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

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



Case Details (Reverse Sorted by Onset Date)

This is page 121 out of 3,524

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VAERS ID: 1337351 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 RA / IM

Administered by: Unknown       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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt had a syncopal episode by vaccinator table. Pt brought to triage and move to bed unassisted. Pt A&Ox3 BP 86/50, HR 68, RR 17 -- $g 94/48, 85, 16 -- $g 89/50. Pt able to move around unassisted with no symptoms. Pt stable and released from the vaccination site.


VAERS ID: 1337361 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-05
Onset:2021-05-20
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Deep vein thrombosis, Immune thrombocytopenia, Peripheral vein occlusion, Pulmonary embolism, Pulmonary infarction, Vaccination complication
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

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

Write-up: Patient is now hospitalized with the following: VITT, bilateral PE with left lateral lower lob infarct, left superficial femoral vein occlusive deep vein thrombosis, and thrombosis of the posterior tibial vein according to hematologist.


VAERS ID: 1337392 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-06
Onset:2021-05-20
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia, Bell's palsy, Ear pain, Exposure during pregnancy, Eyelid ptosis, Facial paralysis, Neck pain
SMQs:, Taste and smell disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Insulin, prenatal vitamin, aspirin 81 mg, zyrtec
Current Illness: Gestational Diabetes
Preexisting Conditions: None
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Had right ear and neck pain on 5/19/21. Woke up on 5/20/21 with ear pain still present, noticed loss of taste. Had facial paralysis on right side of my mouth. Right eye won''t close, excessive watering. Diagnosed with Bell''s Palsy 5/20/21.


VAERS ID: 1337434 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

Administered by: School       Purchased by: ?
Symptoms: Arthralgia, Exposure during pregnancy, Headache, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: At time of shot, I was 23 weeks pregnant. This is my third pregnancy, no issues thus far in pregnancy or any previous. At roughly 9:30am the day after the shot was administered (roughly 18 hours after) I begin to get full body aches, strong headaches, joint pain, and a low grade fever. This persisted until around 7am the next morning.


VAERS ID: 1337444 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PFIZER COVID 10 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure measurement, Fall, Heart rate, Nervousness, Vital signs measurement
SMQs:, Accidents and injuries (narrow), Hypoglycaemia (broad)

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

Write-up: After injection, patient stood up and we noticed he was falling. We caught him, laid him on the floor and called 911. His blood pressure was 75/33 and heart rate was 57. Emergency crew took him to the hospital. I called his mom in he evening and she said he was fine, he got nervous during vaccination


VAERS ID: 1337447 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / IM

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

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

Write-up: patient came in on 5/20 to receive second dose of COVID (pfizer) vaccine and her mother called on 5/21 in the morning to inform us that her daughter was having swelling in her face from the eyes down but not involving her mouth, tongue or throat. She had given her daughter ibuprofen and benadryl. I recommended she take her to the ER for further evaluation. She said she would and would contact me later to let me know how she was doing.


VAERS ID: 1337473 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-05-07
Onset:2021-05-20
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA MODERNA / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: SEIZURE


VAERS ID: 1337510 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-03-03
Onset:2021-05-20
   Days after vaccination:78
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Confusional state, Fall
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Pre-Diabetic, history of DVT, hypertension, COPD, anxiety, depression, dementia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was admitted for fall at home and confusion


VAERS ID: 1337517 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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: Synthroid 175mcg, Atenolol 25mg, Lisinopril 5mg, Multi Vitamin
Current Illness: No
Preexisting Conditions: Drop foot spine damage
Allergies: Penicillin, Ibuprofen
Diagnostic Lab Data: No
CDC Split Type:

Write-up: After vaccine my toes got extremely sore and it was bad by midnight and felt like I wanted to lose my ten toes, on the scale of 1 - 10 the pain level was a 6 or 7. When I woke up I had a little pain in my right foot and it went away.


VAERS ID: 1337539 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose increased, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Guillain-Barre 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: metformin
Current Illness: none
Preexisting Conditions: diabetic
Allergies: none
Diagnostic Lab Data: paramedic checked sugar. it was high. she missed the morning dose of metformin.
CDC Split Type:

Write-up: tingling started from feet and radiated to upper body . paramedics was called right away. She refused to go to emergency as she started feeling better after paramedic came.


VAERS ID: 1337542 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-18
Onset:2021-05-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 RA / IM

Administered by: School       Purchased by: ?
Symptoms: Full blood count, Hypoaesthesia, Magnetic resonance imaging head, Magnetic resonance imaging spinal, Metabolic function test, Neurological examination normal, Urine analysis
SMQs:, Peripheral neuropathy (broad), Guillain-Barre 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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: MRI Brain and Spine 5/20 and 5/21 CBC, CMP, Urinalysis 5/20
CDC Split Type:

Write-up: Patient reports right arm, right leg, and right face numbness that resolved over the course of 24 hours without treatment. No loss of function, no muscle weakness, normal neurologic exam.


VAERS ID: 1337558 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Electrocardiogram normal, Limb discomfort, Neck pain, Pain, Pain in extremity, Pain in jaw
SMQs:, Osteonecrosis (broad), Arthritis (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: Client denies any routine medications. Client reports he had ibuprofen twice during the day from the staff. Client reports he had been clean from cocaine use for the last 6 weeks.
Current Illness: Client denies any illnesses. However reports he is current in rehab for cocaine use. Denies use of cocaine in the last 6 weeks
Preexisting Conditions: None reported
Allergies: Client denies any allergies
Diagnostic Lab Data: None done
CDC Split Type:

Write-up: Patient is a 42 y/o male residing. At approximately 4: 40PM received a Johnson and Johnson Janssen vaccine in the left from . Client approached this nurse at 5:37PM complaining of pain in his left arm. Client described pain as ?pressure? in his left upper and lower arm and the pain radiated to the left side of his neck and left jaw. Client was alert and oriented; client was had no diaphoresis and client color was within normal limited; reparations deep even and unlabored; heart rate 70 bmp and pulse were strong and regular. Explained to client the need to call 911 and client refused.5:40PM Client remained alert and oriented without change in physical appearance; heart rate 80 bmp and pulse remained strong and regular. Resident denies any routine medications. Reports he had ibuprofen twice during the day from the staff. Client reports he had been clean from cocaine use for the last 6 weeks. 5:40PM Had Program Assistant/Counselor summoned to the room and explained to Patient client''s refusal for 911 assistance. Patient was able to get client to agree to a 911 call. At 5:45PM 911 was called. 5:55PM Paramedics arrived and assessed client. According to paramedics? EKG and vital signs ?looked good?. Paramedics suggested client go to the emergency room for further evaluation; client declined. Paramedics explained to client the risk involved in refusing additional assessment by the emergency room. Client verbalized he understood the risks he was taking by refusing transportation to the emergency room. 5/21/2021 approximately 11AM Called to follow up with client; was not in but spoke with Manager. According to has no residual effects and was ?up and about? as usual.


VAERS ID: 1337571 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Feeling hot, Oropharyngeal pain
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

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

Write-up: Covid vaccine administered on 5/20. 1704 - in observation room pt complained of feeling warm and a sore throat. 1706 - 50 mg Benadryl PO given, VS HR 93, POX 99, BP 128/68 1710 - VS HR 97, POX 98 1712 - pt states throat feels better. 1715 - pt states throat feels okay. 1720 - pt states she feels fine. No dizziness, throat all better. 1723 - VS HR 97, POX 99 1725 - VS HR 93, POX 98 Pt monitored by 2 RNs for 30 minutes throughout this encounter prior to leaving observation.


VAERS ID: 1337581 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-16
Onset:2021-05-20
   Days after vaccination:65
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Intensive care, Sepsis
SMQs:, Sepsis (narrow), 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Morphine Augmentin Clindamycin Crestor Hydrocodone Pravastatin Prednisone
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient admitted to intensive care with sepsis 5/20/2021


VAERS ID: 1337614 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dysstasia, Mobility decreased, Muscular weakness, Musculoskeletal stiffness, SARS-CoV-2 test negative, Walking aid user, Wheelchair user
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: atorvastatin (LIPITOR) 10 MG tablet Take 10 mg by mouth nightly. diazepam (VALIUM) 2 MG tablet Take 2 mg by mouth 2 (two) times daily. diazepam (VALIUM) 2 MG tablet Take 2 mg by mouth daily as needed for Anxiety. Take in the aft
Current Illness:
Preexisting Conditions: multiple sclerosis, neurogenic bladder with chronic indwelling catheter, hyperlipidemia, restless leg syndrome, anxiety/depression
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient with hx of multiple sclerosis presented to ED on 5/20/21 with bilateral lower extremity weakness. Patient got her 2nd COVID vaccine on 5/19/21 (Pfizer), and since that time she developed bilateral lower extremity weakness. She generally uses a wheelchair and a walker but at baseline can ambulate with a walker and currently she cannot stand at all. She reports her last MS flare was about 6 months ago and when she has MS flares, she always has symptoms with her legs. She gets ocrelizumab injections every 6 months (last dose was 5/18/21). She denies any vision changes or difficulty with speech, no upper extremity weakness, numbness/tingling. Denies any bowel or bladder incontinence. She denies any chest or abdominal pain, nausea, emesis, diarrhea, urinary issues, cough, fevers, chills. SARSCOV2PCR test on 5/20/21 = not detected. She does report some mild stiffness in her right upper arm but states that also happened with the first dose of the vaccine. Case was discussed with neurologist who recommended admission and observation but deferring on steroids at this time. As of 5/21/21, patient is still hospitalized. Her lower extremity weakness is improving, but the medical team anticipates she will need short term inpatient rehab or possibly home PT/OT before being able to safely return home.


VAERS ID: 1337620 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Aphasia, Dyspnoea, Headache, Hyperhidrosis, Lip discolouration, Pallor, Tachypnoea
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (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: Prozac
Current Illness: none
Preexisting Conditions: h/o anxiety
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: 15yo patient in observation parking lot c/o headache and laid down. honked horn because patient stated she had trouble breathing. RN''s in observation area ran to the car. Patient tachypnic and couldn''t talk, slightly pale with no signs of cyanosis. 911 called immediately and epi pen, 0.3mg administered at 1621. Patient layed down in the back of her car until ambulance arrived. BP stable, no pulse-ox available, respirations 66 bpm. Patient awake and alert, still unable to talk, lips pink, diaphoretic. Care turned over to Paramedics on site. No h/o allergies or anaphylactic reactions. H/O anxiety and on Prozac.


VAERS ID: 1337638 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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 was given the vaccine then sat down and felt dizzy about 5 minutes later. Patient then vomited and felt better after.


VAERS ID: 1337661 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Insomnia, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omega 3 EFAs, Vitamin D
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Fever, chills, nausea, fatigue, inability to sleep


VAERS ID: 1337674 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-14
Onset:2021-05-20
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Exposure to SARS-CoV-2, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient recieved Jannsen vaccine 1 week ago. reported shortness of breath x 6 days. arrived at hospital tested c/o shortness of breath. Currently admitted inpatient positive covid test 5/20/21. patient did note exposure to covid positive person 10 days ago.


VAERS ID: 1337683 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-11
Onset:2021-05-20
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 2 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / UNK RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Antiplatelet therapy, Sensory loss, Transient ischaemic attack
SMQs:, Peripheral neuropathy (narrow), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Guillain-Barre 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: TIA (transient ischemic attack); symptoms appeared a week prior to presentation to ED but subsided then reappeared again so she came to ED and was admitted for observation. Under observation symptoms subsided again, except for a decreased sensation on the left arm and right foot. Patient is currently on stroke work up and was started on dual antiplatelet therapy with aspirin and plavix for 21 days.


VAERS ID: 1337708 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Heavy menstrual bleeding, Pain in extremity, Thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: The day before she got her vaccine she had started her menstruation cycle. She is not on any medications, everything was normal, went to work and went to get her vaccine. She got her vaccine and around 4:15 she started gushing, which is abnormal for her and having clots the size of a half dollar and covered in blood. This is not normal for her periods, and she is now in the bathroom every hour and a half and looks like a murder scene. Her normal menstrual cycle is heavy for one day and then gradually lessens and only lasts a few days. She does occasionally have small clots with hers, but this are large and bleeding profusely. The only side effect she has is that she is extremely tired. She slept from 4:30 yesterday to 2:00 AM and feels like she could sleep the rest of the day. Her arm is a little bit sore, but otherwise fine from the injection site. Is concerned due to the heavy volume of bleeding, which is extremely abnormal for her. She has taken Tylenol and drinking a lot of fluids.


VAERS ID: 1337726 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

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

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

Write-up: Administered the incorrect volume of vaccine


VAERS ID: 1337740 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

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

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

Write-up: HE IS UNDER THE AGE OF 18. AT THIS TIME HE IS EXPERIENCING NORMAL SIDE EFFECTS. WE ARE MONITORING HIS SYMPTOMS THROUGH HIS PARENTS.


VAERS ID: 1337765 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Lethargy, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient fainted two minutes after receiving vaccine. Loss of consciousness was not total. Patient was pale, clammy, and lethargic. Patient''s mother and myself held patient is place while she recovered in chair. Resolution was within 15 minutes from start of episode. Followed up with mother two and one-half hours post incident and mother said patient was completely recovered.


VAERS ID: 1337771 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816025 / UNK - / IM

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

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

Write-up: patient vaccinated under age 18


VAERS ID: 1337777 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-07
Onset:2021-05-20
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Full blood count, Hepatic enzyme, Metabolic function test, Rash, Rash pruritic, Skin warm
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: esomeprazole 40 mg day for hx of esophagitis; ester c 1000 mg daily; zinc picolonate 30 mg daily; turmeric capsule 500 mg 2x day; cinnamon capsule 500 mg 2x day; coq10 100 mg day; vitamin d3 25 mcg; gabapentin 300 mg at bedtime PRN for hip
Current Illness: none, not even a cold
Preexisting Conditions: arthritis; history of esophagitis
Allergies: statins
Diagnostic Lab Data: ordered 5/21/2021 - results pending: complete metaboli panel, cbc and liver enzymes Patient started on medral dose pack therapy 5/21/2021
CDC Split Type:

Write-up: Early evening of 5/20/2021 large red rash appeared bilaterally on calves, with spreading of rash overnight of 5/20 to 5/21/21 to the front of right leg. Affected areass hot to touch with minimal itching. No exposure to possible irritants. It should be noted that patient had also started on tricor 4/20/2021. The rash is a known symptom of both the covid vaccine and tricor therapy in some cases. Blood tests ordered (cbc, complete metabolic panel and liver enzymes) but results not yet available. PCP has seen similar rashes in other patients after covid vaccine so recommended filing the report to vaers out of an abundance of caution.


VAERS ID: 1337845 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Headache, Painful respiration, Sleep disorder, Swelling
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: prenatal vitamin (I took it at 9pm that night); tylenol (I took it at 9pm that night); drank a Hop Tea at 8:30pm that night
Current Illness: No, but I''m pregnant, 37 weeks
Preexisting Conditions: No, but I''m pregnant, 37 weeks
Allergies: No
Diagnostic Lab Data: None at this time
CDC Split Type:

Write-up: Currently 37 weeks pregnant, 2nd shot, will be induced June 3, due date June 11. Shot administered at 11:20am, I waited 15 minutes, no reaction. That night I took tylenol at 9pm for my headache (recommend and approved by pharmacist who administered my shot), then I took my prenatal vitamin. Around 9:30 I had trouble breathing. It lasted throughout the night. I had to sit up all night. I had to take off my necklace due to my neck swelling. I couldn''t take any deep breaths. I was able to fall asleep around 5am when it subsided a bit. I have continued to be short of breath today, neck still looks a bit puffy. It''s hard to know whether the more mild difficulty breathing is due to pregnancy or not. I haven''t had trouble breathing with this pregnancy unless I am active. This morning I was sitting on the couch and it was hard to breathe (but more mild than last night). No other side effects, my headache is gone and went away after I took the tylenol that night.


VAERS ID: 1337857 (history)  
Form: Version 2.0  
Age: 100.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-02-10
Onset:2021-05-20
   Days after vaccination:99
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood pressure increased, COVID-19, Chest X-ray abnormal, Dyspnoea, Heart rate increased, Oxygen saturation decreased, Pulmonary fibrosis, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Hypertension (narrow), Cardiomyopathy (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (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? Yes, 99999 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen 500 MG capsule, Aricept 5 MG tablet, Bisacodul laxative 10 MG suppository, Docusate Sodium 150 MG/15 Ml liquid, Fleet Enema 7-19 GM/118 Ml Enema, Flomax 0.4 MG Capsule, HYDROcodone-acetaminophen 5-325 MG Tablet, Ipratropium-Al
Current Illness: had a fracture on 1/29/21 that is still healing
Preexisting Conditions: Chronic Kidney Disease, Unspecified asthma uncomplicated, unspecified contact dermatitis unspecified, unspecified osteoarthritis unspecified, unspecified glaucoma, unspecified hearing loss, essential primary hypertension, enlarged prostate without lower urinary tract symptoms, hypothyroidism unspecified, dementia with other diseases classified elsewhere without behavioral disturbances, basal cell carcinoma skin unspecified upper limb including shoulder, melanoma of site of other parts of face, pain in right leg, Alzheimer?s disease with late onset, dysphagia unspecified, iron deficiency anemia, pain unspecified, abnormal weight loss, fall from bed, other thrombophilia, unspecified fracture of lower end of right tibia, generalized anxiety disorder
Allergies: codeine
Diagnostic Lab Data: Chest x-ray shows pulmonary fibrosis without acute infiltrates or effusion 5/21/2021, 05/20/2021 positive SARS-CoV-2 PCR test.
CDC Split Type:

Write-up: Patient tested positive for COVID-19 on 5/20/2021, started showing symptoms around 3:30pm. "He drastically decreased in O2sats from WNL to 79% in about an hour?s time. His BP elevated, 152/90, and then dropped to 101/65. His HR increased 132-156 bpm. He had SOB." 99.5 fever while in hospital, on 2 liters oxygen


VAERS ID: 1337862 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Unknown       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: None
Current Illness: None
Preexisting Conditions: None
Allergies: Pet dander
Diagnostic Lab Data:
CDC Split Type:

Write-up: Parent note sent in with child stating child has syncopal episodes while getting shots. Pt was given the vaccine and had a syncopal episode. Pt moved to wheelchair, taken to medical and moved to mat. Pt then became alert and oriented. Ice pack applied to pt''s forehead. Pt moved to fowler''s position, then to standing and stated she "felt fine". Pt then sat in chair to continue observation period.


VAERS ID: 1337898 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Choking sensation, Cyanosis, Hypoaesthesia, Paraesthesia, Peripheral swelling, Skin discolouration
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol Calcium citrate Cardizem Cholecalciferol Dotti Epinephrine Fluoxetine Hydrochlorothiazide Levothyroxine Lorazepam Losartan Magneesium oxide Multivitamin Pantoprazole Rosuvastatin Spironolactone Topirmate Valacyclovir
Current Illness: No
Preexisting Conditions: Asthma Breast lesion Chest pain GERD Migraine SOB Tachycardia
Allergies: ASA Ibuprofen Imitrex Neurontin Toradol Zantac
Diagnostic Lab Data:
CDC Split Type:

Write-up: She states that within 5 minutes of receiving the vaccine she developed numbness and tingling and swelling in 3 fingers of her hand as well as they began to turn blue. She then noted the feeling that someone was strangling her.


VAERS ID: 1337923 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose increased, Electrocardiogram normal, Fatigue, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), 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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None reported
Preexisting Conditions: None reported
Allergies: None reported
Diagnostic Lab Data: Blood sugar tested: 108 Patient mother reported to writer that the hospital did an EKG & it was normal
CDC Split Type:

Write-up: Patient fainted three minutes after receiving the Moderna vaccine. Patient''s mom was at clinic with her and reported after the patient had fainted that the patient had played an outdoor La Crosse game in the heat & humidity the evening before receiving the MODERNA vaccine & had not eaten breakfast or had much to drink the day of the MODERNA vaccine. Provider who responded to take care of the patient indicated the patient was most likely dehydrated & needed IV fluids. Blood pressure was 97/58; pulse 64; Oxygen saturation 96%. Patient became responsive within 30-45 seconds from fainting but then fainted a second time when being transferred from a wheelchair to an exam room table. Patient was very tired and would be awakened & responsive when patient mom speaking to her, but faded in & out. 911 called & patient transported to hospital for hydration with IV fluids.


VAERS ID: 1337932 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 - / IM

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

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

Write-up: Patient developed a headache similar to her chronic migraines (bifrontal, rated 4/10) with no associated nausea/vomiting, altered mental status, LOC, shortness of breath. She preferred to leave with mom (who agreed that her symptoms were similar to chronic headaches) and were going to take medication when she got home. Mom was going to bring her back if the symptoms worsened or were not resolved with her regular medication.


VAERS ID: 1338086 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-05-18
Onset:2021-05-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Genital ulceration
SMQs:, Severe cutaneous adverse reactions (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: Isotretinoin 40mg
Current Illness: none
Preexisting Conditions: none
Allergies: NKDA
Diagnostic Lab Data: prescription sent for pain control lidocaine topical
CDC Split Type:

Write-up: Lipshutz ulcer


VAERS ID: 1338391 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 LA / IM

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

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

Write-up: patient''s friend''s alerted me that he was feeling dizzy about 2:10pm. I went over to patient just as he was passing out. small muscle jerk was noted. I obtained assistance to place patient on the floor. He regained consciousness before we could put him on the floor. He was out only 5-10 seconds. he was given some water and proceeded to sit for 20 more minutes. Patient was feeling fine. He did state he had fainted receiving flu shot previously. Patient walked home and called to inform us he made it home safely and was feeling fine. He was instructed to hydrate and take it easy for the day. He refused offer to call the squad


VAERS ID: 1338599 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Interchange of vaccine products
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: NO
Current Illness: NO
Preexisting Conditions: NO
Allergies: NO
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: patient had the first dose moderna vaccine. Came to the pharmacy and pharmacist gave patient pfizer covid 19 vaccine.


VAERS ID: 1339374 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

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

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: So it happened later when I got home, but I suffered from extreme body and muscle pain, heavy fatigue, severe naseua, a fever at about 100 degrees Fahrenheit, and severe migraines. This continued till about 8 am the next morning when my fever finally broke, and the other symptoms have gradually lessened over the period of today.


VAERS ID: 1340249 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN JANSSEN 207A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Nausea, Pyrexia, Tinnitus, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever 102.2 lasting about 18 hours; Severe headache lasting about 24 hours; Nausea with vomiting lasting about 10 hours; Ringing in ears still occurring; Tiredness lasting 24 hours


VAERS ID: 1340252 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Delaware  
Vaccinated:0000-00-00
Onset:2021-05-20
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210539925

Write-up: SEVERE HEADACHE/ SPLITTING HEADACHE; This spontaneous report received from a patient concerned a patient of unspecified age and sex. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: unknown) dose was not reported, administered on 19-MAY-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 20-MAY-2021, the subject experienced severe headache/ splitting headache. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of severe headache/ splitting headache was not reported. This report was non-serious.


VAERS ID: 1340262 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:2021-05-20
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Military       Purchased by: ?
Symptoms: Back pain, Chills, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Guillain-Barre 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: Chest pain; General body pain; Post-traumatic stress disorder
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210540352

Write-up: BACK PAIN; NUMBNESS IN BACK AND ARMS; CHILLS FEELING HOT AND THEN COLD; This spontaneous report received from a patient concerned a 33 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included post traumatic stress disorder, chest pain (heart and lungs problems), and body pain. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 043A21A) dose was not reported, administered on 20-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 20-MAY-2021, the subject experienced back pain. On 20-MAY-2021, the subject experienced numbness in back and arms. On 20-MAY-2021, the subject experienced chills feeling hot and then cold. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from chills feeling hot and then cold, back pain, and numbness in back and arms. This report was non-serious.


VAERS ID: 1340578 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysphagia, Ear swelling, Erythema, Impaired work ability, Pharyngeal swelling, Pruritus, Rash, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: 81mg of aspirin
Current Illness: ear infection, EBV
Preexisting Conditions: EBV
Allergies: Iodine
Diagnostic Lab Data: No testing was performed at the hospital. Only examination was inside the throat and my back.
CDC Split Type:

Write-up: Thursday, 05/20/2021 02:05PM received Janssen 0.5mL to left deltoid IM injection. 04:55PM Noticed a pin needle like rash on my chest, stomach, and neck. 05:00PM Took 50mg of Benadryl. 05:40PM Took another 50mg of Benadryl due to rash being more present on my chest, stomach, and neck. Itching began on the neck behind the ears. 05:50PM Noticed difficulty/restriction to swallowing. 06:20PM Checked into a facility. Waited an hour to be seen by a provider, Dr. He states only an acute reaction without examining my body of the rash; only examined my back & inside my mouth. I informed him that my rash was on my chest, stomach, neck, now my arms, and top of my thighs. He provided Prednisone and dismissed me. (I will be filing for malpractice) 08:00PM- Got home, still have rash with some difficulty swallowing. Friday, 05/21/21 06:00AM- Rash seems to subside and throat is fine, but swollen. 09:00AM While at work, coworker mentions my face is red. Rash came back to my arms and is now on my face. I took 50mg of Benadryl. 03:00PM Left work early since I could not take another dose of Benadryl to drive home. 03:20PM Rash has spread to whole entire body except lower than the knee. Took another 50mg of Benadryl. 09:00PM Took 25 mg of Benadryl went to bed. Saturday, 05/22/21 07:00AM Rash is more noticeable and red. Everywhere on the body, swelling to ears and throat. Took 50mg of Benadryl.


VAERS ID: 1340588 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 AR / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Limb injury, Pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Accidents and injuries (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: Shoulder Joint Injury (prolonged pain, tingling, etc.)


VAERS ID: 1340628 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure decreased, Confusional state, Dyspnoea, Hypotension
SMQs:, Anaphylactic reaction (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), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Allergic: Difficulty Breathing-Medium, Systemic: Confusion-Medium, Systemic: Hypotension-Severe, Additional Details: Blood pressure dropped 94/33, heart rate 43. Epi-pen 0.3mg wagiven. (911 team) confirmed patient recovered, vital stable, Ok for parents take Pt to ER or home. Dr confirmed patient had vagal response on 7/12/2019 after vaccinated HPV.


VAERS ID: 1340629 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dyspnoea, Hypotension
SMQs:, Anaphylactic reaction (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), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Allergic: Difficulty Breathing-Medium, Systemic: Confusion-Medium, Systemic: Hypotension-Severe, Additional Details: Blood pressure dropped 94/33, heart rate 43. Epi-pen 0.3mg wagiven. Personnel (911 team) confirmed patient recovered, vital stable, Ok for parents take patient to ER or home. Doctor confirmed patient had vagal response on 7/12/2019 after vaccinated HPV.


VAERS ID: 1340667 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-14
Onset:2021-05-20
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Full blood count normal, Musculoskeletal stiffness, Seizure, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Arthritis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None at time of vaccination. Took 1/2 pill of over-the-counter Unisom (25mg) the night before seizure. Has been taking Unisom as needed for years with no adverse effects ever
Current Illness: No
Preexisting Conditions: Autism
Allergies: No
Diagnostic Lab Data: CBC conducted during ER visit came back normal
CDC Split Type:

Write-up: Seizure. He was stiff, shaking uncontrollably, gasping for air. Seizure lasted 2-3 minutes. Rescue was called to the house. Had to be taken to ER. ER conducted CBC test. Results came back normal. Was prescribed as needed Valium suppository bc this was his first seizure ever


VAERS ID: 1340794 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 026A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Chills, Electrocardiogram, Hyperhidrosis, Nausea, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness:
Preexisting Conditions:
Allergies: unknown
Diagnostic Lab Data: EKG and bloodwork at ED; patient unsure of which one
CDC Split Type:

Write-up: Pt watching TV, experienced sweating, chills, extreme nausea, and shakiness. Patient went to Emergency dept. BP was 187/71 and all tests were clear. Patient was kept for approx 5 hours and released with no further symptoms.


VAERS ID: 1340798 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 2 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Unknown - answered "No" to screening question about serious reaction to previous vaccine or shot.
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 17 year old patient received their first dose of Moderna at mass vaccination site the previous month. Patient presented at mass vaccination site for second dose. Guidance dictates that if patient has received first dose of Moderna, they should still receive second dose. Second dose was administered with no problems/adverse outcome. The only reason for submitting this VAERS report is due to a 17 y.o. patient receiving a Moderna dose.


VAERS ID: 1340832 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-05-13
Onset:2021-05-20
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW 0179 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain, Appendicectomy, Appendicitis, Computerised tomogram abdomen, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: CT Scan abdominal -05/20/2021
CDC Split Type:

Write-up: Abdominal pain and vomiting, It turned out to be appendicitis and he underwent surgery to remove it.


VAERS ID: 1340876 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 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: Vaccine administered after vial was punctured and left at room temp for over 2 hours. Vaccine administered about 3&1/2 hours after initial puncture.


VAERS ID: 1340948 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-08
Onset:2021-05-20
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Anticoagulant therapy, Deep vein thrombosis, Dyspnoea, Pulmonary embolism, Ultrasound Doppler abnormal
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: moderate to severe aortic stenosis
Allergies: Ace inhibitors, etodolac, peanut oil, tramodol
Diagnostic Lab Data: CTA chest 5/20 - multiple filling defects are identified the bilateral main pulmonary arteries and descending and subsegmental branches suspicious for pulmonary emboli. U/S doppler - Acute DVT from mid-distal left femoral vein down to the visualized calf veins. Acute DVT from the right popliteal vein down to visualize the calf veins.
CDC Split Type:

Write-up: Patient had increasing dyspnea - difficult to assess whether this was from her aortic stenosis, but this progressively worsened after the vaccine. She a lower extremity dopplers and CT-Angiogram consistent with a pulmonary embolus. She was initially started on IV heparin, which was transitioned to eliquis. Her symptoms improved.


VAERS ID: 1340969 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 59676-0580-15 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Decreased appetite, Headache, Influenza like illness, Injection site pain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (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: Flomax, 40mg; Lipitor, 20mg, Aspirn, 88mg
Current Illness: None
Preexisting Conditions: None
Allergies: IVP Dye, Amoxicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Injection Site soreness, by bedtime, slight fever, chills (all night), overall aches (like the Flu), terrible headache upon waking. No appetite, symptoms continued for 3 days. Back to somewhat normal on day #4.


VAERS ID: 1340981 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-02
Onset:2021-05-20
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blister, Erythema, Inflammation, Pustule, Swelling
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient presented to pharmacy with a red blister that was raised, inflamed and pussing on right arm that she received J&j vaccine in on 5/2/21. She reports pain started 5/20/21 and blister open overnight. Recommended patient go to urgent care to be seen by a medical doctor right away .


VAERS ID: 1341008 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-11
Onset:2021-05-20
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Full blood count abnormal, Immune thrombocytopenia, Immunoglobulin therapy, Platelet count decreased
SMQs:, Haematopoietic leukopenia (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: IBUPROFEN
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: CLINDAMYCIN
Diagnostic Lab Data: CBC (5/21/2021): PLATELETS 7000/UL CBC (5/22/2021): PLATELETS 35000/UL
CDC Split Type:

Write-up: DEVELOPED DECREASE IN PLATELET COUNTS, CONSISTENT WITH IMMUNE THROMBOCYTOPENIA, TEN DAYS POST VACCINATION. PLATELET COUNT 7000 ON MAY 21, 2021. HE WAS ADMITTED TO HOSPITAL AND RECEIVED TWO DOSES OF IMMUNE GLOBULIN AND DECADRON WITH IMPROVEMETN IN PLATELET LEVELS. HE REMAINED ASSYMPTOMATIC.


VAERS ID: 1341037 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 2 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 LA / SYR

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

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

Write-up: At the time of the injection, it felt like there was a knife being inserted in my arm. The pain was overwhelming. The pain has been consistent, the swelling has not gone down around the injection site. Around the injection site is very warm to the touch. It feels like the injection hit the joint in my upper left arm.


VAERS ID: 1341056 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-15
Onset:2021-05-20
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Albumin urine, Blood pressure increased, Electrocardiogram, Metabolic function test, Urine analysis
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: holy basil, ashwaganda
Current Illness: none known
Preexisting Conditions: none known
Allergies: none known
Diagnostic Lab Data: EKG, CMP, urinalysis, urine albumin
CDC Split Type:

Write-up: Acute elevation in BP in person with no previous history of HTN (150/100s)


VAERS ID: 1341095 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-14
Onset:2021-05-20
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Lip swelling, Lip ulceration, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allergy shots once monthly (last shots were 05/18/2021 at 12:15pm) Zyrtec 10mg per os once every night before allergy shots (last taken 05/17/2021 at 7:00pm) CVS Health Gummy Dinos multivitamin 2 dummies once daily for os NAC 600mg once dai
Current Illness: None
Preexisting Conditions: Asthma Environmental allergies Previous history of septic arthritis of left hip which has completely resolved.
Allergies: Numerous environmental allergies including grasses, pollen, ragweed, animal dander, dust mites. Oral allergy syndrome to avocado (previously to banana and some stone fruits). Has had intermittent idiopathic pruritic rash on body on a few occasions whilst swimming in a chlorinated pool environment.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling of the upper left lip on 05/20/2021 noticed when she woke up at 7am. No signs or history of trauma. Gave Benadryl 25mg liquid orally and iced the area. A second dose of Benadryl was given at 1pm as the swelling had not subsided. By evening her lip was normal. When waking up on 05/21/2021 she noticed a approx 1cm ulcerative type lesion on her inner upper lip. The lip was swollen again, but slightly less so. Repeated Benadryl 25mg three times that day at 6 hour intervals. Started on triamcinolone 0.1% cream prescribed by her pediatrician that evening. On 05/22/2021 the lip was not swollen and the ulcer appears to be healing on the upper lip, but a small portion of her lower left lip now shows an approx 1-2mm ulcerative lesion. Triamcinolone 0.1%cream applied 3x daily. She noticed a irregular confluent red rash approx 4cmx2cm on her right mid abdomen on Tuesday after swimming, but unsure if this is related. She had her regular maintenance allergy shots (one shot in each arm) on Tuesday at 12:15pm.


VAERS ID: 1341115 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-16
Onset:2021-05-20
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Appendicitis
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Letrozole Levothyroxine Minocycline Somatropin
Current Illness:
Preexisting Conditions: Non-classical CAH Alice in Wonderland Syndrome
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Acute appendicitis without perforation within 5 days of administration


VAERS ID: 1341150 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Dizziness, Fall, Hyperhidrosis, Skin warm
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: after receiving the vaccine pt felt sweaty and lightheaded and wanted to lay down, so the nurse directed and walked with pt to move him by the privacy area so he can lay there. while walking to the privacy area pt fell on the floor. when i examined the pt his body felt hot at touch and he stated that he was feeling dizzy. after few minutes the pt felt better and after waiting for 20 minutes pt stated he is feeling better again.


VAERS ID: 1341163 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Hyperglycemia
Preexisting Conditions: Prediabetes, Obesity, Dyslipidemia
Allergies: None
Diagnostic Lab Data: 12/09/2020 12/09/2020 12/11/2020 BASIC METABOLIC... Attributes Values Reference Range GLUCOSE 147 H 65-99 - mg/dL UREA NITROGEN (BUN) 6 L 7-20 - mg/dL CREATININE 0.52 0.50-1.00 - mg/dL BUN/CREATININE RATIO 12 6-22 - (calc) SODIUM 137 135-146 - mmol/L POTASSIUM 4.1 3.8-5.1 - mmol/L CHLORIDE 103 98-110 - mmol/L CARBON DIOXIDE 25 20-32 - mmol/L CALCIUM 9.7 8.9-10.4 - mg/dL 12/09/2020 12/09/2020 12/11/2020 HEMOGLOBIN A1c Attributes Values Reference Range HEMOGLOBIN A1c 9.1 H <5.7 - %
CDC Split Type:

Write-up: Patient given vaccination ID unclear if this was the LOT number. She developed a mild skin rash one day after vaccination, which spread over her face, neck and chest and arms, with lip swelling, but no other oropharyngeal edema. The rash was itchy and pruritic, raised macules that were slightly erythemaic on the face, and sparsely papular on the arms. We prescribed benadryl and prednisone, with instructions to call our service line and also see us in the office on Monday. She had unresolved blood tests, hyperglycemia, which we were trying manage with our staff however she was not adherent to follow up with us due to college coursework. My associate is her primary care attending, and had requested assistance in filling out the VAERS form.


VAERS ID: 1341167 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Blood creatine phosphokinase increased, C-reactive protein, Chest X-ray normal, Chest pain, Echocardiogram, Electrocardiogram PR segment depression, Electrocardiogram ST segment elevation, Fatigue, Leukocytosis, Malaise, Myalgia, Myocarditis, Pyrexia, Red blood cell sedimentation rate increased, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Other ischaemic heart disease (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Immune-mediated/autoimmune disorders (broad)

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

Write-up: The following 2 days after second dose with malaise, fatigue, myalgias, subjective fevers, third day post vaccine with chest pain consistent with myopericarditis after evaluation. Echocardiogram pending, elevated ESR, CRP, Leukocytosis, elevated CPK level, Tropnins uptrending from 8, EKG with diffuse ST segment elevation and PR interval depression, clear CXR.


VAERS ID: 1341176 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Immediate post-injection reaction, Pallor, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Patient was light-headed, dizzy, and pale minutes after receiving the vaccine. They also reported difficulty seeing (their field of vision was all bright light.)


VAERS ID: 1341278 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Back pain, Chest pain, Dyspnoea, Electrocardiogram, Hypoaesthesia, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluoxetine 20 mg daily
Current Illness: None
Preexisting Conditions: None
Allergies: Doxycycline and Cipro
Diagnostic Lab Data: EKG. I Went to Medical Center for chest pain around 6 pm
CDC Split Type:

Write-up: Chest pain. Difficulty breathing, upper back pain, numbness and tingling in right arm.


VAERS ID: 1341356 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

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

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

Write-up: Nurses chart note: "pt came with four other siblings for covid vaccine. when speaking with me, patient was visibly upset and nervous about vaccine. i asked her age but patient did not respond as she continued to express her fear of shots. Pt did tell me her birthday but i did not realize her age. After administering the vaccine, staff then realized patient was only 11 years old. She turns 12 in July 2021.


VAERS ID: 1341426 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Epistaxis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: Received telephone call stating that he has been having frequent nose bleeds since the date of vaccination. States it is as frequent as 5 times per day with a steady amount lasting approx 5 min.


VAERS ID: 1341473 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-13
Onset:2021-05-20
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / IM

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

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

Write-up: Diffuse urticaria starting 1 week after vaccine, that has since lasted 2 days


VAERS ID: 1341632 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-13
Onset:2021-05-20
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Sotalol 80mg (take in AM) Sotalol 120 mg (take in PM) Losartan Potassium 50 mg (daily) Alprazolam .5mg (as needed)
Current Illness: History of ventricular tachycardia, have an implantable defibrillator
Preexisting Conditions: History of ventricular tachycardia have an implantable defibrillator
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Large red welt appeared next day 7 days after injections received 4 shocks from ICD after 7 years with no issues


VAERS ID: 1341694 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / SYR

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

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

Write-up: Red, itchy hives started developing on abdomen, arms, legs 24 hours after injection.


VAERS ID: 1341707 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain in extremity, Product administration interrupted
SMQs:, Tendinopathies and ligament disorders (broad), Medication errors (broad)

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

Write-up: A 12 years old female patient accompanied by mother to receive firs dose of Pfizer. When the pharmacist tried to administer the vaccine, she noticed the arm muscle was tensed and experienced a bit of difficulty to penetrate the needle in to the arm. Once the needle inside, the pharmacist tried to inject the vaccine in and noticed the plunger moved a bit and then stopped. She tried to use a bit of force to push the vaccine in further but it did not work. So the pharmacist pulled the injection out and attempt to administer again. She did inform patient''s mother that she has to try again. This time the injection went well and as precaution, the pharmacist did not inject all the vaccine in since she knew the patient got a bit of the vaccine in on the first time. Mother was advised to give patient a dose of Tylenol or Ibuprofen that night (if patient is not allergic to those meds) to help out with the soreness. Mother came back to store the next day to ask more questions but there was another pharmacist on duty. That pharmacist did explain to patient''s mother the mechanism of vanish point syringe and how it is supposed to work. He relayed the message with the administering pharmacist to follow up. The administering pharmacist called on Friday (May 21) but could not leave the message. She tried again on Saturday (May 22) and was able to explain in detail what happened that day. Her concern is the possibility of her daughter getting double dose and the long term effect of the vaccine. Pharmacist did ask how the patient doing and exhibits any noticeable or severe side effects beside soreness. Mother said so far she is ok besides sore arm. Pharmacist advised mother to monitor the child for a few more days to be safe and call the pharmacist or even her pediatrician if there is further concern. Pharmacist also will follow up with mother to check on how the patient is doing


VAERS ID: 1341773 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-18
Onset:2021-05-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Echocardiogram, Ejection fraction normal, Electrocardiogram ST segment elevation, Electrocardiogram abnormal, Troponin increased
SMQs:, Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Creatine
Current Illness: congestion and fatigue that lasted a few days about 2 weeks prior to vaccination
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Troponin 8.36 EKG with ST elevation TTE with low normal ejection fraction of 50-55%; Left ventricular segmental wall motion is abnormal; mid to distal anteroseptum along with apex is mildly hypokinetic; no valvular abnormalities; no coronary artery abnormalities
CDC Split Type:

Write-up: Pt developed chest pain on 5/20, 2 days after receiving the vaccination. It persisted and he presented to the ED on 5/21 and was found to have elevated troponins and ST elevation concerning for myocarditis/pericarditis. Symptoms improved with ibprofen.


VAERS ID: 1341797 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-18
Onset:2021-05-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Epistaxis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (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: Birth control pills
Current Illness: None
Preexisting Conditions: Elevated factor 8
Allergies: Pd Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nosebleeds Bruising


VAERS ID: 1341889 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-15
Onset:2021-05-20
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort
SMQs:, Anaphylactic reaction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: ADMITTED TO HOSPITAL 10 DAYS AFTER 2ND DOSE.
CDC Split Type:

Write-up: CHEST DISCOMFORT STARTED 5 DAYS AFTER 2ND DOSE. HEALTHY 64 YEAR OLD WITH NO HEALTH PROBLEMS


VAERS ID: 1341994 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-17
Onset:2021-05-20
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Intensive care, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: seizures, iron deficiency anemia
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vfib cardiac arrest admitted to the ICU one week after receiving second dose of Pfizer vaccine. Unclear if related to vaccine administration but pt is 22 years old with no prior cardiac history. Pt still currently admitted but recovering.


VAERS ID: 1342084 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-11
Onset:2021-05-20
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003CZ1A / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute myocardial infarction, Atrial fibrillation, Bladder neoplasm, Blood cholesterol normal, Blood magnesium normal, Blood phosphorus normal, Blood triglycerides increased, COVID-19, Dysuria, Electrocardiogram delta waves abnormal, Full blood count normal, Glycosylated haemoglobin normal, High density lipoprotein decreased, Low density lipoprotein normal, Metabolic function test normal, SARS-CoV-2 test positive, Troponin
SMQs:, Dyslipidaemia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Myocardial infarction (narrow), Conduction defects (narrow), Supraventricular tachyarrhythmias (narrow), Embolic and thrombotic events, arterial (narrow), Lipodystrophy (broad), Non-haematological tumours of unspecified malignancy (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Diagnosed with a bladder tumor 04/29/2021 in between first and second COVID vaccine
Preexisting Conditions: None
Allergies: No known medications
Diagnostic Lab Data: Magnesium normal Phosphorous normal HA1c 5.3 Cholesterol 195 Triglycerides 169 HDL 40 LDL 121 HS Troponin 0hr 6, 1hr 21, Delta 15 EKG at presenting Atrial fibrillation RVR at rate 146 CBC and BMP unremarkable
CDC Split Type:

Write-up: Patient received 1st moderna vaccine on 4/13/2021. He then began to have urinary issues and diagnosed with a bladder tumor on 4/29. He then tested positive for covid 19 on May1st. He got his 2nd covid 19 vaccine on 5/11/2021 and was hospitalized on 05/20 with new onset rapid atrial fibrillation and NSTEMI. He reports he was healthy with no medical problems and took no medications prior to his vaccines. A pulmonary emboli was ruled out, no history or suspicion of sleep apnea.


VAERS ID: 1342104 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Chills, Heart rate increased, Muscular weakness, Pyrexia, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 10/325 hydrocodone.
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: 102 temperature. Strong involuntary shaking. Chills. Back pain. Elevated pulse. Muscle Weakness. Fever broke around 0600. Adverse reaction appeared to be resolved by 36 hours from time of administering vaccine.


VAERS ID: 1342199 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Headache, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: 1. Headache - for 24 hours. Treated with acetaminophen & naproxen. 2. Nausea when standing - duration 24 hrs 3. Dizziness when standing - duration 24 hrs 4. Fever up to 103 F - duration 18-24 hrs. Unknown due to taking acetaminophen & naproxen.


VAERS ID: 1342354 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-17
Onset:2021-05-20
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Pyrexia, Troponin I increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), 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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 5/22/2021 TROPONIN I, HIGH SENSITIVITY: 4,647 (AA) 5/22/2021 TROPONIN I, HIGH SENSITIVITY: 8,867 (AA) 5/23/2021 TROPONIN I, HIGH SENSITIVITY: 5,235 (AA)
CDC Split Type:

Write-up: 18 year old male, is presenting with RECURRENT , NON-EXERTIONAL CHEST DISCOMFORT. PATIENT RECEIVED 2ND PFIZER VACCINE 5/17/21, ON 5/18/21 HE DEVELOPED FEVER, ON 5/20/21 HE DEVELOPED NON EXERTIONAL, RECURRENT CHEST DISCOMFORT. UP TO 7/10 IN SEVERITY AND LASTING A FEW HOURS AT A TIME AND THEN RESOLVING. Discharged home on 5/23/21 with Indomethacin 25 mg Cap Commonly known as: INDOCIN Take 1 capsule by mouth 2 times a day


VAERS ID: 1342359 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / IM

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

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

Write-up: Developed severe body aches, headache, fatigue. Fever reached 103.9.


VAERS ID: 1342399 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Dizziness, Fatigue, Hallucination, Nausea, Pain in extremity, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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: Moderna vaccine #1, left arm muscle shot. Sore shoulder muscle several days
Other Medications: Fitness Supplement: Quest Protein Powder (Chocolate Milkshake)
Current Illness: None
Preexisting Conditions: Osgood Schlaetter''s Raynaud''s Syndrome
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Thursday, day of 2nd vaccine dose: 1) Sore arm within a few hours of 2nd dose (9:00 AM), same reaction to 1st dose. 2) During fitness workout (5:30-6:30 PM), split second of dizziness. 3) At home (7:00) aggressive fever(temp unknown)/chills, dizziness; mild nausea 4) Bedtime (9:30) hallucination for about an hour Friday, day after 2nd vaccine dose: 5) Nighttime (2:00 AM) fever broke, no hallucinations 6) Remainder of day, fatigue (attributed to stress from issues 1-4)


VAERS ID: 1342400 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-12
Onset:2021-05-20
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Dizziness, Headache
SMQs:, Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reporting worsening chest pain x 3 days, headache x 3 weeks, dizziness today


VAERS ID: 1342413 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A-1 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Body temperature increased, Chapped lips, Chills, Decreased appetite, Dizziness, Ear pain, Feeling hot, Gingival disorder, Gingival pain, Glossodynia, Headache, Hypersomnia, Injection site induration, Injection site urticaria, Injection site warmth, Lip exfoliation, Nausea, Oral pain, Pruritus, Pyrexia, Skin warm, Tinnitus, Tongue disorder, Toothache
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gingival disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Hearing impairment (narrow), Vestibular disorders (broad), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Only multivitamin gummies
Current Illness: None. I did get 2 large hives at injection site from the first shot, but not until 10 days AFTER that shot.
Preexisting Conditions: Mild heartburn, tinnitus.
Allergies: NKA. Epinephrine gives heart palpitations and fear.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: The normal symptoms started in about 12 hours. Chills, but hot body, sleeping alot. Achey bones, even skin. Nausea, headache, fever 102. The second day was noticeably louder tinnitus, teeth hurt, inner ear weird feeling, no appetite, 103 temp. 3rd day was 103 temp, lightheaded, achey, 2 hives at the site but very large, warm and hard. Lower back and neck were really warm. Suddenly small pits in part of my gum that continued to spread, even under my tongue. Very sore and burned with everything I ate or drank. My body seemed to be very itchy at night. Temp went down tho. The 4th day, today was sore mouth, lips peeling and chapped, still lightheaded and arm site is sore and warm.


VAERS ID: 1342417 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Asthenia, Cough, Diarrhoea, Dyspnoea, Fatigue, Nausea, Pain in extremity, Peripheral swelling, Pharyngeal swelling, Pruritus, Pyrexia, Rash, Throat irritation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan, Xanax
Current Illness: Young Onset Parkinson''s Disease, Seizures, Lupus, Idiopathic Intracranial Hypertension, High blood pressure, PCOS
Preexisting Conditions: Young Onset Parkinson''s Disease, Seizures, Lupus, Idiopathic Intracranial Hypertension, High blood pressure, PCOS
Allergies: Peaches
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe pain in arm, swelling in arm, ongoing fever, allergic reaction (itching that benadryl doesn''t help), throat swelling, trouble breathing, visible rash on entire arm, weakness, fatigue, coughing, burning nose and throat, nausea, abdominal pain, diarrhea


VAERS ID: 1342451 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Decreased appetite, Discomfort, Fatigue, Flatulence, Loss of personal independence in daily activities, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Asthma Eczema Scoliosis Pancreatic cyst
Allergies: None
Diagnostic Lab Data: Pesto bismol. Anti-gas otc pill. Digestive enzymes herbal supplement. Will try Omeprazole soon.
CDC Split Type:

Write-up: Extreme fatigue. Extreme gas. Left upper Abdominal pain. Nausea. Poor appetite. Feels similar to gastritis. Pain and discomfort wakes me up and disrupts daily activities. Onset 1-2 days after vaccination. Symptoms getting worse.


VAERS ID: 1342983 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-18
Onset:2021-05-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

Write-up: 2.5 INCH RED, ITCHY, RAISED , BURNING AREA NEAR INJECTION SITE


VAERS ID: 1342997 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram ST segment elevation, Myocarditis, Troponin T increased, Troponin increased
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: EKG w/ diffuse ST elevations. Troponin T-hs 2,766.
CDC Split Type:

Write-up: Patient developed chest pain and on workup had diffuse ST elevations on EKG w/ elevated troponin suggestive of peri/myocarditis


VAERS ID: 1343059 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH BA0185 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Injection site erythema, Nasopharyngitis, Respiratory tract congestion
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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

Write-up: Nearly immediate cold symptoms - congestion which has continued for 5 days now. Chills. Severe redness around injection site which persists after 5 days.


VAERS ID: 1343062 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-14
Onset:2021-05-20
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fungal infection
SMQs:, 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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type: 009C21A

Write-up: I believe that the shot caused me to develop a severe yeast infection. I am not sexually and have not been sexually active for at least 22 years. I never have yeast infections. I purchased Monistat from the pharmacy.


VAERS ID: 1343079 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-09
Onset:2021-05-20
   Days after vaccination:72
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Contusion, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Severe bruising and swelling after botox injection


VAERS ID: 1343091 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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, other than home tested temperature (in ear).
CDC Split Type:

Write-up: Severe headache, Fever (101.5), Chills, Muscles aches. Symptoms lasted for 2 days and were significant . This vaciine cause the most severe sickness I have had in several years. I am reporting this because I think it is important to have accurate data on side effects.


VAERS ID: 1343094 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-17
Onset:2021-05-20
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Erythema, Fatigue, Sensation of foreign body
SMQs:, Anaphylactic reaction (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fatigue, shortness of breath, trouble catching her breath, red face, lump in throat, dizziness, when exercising. Took rescue inhaler 5x , but did not see any improvement. Symptoms went away after an hour of rest.


VAERS ID: 1343101 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

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

Write-up: My left eye started twitching 5/20 a couple hours after I received my 2nd COVID vaccine. It''s been several days and my eye is still twitching. Sometimes it twitches several times an hour and sometimes I go a few hours without twitching. No other symptoms and only my right eye has the twitch. I do not have a history of eye twitching.


VAERS ID: 1343109 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Discomfort, Fatigue, Feeling abnormal, Headache, Nausea, Pruritus, Pyrexia, Rash erythematous, Rash macular, Skin discolouration
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Onset of strong nausea, chills with fingertips turning blue and fever. Brain fog and exhaustion made it difficult to get up throughout the evening into the next day. Nausea, headache and low-grade fever continue to linger and it has now been 3 full days. Developed an "angry" looking rash in lower left groin area - large red splotches with some itching and discomfort. Noted rash on the day following the injection and it hasn''t diminished as of today.


VAERS ID: 1343155 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-09
Onset:2021-05-20
   Days after vaccination:72
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID-19 RNA DETECTION posiitve 05/20/2021 for covid 19
CDC Split Type:

Write-up: Pt currently had Covid 19


VAERS ID: 1343162 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-10
Onset:2021-05-20
   Days after vaccination:99
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID-19 RNA DETECTION BDMAX posiitve 05/20/2021
CDC Split Type:

Write-up: Pt currently has covid 19


VAERS ID: 1343165 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / UN

Administered by: Other       Purchased by: ?
Symptoms: Skin discolouration
SMQs:, Hypotonic-hyporesponsive episode (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: Marijuana
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: on 5/20/21 I noticed 3 yellow spots on my chest that look like bruises but didn''t hurt to touch. Now on 5/24/21 I have another yellow spot right under my right eye and the 3 on my chest are still there. I dont technically now if it is the vaccine that caused this but it did happen right after i took it.


VAERS ID: 1343174 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-05-15
Onset:2021-05-20
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

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

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

Write-up: chest pain


VAERS ID: 1343176 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Erythema, Fatigue, Headache, Hyperhidrosis, Illness, Influenza like illness, Lip pain, Lip swelling, Nausea, Pain, Pain in extremity, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tizanidine, Clonazepam, OTC potassium, Famotidine, Atenolol, Vitamin D, Zyrtec, Nasacort, Probiotic, Tramadol, Ondansetron.
Current Illness: Hypokalemia, weight loss
Preexisting Conditions: Sleep apnea, insomnia (0-2 hrs of sleep for last 2 years), inactive seizure disorder, chemo-brain, fibro-fog, uncontrolled blood pressure high/low, tachycardia, arthritis, fibromyalgia, bulging disc disease, kidney stones, migraines, Crohn''s disease, IBS (C&D), lactose intolerance, malabsorption, spondylosis, chemo-neuropathy, nerve damage in bowel and bladder, acid reflux, hiatal hernia, asthma, golfer''s elbow, depression/anxiety, hemorrhoids, osteopenia, small capacity bladder, history or UTI and kidney infections, hypokalemia, hypophosphatemia, bursitis of the Pes-Ancerine bursa of the left knee, POTs, costochondritis, ulcerations of stomach, phlebitis, wasting syndrome, paresthesias, anemia, liver and kidney functions abnormality.
Allergies: IV contrast, Bactrim (anaphylaxis), Promethazine HCL, Simvastatin/statin drugs, anti-seizure meds, antidepressants, Compazine any meds ending in zine, Penicillin, Phenergan, Amitiza, Linzess, Cholestamine, Metoprolol, Dilaudid, Lomictal, Reglan, Sulfa drugs, Fentanyl, PPI''s, Losartan, barium contrast.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: She got her vaccine, she told her about the medicine that she had anaphylaxis too, she asked if she had any lip fillers. She waited the 15 minutes and then left, then started with a really bad headache and nausea, which she was fine before that. On the way home her husband wanted to stop and she said no as she was sick, made it home and started throwing up, very tired and went to bed which she never does but was extremely sick. Had fever of 100.1. She would go from sweating to fever, aches and pains, flu-like symptoms, everything hurt, pain in the arm, couldn''t use her dominant arm but has lymphedema in the other arm due to having her breast removed due to cancer. Her lips were hurting her and never has chapped lips and had a lot of pain in them. Looked in the mirror on Friday as her lips were really hurting and found they were swollen and her eyes looked like somebody had punched her in them. She called her doctor and they did not return her call. She didn''t feel it was anaphylaxis as she did not have any other symptoms. She put ice on her lips, had take a Zyrtec before the vaccine, but did use the Nasacort and couldn''t figure out was going on. She had not used anything new on her lips or anything. Was thinking she had partial anaphylaxis. Went online and saw the reactions as they did not give her a list of them. She called her doctor and they told her to go to the ER. She still has some swelling and redness with pain, but not an emergency for her to go to the ER. Her lips are swollen, very tiny flat things in her mouth. Wants to know if she''s OK to get 2nd vaccine as her PCP will not call her back.


VAERS ID: 1343181 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Headache, Nausea
SMQs:, Acute pancreatitis (broad), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ramipril 5mg daily Alphagan Medicated Eyedrops
Current Illness: None
Preexisting Conditions: Elevated blood pressure elevated eye pressure
Allergies: None
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Day 1 - headaches Day 2 - headaches & extreme fatigue Day 2 & 3 - nausea


VAERS ID: 1343182 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Tb test plant on 05/17/2021
Current Illness: None
Preexisting Conditions: Meniers disease
Allergies: Sulfa drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tb insert site extremely red swollen and painful. Pictures were taken at emergency room by doctor. Hypersensitive reaction from Tb and vaccine at same time.


VAERS ID: 1343189 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chapped lips, Eye swelling, Fatigue, Headache, Hyperhidrosis, Influenza like illness, Joint range of motion decreased, Lip pain, Lip swelling, Malaise, Nausea, Pain, Pain in extremity, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tizanidine, Clonazepam, OTC potassium, Famotidine, Atenolol, Vitamin D, Zyrtec, Nasacort, Probiotic, Tramadol, Ondansetron.
Current Illness: Hypokalemia, weight loss.
Preexisting Conditions: Sleep apnea, insomnia (0-2 hrs of sleep for last 2 years), inactive seizure disorder, chemo-brain, fibro-fog, uncontrolled blood pressure high/low, tachycardia, arthritis, fibromyalgia, bulging disc disease, kidney stones, migraines, Crohn''s disease, IBS (C&D), lactose intolerance, malabsorption, spondylosis, chemo-neuropathy, nerve damage in bowel and bladder, acid reflux, hiatal hernia, asthma, golfer''s elbow, depression/anxiety, hemorrhoids, osteopenia, small capacity bladder, history or UTI and kidney infections, hypokalemia, hypophosphatemia, bursitis of the Pes-Ancerine bursa of the left knee, POTs, costochondritis, ulcerations of stomach, phlebitis, wasting syndrome, paresthesias, liver and kidney functions abnormality.
Allergies: IV contrast, Bactrim (anaphylaxis), Promethazine HCL, Simvastatin/statin drugs, anti-seizure meds, antidepressants, Compazine any meds ending in zine, Penicillin, Phenergan, Amitiza, Linzess, Cholestamine, Metoprolol, Dilaudid, Lomictal, Reglan, Sulfa drugs, Fentanyl, PPI''s, Losartan, barium contrast.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: She got her vaccine, she told her about the medicine that she had anaphylaxis too, she asked if she had any lip fillers. She waited the 15 minutes and then left, then started with a really bad headache and nausea, which she was fine before that. On the way home her husband wanted to stop and she said no as she was sick, made it home and started throwing up, very tired and went to bed which she never does but was extremely sick. Had fever of 100.1. She would go from sweating to fever, aches and pains, flu-like symptoms, everything hurt, pain in the arm, couldn''t use her dominant arm but has lymphedema in the other arm due to having her breast removed due to cancer. Her lips were hurting her and never has chapped lips and had a lot of pain in them. Looked in the mirror on Friday as her lips were really hurting and found they were swollen and her eyes looked like somebody had punched her in them. She called her doctor and they did not return her call. She didn''t feel it was anaphylaxis as she did not have any other symptoms. She put ice on her lips, had take a Zyrtec before the vaccine, but did use the Nasacort and couldn''t figure out was going on. She had not used anything new on her lips or anything. Was thinking she had partial anaphylaxis. Went online and saw the reactions as they did not give her a list of them. She called her doctor and they told her to go to the ER. She still has some swelling and redness with pain, but not an emergency for her to go to the ER. Her lips are swollen, very tiny flat things in her mouth. Wants to know if she''s OK to get 2nd vaccine as her PCP will not call her back.


VAERS ID: 1343215 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-04-25
Onset:2021-05-20
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Muscle spasms
SMQs:, Acute pancreatitis (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 3/25/2021 Pfizer Vaccine (Covid)
Other Medications: Vitamin D
Current Illness: None
Preexisting Conditions: PTSD Pre-Diabetic Hypertension
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Severe Cramping in Legs and Left Side of Stomach


VAERS ID: 1343238 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthma, Atrial fibrillation, Condition aggravated, Dyspnoea, Rhonchi, Skin warm, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (narrow), Supraventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Infective pneumonia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prednisone taper, albuterol inhaler
Current Illness: Chronic asthma, frequent pneumonia, transient afib
Preexisting Conditions: asthma
Allergies: Allergies to codeine and NSAIDS
Diagnostic Lab Data: Per patient follow up, she was admitted to the hospital for two nights from the ED with a diagnosis of asthma exacerbation and afib episode. She was given breathing treatments. Her prednisone taper was revamped and she had nitroglycerin in the ED. She was discharged on the eve of 5/22 with 3 new inhalers and prednisone. She was following up by phone today (5/24) with her pulmonologist. She was told in the hospital that it is unknown if her asthma flare was induced by the Moderna shot.
CDC Split Type:

Write-up: Patient began experiencing some shortness of breath 15 minutes after the injection with audible wheezing. This nurse assessed her and found the following: LS tight/rhonci whole L side w/wheezing in bilat upper lungs, O2 sat 96% on RA, skin pink/warm, no change in color, no diaphoresis noted, HR regular/98. Patient was able to converse. 911 was activated, paramedics heard air movement throughout lungs, still 96% on RA, BP 141/92. Taken by ambulance to ED due to long history of asthma and no recue inhaler on her person.


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