Fatigue, Lymphadenopathy, Nausea, Oropharyngeal pain, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Methotrexate, Plaquenil, Trilogy, Augmentin, Medrol, NP Thyroid, and Gammagard infusion twice a week.
Current Illness: No
Preexisting Conditions: CVID, Chronic Mycoplasma pneumoniae infection, Hypothyroidism, Ataxic gait, Adrenal insufficiency, Pleurisy, and pericarditis.
Allergies: No
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fatigue, sore throat, bruising, body aches, nausea, fever, swollen lymph nodes. The symptoms continue until present.


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