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From the 1/21/2022 release of VAERS data:

Found 1,049,249 cases where Vaccine is COVID19 and Patient Did Not Die

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 122 out of 10,493

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VAERS ID: 2018779 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-12-28
Onset:2021-12-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Chills, Headache, Injection site pain, Lymph node pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre 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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: fever, chills, headache. day 1. feeling very weak overall. arm pain at injection and lymph node very sore (3 days)


VAERS ID: 2018823 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-12-27
Onset:2021-12-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1611 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Nausea, Vaccination site erythema, Vaccination site pain, Vaccination site rash, Vaccination site warmth
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19 (Prior to vaccination, was the patient diagnosed with COVID-19?:Yes); Penicillin allergy (Known allergies: Penicillin)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101881897

Write-up: COVID arm - large red rash at injection site; COVID arm - large red rash at injection site; Warm to the touch and sore; Warm to the touch and sore; Mild nausea; This is a spontaneous report from a contactable reporter (consumer or other non-HCP). The reporter is the patient. A 35-year-old female patient (not pregnant) received bnt162b2 (BNT162B2), administered in left arm, administration date 27Dec2021 (Lot number: FJ1611) at the age of 35 years as dose 1, single for COVID-19 immunisation. Relevant medical history included: "COVID-19" (unspecified if ongoing), notes: Prior to vaccination, was the patient diagnosed with COVID-19?: Yes and "Penicillin allergy" (unspecified if ongoing), notes: Known allergies: Penicillin. There were no concomitant medications. The following information was reported: VACCINATION SITE RASH (non-serious), VACCINATION SITE ERYTHEMA (non-serious), all with onset 29Dec2021 at 10:00, outcome "recovering", and all described as "COVID arm - large red rash at injection site"; VACCINATION SITE WARMTH (non-serious), VACCINATION SITE PAIN (non-serious), all with onset 29Dec2021 at 10:00, outcome "recovering", and all described as "Warm to the touch and sore"; NAUSEA (non-serious) with onset 29Dec2021 at 10:00, outcome "recovering", described as "Mild nausea". Therapeutic measures were taken as a result of vaccination site rash, vaccination site erythema, vaccination site warmth, vaccination site pain and nausea. Additional information: The patient did not receive any other vaccines within four weeks prior to the COVID vaccine. Prior to vaccination, the patient was diagnosed with COVID-19. Since the vaccination, the patient had not been tested for COVID-19. The events did not result in doctor or other healthcare professional office/clinic visit and emergency room/department or urgent care. Treatment included over the counter (OTC) pain relief and antihistamines for vaccination site rash, vaccination site erythema, vaccination site warmth, vaccination site pain and nausea.


VAERS ID: 2018840 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-22
Onset:2021-12-29
   Days after vaccination:310
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20211229; Test Name: COVID-19 Ag Test; Test Result: Positive ; Comments: Nasal Swab
CDC Split Type: USPFIZER INC202101883479

Write-up: Tested positive for COVID-19; Tested positive for COVID-19; This is a spontaneous report received from contactable reporter from a sales representative. The reporter is the patient. A 23 year-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), administration date 22Feb2021 (Lot number: EL3247) at the age of 22 years as dose 2, single and administration date 01Feb2021 (Lot number: EL3247) as dose 1, single for covid-19 immunisation. The patient''s relevant medical history and concomitant medications were not reported. No covid prior vaccination. The following information was reported: COVID-19, VACCINATION FAILURE all with onset 29Dec2021, outcome recovering. Therapeutic measures were not taken as a result of covid-19, vaccination failure. Follow-up attempts are completed. No follow-up attempts are needed. No further information is expected.


VAERS ID: 2018853 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1611 / 3 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Penicillin allergy (Known allergies: Penicillin)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101885417

Write-up: Chills; Fever; My left lymph nodes were swollen; Dose number 3; This is a spontaneous report from a contactable reporter (consumer or other non-hcp). The reporter is the patient. A 38-year-old female patient (not pregnant) received bnt162b2 (BNT162B2), administered in arm left, administration date 29Dec2021 at 11:15 (Lot number: FJ1611) at the age of 38 years as dose 3 (booster), single for COVID-19 immunisation. Relevant medical history included: "Penicillin allergy" (unspecified if ongoing), notes: Known allergies: Penicillin. Concomitant medication included unspecified birth control medication. Past drug history included: Monosodium glutamate, reaction: "Reaction to monosodium glutamate", notes: Known allergies: MSG. Vaccination history included: Bnt162b2 (DOSE 1, SINGLE; Lot number: EW0195; Anatomical location: Left arm), administration date: 02Jun2021, when the patient was 37 years old, for COVID-19 immunisation and Bnt162b2 (DOSE 2, SINGLE; Lot number: EW0191; Anatomical location: Left arm), administration date: 23Jun2021, when the patient was 37 years old, for COVID-19 immunisation. The following information was reported: IMMUNISATION (non-serious) with onset 29Dec2021 at 11:15, outcome "unknown", described as "Dose number 3"; CHILLS (non-serious) with onset 29Dec2021 at 23:00, outcome "recovering", described as "Chills"; PYREXIA (non-serious) with onset 29Dec2021 at 23:00, outcome "recovering", described as "Fever"; LYMPHADENOPATHY (non-serious) with onset 29Dec2021 at 23:00, outcome "recovering", described as "My left lymph nodes were swollen". Therapeutic measures were not taken as a result of chills, pyrexia and lymphadenopathy. Additional information: Prior to vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the COVID vaccine. After 12 hours of receiving the vaccine booster, the patient had chills, a fever, and her left lymph nodes were swollen. The events did not result in doctor or other healthcare professional office/clinic visit and emergency room/department or urgent care. Since the vaccination, the patient had not been tested for COVID-19.


VAERS ID: 2018856 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD7218 / 3 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature, Chills, Headache, Immunisation, 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:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None, Comment: Other medical history: None; Known allergies: No
Allergies:
Diagnostic Lab Data: Test Date: 20211230; Test Name: Body temperature; Result Unstructured Data: Test Result:101.6 degree
CDC Split Type: USPFIZER INC202101885472

Write-up: Slight headache; Chills; 101.6 degree fever; Dose number 3; This is a spontaneous report from a non-contactable reporter (consumer or other non-HCP). The reporter is the patient. A 59-year-old male patient received bnt162b2 (BNT162B2), administered in right arm, administration date 29Dec2021 at 12:30 (Lot number: FD7218) at the age of 59 years as dose 3 (booster), single for COVID-19 immunisation. Relevant medical history included: "None", notes: Other medical history: None; Known allergies: No. There were no concomitant medications. Vaccination history included: Bnt162b2 (DOSE 1, SINGLE; Lot Number: EP7534; Administration location: Right arm), administration date: 01Apr2021, when the patient was 58 years old, for COVID-19 immunisation and Bnt162b2 (DOSE 2, SINGLE; Lot Number: ER8734; Administration location: Right arm), administration date: 22Apr2021, when the patient was 58 years old, for COVID-19 immunisation. The following information was reported: IMMUNISATION (non-serious) with onset 29Dec2021 at 12:30, outcome "unknown", described as "Dose number 3"; HEADACHE (non-serious) with onset 30Dec2021 at 00:15, outcome "recovered" (30Dec2021 at 08:15), described as "Slight headache"; CHILLS (non-serious) with onset 30Dec2021 at 00:15, outcome "recovered" (an unknown date in Dec2021), described as "Chills"; PYREXIA (non-serious) with onset 30Dec2021 at 00:15, outcome "recovered" (an unknown date in Dec2021), described as "101.6 degree fever". Relevant laboratory tests and procedures are available in the appropriate section. Therapeutic measures were not taken as a result of headache, chills and pyrexia. Additional information: Prior to vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the COVID vaccine. Commencing approximately 12 hours after receiving dose began having chills and slight headache and then within an hour had a 101.6-degree fever, the fever and chills lasted several hours and started to wane. The headache lasted 8 hours. Since the vaccination, the patient had not been tested for COVID-19. The events did not result in doctor or other healthcare professional office/clinic visit and emergency room/department or urgent care. No follow-up attempts are possible. No further information is expected.


VAERS ID: 2019148 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202200000087

Write-up: Swollen lymph node in left armpit the day after vaccination; Dose number 3; This is a spontaneous report from a contactable reporter (consumer or other non-HCP). The reporter is the patient. A 45-year-old female patient (not pregnant) received bnt162b2 (BNT162B2), administered in left arm, administration date 29Dec2021 at 12:00 (Lot number: unknown) at the age of 45 years as dose 3 (booster), single for COVID-19 immunisation. The patient had no relevant medical history. There were no concomitant medications. Vaccination history included: Bnt162b2 (DOSE 1, SINGLE, Lot number: UNKNOWN, Anatomical location: Left arm, Administration time: 14:30), administration date: 18Mar2021, when the patient was 44 years old, for COVID-19 immunisation and Bnt162b2 (DOSE 2, SINGLE, Lot number: UNKNOWN, Anatomical location: Left arm, Administration time: 12:45), administration date: 08Apr2021, when the patient was 44 years old, for COVID-19 immunisation. The following information was reported: IMMUNISATION (non-serious) with onset 29Dec2021 at 12:00, outcome "unknown", described as "Dose number 3"; LYMPHADENOPATHY (non-serious) with onset 30Dec2021, outcome "not recovered", described as "Swollen lymph node in left armpit the day after vaccination". Therapeutic measures were not taken as a result of lymphadenopathy. Additional Information: The patient had no known allergies. The patient did not receive any other vaccines within four weeks prior to the COVID vaccine. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient had not been been tested for COVID-19. The events did not result in doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care. The lot number for BNT162b2 was not provided and will be requested during follow up.


VAERS ID: 2019183 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:0000-00-00
Onset:2021-12-29
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Drug ineffective, Fatigue, Nasal congestion, Pain, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20211230; Test Name: Covid-19 rapid test; Test Result: Positive
CDC Split Type: USPFIZER INC202200007900

Write-up: Covid-19 rapid test came back positive; Covid-19 rapid test came back positive; chills; fatigue; cough; congestion; body aches; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP). The reporter is the patient. A 37 year-old female patient received bnt162b2 (BNT162B2) (Batch/Lot number: unknown) at the age of 37 years as dose number unknown, single for covid-19 immunisation. The patient''s relevant medical history and concomitant medications were not reported. The following information was reported: DRUG INEFFECTIVE (medically significant), COVID-19 (medically significant) all with onset 30Dec2021, outcome "unknown" and all described as "Covid-19 rapid test came back positive"; CHILLS (non-serious) with onset 29Dec2021, outcome "not recovered", described as "chills"; FATIGUE (non-serious) with onset 29Dec2021, outcome "not recovered", described as "fatigue"; COUGH (non-serious) with onset 29Dec2021, outcome "not recovered", described as "cough"; PAIN (non-serious) with onset 29Dec2021, outcome "not recovered", described as "body aches"; NASAL CONGESTION (non-serious) with onset 29Dec2021, outcome "not recovered", described as "congestion". The patient underwent the following laboratory tests and procedures: sars-cov-2 test: (30Dec2021) positive. Clinical course: On the evening of 29Dec2021 patient became quickly I''ll with chills, fatigue, cough, body aches, and congestion. The morning of 30Dec2021 patient work up not better and went for a Covid test. Patients Covid-19 rapid test came back positive. The lot number for bnt162b2 was not provided and will be requested during follow up.


VAERS ID: 2019305 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-12-28
Onset:2021-12-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Electrocardiogram, Laboratory test, X-ray
SMQs:, Anaphylactic reaction (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? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Trikafta, pulmozyme, albuteral, hypersal 7
Current Illness:
Preexisting Conditions: Cystic Fibrosis
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Developed chest pain approximately 30 hours later as well as pressure. Described as feeling like a heart attack. Went to local ER approximately 48 hours following the vaccination. Completed labs, X-ray, and EKG. Transferred from local ER to nearest hospital ER. Labs, X-ray, and EKG were completed again. Spent approximately 12 hours in both ERs. Admitted to the step-down cardiac unit to monitor. Labs, X-ray, and EKG again. Discharged approximately 10 hours later.


VAERS ID: 2019356 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-23
Onset:2021-12-29
   Days after vaccination:281
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest pain, Dyspnoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: short of breath, chest pain + COVID test


VAERS ID: 2019397 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-12-17
Onset:2021-12-29
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067H21A / 3 LA / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308498 / 1 RA / SYR

Administered by: Pharmacy       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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Singular, Zyrtec, protonix
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Nexium, Prevacid
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Hives started 12 days after vaccination and hives are still present 10 days later. Increased dosage of Antihistamine. It helps symptoms but does not get rid of hives.


VAERS ID: 2019526 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-12-07
Onset:2021-12-29
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027H21B / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blister, Burning sensation, Herpes zoster, Insomnia, Neuralgia, Pain, Pain in extremity, Sensitive skin
SMQs:, Severe cutaneous adverse reactions (broad), Peripheral neuropathy (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Opportunistic infections (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: Norethindrone. Magnesium.
Current Illness: none
Preexisting Conditions: none
Allergies: Doxycycline
Diagnostic Lab Data: Was told there isn''t a test for shingles but that symptoms were consistent with it.
CDC Split Type:

Write-up: Diagnosed with shingles on 1/5/22. Started antiviral treatment (acyclovir) same day. Had been experiencing pain in arm for over a week but in the few days prior to 1/5 the pain started radiating down my whole arm, deep aching, skin sensitivity and burning sensations, and I developed blisters in different spots along same arm which enabled the provider to identify the cause as Shingles and the pain as nerve pain. The pain had been keeping me from sleeping and making it difficult to get through the day. The pain kept increasing until a couple days into taking the antiviral medication and has been decreasing over the course of the last two days. I have been using ibuprofen regularly to manage pain. I still have half of the antiviral course left to finish.


VAERS ID: 2019582 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3303088 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Fatigue, Feeling abnormal, Immediate post-injection reaction, Lethargy, Nausea
SMQs:, Acute pancreatitis (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi vitamin, creatine, HMB calcium powder, Zinc, L-Arginine, Pygeum Root, Maca.
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Immediately nauseous. Forced out of the office with no waiting space to recover seated Immediately after shot. For several days felt weak and fatigued. Mild brain fog and lethargy beginning 12/30.


VAERS ID: 2019686 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: New York  
Vaccinated:2021-12-15
Onset:2021-12-29
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2022-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 060H21A / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Mechanical urticaria, Skin test
SMQs:, Hypersensitivity (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: Oral contraceptive, b12 injections, multivitamin, calcium
Current Illness:
Preexisting Conditions: Pernicious anemia
Allergies: Amoxicillin
Diagnostic Lab Data: In office skin test confirmed diagnosis
CDC Split Type:

Write-up: I was diagnosed by my Dermatologist with Dermatographism shortly after I received Moderns booster shot.


VAERS ID: 2019796 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-04
Onset:2021-12-29
   Days after vaccination:55
Submitted: 0000-00-00
Entered: 2022-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019F21A / 3 LA / IM

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

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: Lipitor, ferrous sulfate, omeprazole, Zoloft, gemfibrozil
Current Illness: none
Preexisting Conditions: hyperlipidemia, prediabetes
Allergies: PCN, sulfa, cephalosporin''s, tetracycline
Diagnostic Lab Data:
CDC Split Type:

Write-up: None stated.


VAERS ID: 2019798 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-12
Onset:2021-12-29
   Days after vaccination:320
Submitted: 0000-00-00
Entered: 2022-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Chest discomfort, Cough, SARS-CoV-2 test positive, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: chest tightness, cough, wheezing, and generalized weakness. + COVID test


VAERS ID: 2019800 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-20
Onset:2021-12-29
   Days after vaccination:312
Submitted: 0000-00-00
Entered: 2022-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 UN / UN

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

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

Write-up: fatigue, congestion, sore throat + COVID test


VAERS ID: 2019803 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-09
Onset:2021-12-29
   Days after vaccination:264
Submitted: 0000-00-00
Entered: 2022-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 UN / UN

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

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

Write-up: cough, headache + COVID test


VAERS ID: 2019807 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-03
Onset:2021-12-29
   Days after vaccination:240
Submitted: 0000-00-00
Entered: 2022-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Diarrhoea, Oropharyngeal pain, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: sore throat, cough, diarrhea + COVID test


VAERS ID: 2019811 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-04
Onset:2021-12-29
   Days after vaccination:239
Submitted: 0000-00-00
Entered: 2022-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: short of breath + COVID test


VAERS ID: 2019813 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-10
Onset:2021-12-29
   Days after vaccination:233
Submitted: 0000-00-00
Entered: 2022-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Nausea, Pyrexia, SARS-CoV-2 test positive
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: fever, nausea, weakness, + COVID test


VAERS ID: 2020510 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Unknown  
Location: Ohio  
Vaccinated:2021-12-28
Onset:2021-12-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 189 / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Eye pruritus
SMQs:, Anaphylactic reaction (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: arthritis, asthma, heart palpitations,
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I had itchy eyeballs


VAERS ID: 2020794 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-29
Onset:2021-12-29
   Days after vaccination:91
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / UNK - / -

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

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

Write-up: Covid positive contact unknown


VAERS ID: 2020802 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-06
Onset:2021-12-29
   Days after vaccination:267
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019B21A / UNK - / -

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

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

Write-up: Covid positive through contact.


VAERS ID: 2020817 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3198 / 3 LA / IM

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

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

Write-up: Given booster prior to cdc passing guideline


VAERS ID: 2020830 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-10-01
Onset:2021-12-29
   Days after vaccination:89
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cough, Headache, Oropharyngeal pain, Respiratory tract congestion, Rhinorrhoea, Sinusitis
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Micardis 40 mg/ 12 1/2 hctz od Effexor 37 1/2 mg at night
Current Illness: not at all
Preexisting Conditions: high blood pressure
Allergies: no
Diagnostic Lab Data: no
CDC Split Type: vsafe

Write-up: 12/29/2021 I woke up with a sore throat congested all night , one side was congested, one side running, headache, cough, but I was not coughing anything up. I went to clinic, the doctor checked me there, my lungs were clear, she offered me antibiotics. She told me to treat it like a sinusitis. And said it was too early to test me for COVID-19. I wasn''t feeling worse, so I did not go back to the clinic. So I never got tested. I''m still stuffed up and coughing. I think it''s the weather. I get the sinus stuff every year.


VAERS ID: 2020897 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-11-18
Onset:2021-12-29
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213D21A / UNK - / -

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

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

Write-up: Covid positive contact unknown


VAERS ID: 2020899 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-12-28
Onset:2021-12-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33130814 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Chest pain, Nasal congestion, Oropharyngeal pain, SARS-CoV-2 test positive
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: COVID-19-positive
CDC Split Type: vsafe

Write-up: The next morning after the vaccine I had a sore throat and nasal congestion. 1/2 Chest pains developed with prompted me to get a COVID test and on 1/2 I tested positive to COVID-19.


VAERS ID: 2020913 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-26
Onset:2021-12-29
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 3 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Chills, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Guillain-Barre syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: chills, congestion, weakness + COVID test


VAERS ID: 2020923 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-07
Onset:2021-12-29
   Days after vaccination:205
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Myalgia, Pyrexia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (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), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: fever, cough, myalgias + COVID test


VAERS ID: 2020941 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-12-28
Onset:2021-12-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Pain, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (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: Second dose on 04/14/2021 experienced body aches and headache
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Full body aches, full body chills (no fever), heart palpitations


VAERS ID: 2021035 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-09
Onset:2021-12-29
   Days after vaccination:264
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / UNK - / -

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

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

Write-up: Covid positive contact unknown


VAERS ID: 2021159 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-25
Onset:2021-12-29
   Days after vaccination:218
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / UNK - / -

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

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

Write-up: Covid positive contact through nursing home


VAERS ID: 2021165 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-12-27
Onset:2021-12-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D, Allegra, Omeprazole, Tadalafil, Kenalog cream
Current Illness: none
Preexisting Conditions: Barrett''s esophagus, GERD, Vitamin D deficiency, osteoarthritis, carpal tunnel
Allergies: environmental allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: swelling of left arm pit


VAERS ID: 2021247 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-12-28
Onset:2021-12-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Chest X-ray, Chills, Injection site pain, Pain, Pulmonary pain
SMQs:, Retroperitoneal fibrosis (broad), 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: Had Jansen Covid vaccine May 2021 ran fever 12 hours
Other Medications: B complex
Current Illness: None
Preexisting Conditions: Shingles in Jan 2021 after contracting COVID in Dec 2020. Mild case of shingles no major breakout-had extreme nerve sensitivity
Allergies: Zithromax
Diagnostic Lab Data: Had lung x-ray on 1/4/22
CDC Split Type:

Write-up: Chills Sever pain in upper right back/lung Pain in right arm at injection site causing pain in raising shoulder


VAERS ID: 2021267 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-21
Onset:2021-12-29
   Days after vaccination:342
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Condition aggravated, Cough, Diarrhoea, Nausea, Pyrexia, SARS-CoV-2 test positive, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acyclovir, Amlodipine, ASA, Eliquis, Enalapril, Invokana
Current Illness: Syncope, Shingles
Preexisting Conditions: HTN, Hyperlipidemia, DM, HX TIA, Neuropathy
Allergies: No known allergies
Diagnostic Lab Data: 12/29/2021 SARS COV2 COVID 19 PCR--POSITIVE. 12/31/2021 SARS COV2 COVID 19 PCR--DETECTED.
CDC Split Type:

Write-up: 12/29/2021- History of Present Illness: The patient presents with episode of syncope during physical therapy at the house PTA. Daughter denies patient hitting her head or trauma. Patient had vomiting and diarrhea. Yesterday patient was doing OK with no vomiting or diarrhea. Patient has had a dry cough starting today. Patient got COVID test for the cough for which she sometimes has. Patient had no fever at home. Per EMS: BP 62/38, 100.4 F, 1200 mL saline given. Patient says she is now feeling fine. Associated symptoms: nausea, vomiting, fever, denies chest pain, denies abdominal pain, denies headache, denies dizziness and denies back pain.


VAERS ID: 2021415 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: No adverse event, Underdose
SMQs:, Medication errors (broad)

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

Write-up: Patient should have received Pfizer 12+ vaccine. RN miscalculated his birthday and patient received a 5-11 Pfizer vaccine. Mother notified that when the patient returns for his second dose he is to receive Pfizer 12+vaccine. Mother was agreeable to plan. Patient had no reported side effects while being observed or since receiving vaccine.


VAERS ID: 2021431 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-12-04
Onset:2021-12-29
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045J2179 / 3 LA / SYR

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

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

Write-up: Shingles above the left eye. Had to take 2 ibuprofen 600mg a day until recently where I take only one or none depending on how bad the pain is. Very itchy and painful, appeared about 2 weeks after my vaccine. It was random and at first I thought it was nothing until it got so bad I had to call my doctor virtually until she confirmed it was shingles.


VAERS ID: 2021596 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-12-15
Onset:2021-12-29
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 070H21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Atrial fibrillation, Chest X-ray normal, Electrocardiogram abnormal, Laboratory test normal, Palpitations, Sinus tachycardia
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Cardiomyopathy (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Dextroamphetamine, Coffee, Multivitamin, Vitamin-B Complex, Magnesium bisglycinate, Fish oil, N-acetylcysteine
Current Illness: None
Preexisting Conditions: None
Allergies: Strattera
Diagnostic Lab Data: 12-lead EKG, chest X-ray and labs drawn. Labs normal, X-ray normal and the EKG revealed what I detailed in the prior answer.
CDC Split Type:

Write-up: Heart palpitations. Went to ER, and found to be in atrial fibrillation with RVR. I had to get a calcium-channel blocker to break rhythm to sinus tachycardia. Beta-blocker to convert the sinus tachycardia to normal sinus rhythm.


VAERS ID: 2024027 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Illinois  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213D21A / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20220112343

Write-up: This spontaneous report received from a health care professional concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 213D21A expiry: 01-JUN-2022) dose was not reported, administered on right deltoid on 29-DEC-2021 for prophylactic vaccination. No concomitant medications were reported. On 29-DEC-2021, the patient experienced vaccine given 12-24 hours after the 6 hour window was still good (incorrectly stored vaccine administered), out of specification product use, and off label use. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the vaccine given 12-24 hours after the 6 hour window was still good (incorrectly stored vaccine administered), out of specification product use and off label use was not reported. This report was non-serious.


VAERS ID: 2024348 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-19
Onset:2021-12-29
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2022-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Diarrhoea, Headache, Migraine, Nausea, Oropharyngeal pain, Pain in extremity, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20224

Write-up: Diarrhea; Headache/ it was really bad, she couldn''t get rid of the headache; Nauseated; Vomit; coughing; sore throat; Next day she had migraine; Sore arm; This spontaneous case was reported by a consumer and describes the occurrence of MIGRAINE (Next day she had migraine), COUGH (coughing), OROPHARYNGEAL PAIN (sore throat), PAIN IN EXTREMITY (Sore arm) and DIARRHOEA (Diarrhea) in a 61-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 037C21A and 037C21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 19-May-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 21-Jun-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 29-Dec-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 29-Dec-2021, the patient experienced PAIN IN EXTREMITY (Sore arm). On 30-Dec-2021, the patient experienced MIGRAINE (Next day she had migraine). On an unknown date, the patient experienced COUGH (coughing), OROPHARYNGEAL PAIN (sore throat), DIARRHOEA (Diarrhea), HEADACHE (Headache/ it was really bad, she couldn''t get rid of the headache), NAUSEA (Nauseated) and VOMITING (Vomit). The patient was treated with PARACETAMOL (TYLENOL [PARACETAMOL]) for Adverse event, at an unspecified dose and frequency. At the time of the report, MIGRAINE (Next day she had migraine), COUGH (coughing), OROPHARYNGEAL PAIN (sore throat), PAIN IN EXTREMITY (Sore arm), DIARRHOEA (Diarrhea), NAUSEA (Nauseated) and VOMITING (Vomit) outcome was unknown and HEADACHE (Headache/ it was really bad, she couldn''t get rid of the headache) had not resolved. No Concomitant drug reported. The first day after the booster it was normal. Then she had a headache and the next day she had migraine, she was nauseated, vomit, diarrhea. She took her migraine pill, it kind of helped her. The next day she felt much better and has been working since. Sometimes she would get a light headache but it did not get worse until 05 Jan 2022, it was really bad, she couldn''t get rid of the headache, she took Tylenol and ended up having migraine medication again.


VAERS ID: 2024373 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-10-08
Onset:2021-12-29
   Days after vaccination:82
Submitted: 0000-00-00
Entered: 2022-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bell's palsy, SARS-CoV-2 test
SMQs:, Hearing impairment (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: VYVANSE; TRILEPTAL; DOXEPIN; EUTHYROX; PAXIL [PIROXICAM]
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Thyroid disorder; Von Willebrand''s disease
Allergies:
Diagnostic Lab Data: Test Date: 20211230; Test Name: Rapid Covid test; Test Result: Negative ; Comments: Nasal Swab
CDC Split Type: USPFIZER INC202200009698

Write-up: Sudden Bell''s palsy to the right side of my face; This is a spontaneous report received from contactable reporter(s) (Consumer or other non HCP). The reporter is the patient. A 32 year-old female patient (not pregnant) received bnt162b2 (BNT162B2), administered in arm left, administration date 08Oct2021 (Lot number: Ff2590) at the age of 32 years as dose 2, single for covid-19 immunisation. Relevant medical history included: "Von willebrands disease" (unspecified if ongoing); "thyroid disease" (unspecified if ongoing). Concomitant medication(s) included: VYVANSE; TRILEPTAL; DOXEPIN; EUTHYROX; PAXIL [PIROXICAM]. Vaccination history included: Bnt162b2 (Dose Number: 1, Batch/Lot No: Fd8448, Location of injection: Arm Left), administration date: 11Sep2021, when the patient was 31 years old, for Covid-19 immunization. The following information was reported: BELL''S PALSY (disability, medically significant) with onset 29Dec2021, outcome "recovering", described as "Sudden Bell''s palsy to the right side of my face". The event "sudden bell''s palsy to the right side of my face" was evaluated at the emergency room visit. The patient underwent the following laboratory tests and procedures: sars-cov-2 test: (30Dec2021) negative, notes: Nasal Swab. Therapeutic measures were taken as a result of bell''s palsy. Patient did not receive other vaccine in four-weeks. AE treatment medication included Antibiotics, steroids, medications. Patient did not have covid prior vaccination. No Known allergies.


VAERS ID: 2024536 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Angioedema, Back pain, Headache, Nausea, Pain
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Retroperitoneal fibrosis (broad), Oropharyngeal allergic conditions (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D; Prenatal; Zinc; Iberogast; Ginger extract; Neem; NAC; Monolaurin; Allicin
Current Illness:
Preexisting Conditions:
Allergies: Opioids; Doxycycline
Diagnostic Lab Data:
CDC Split Type:

Write-up: Reaction to Booster. Within 3-4 hours: Headache, nausea, severe body aches (especially in back). $g100 F fever off and on for the next 3 days. Morning after booster, woke with significant angioedema of lips and left eye.


VAERS ID: 2024660 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-27
Onset:2021-12-29
   Days after vaccination:216
Submitted: 0000-00-00
Entered: 2022-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood culture negative, COVID-19, Chronic obstructive pulmonary disease, Condition aggravated, Dialysis, Dyspnoea, Hypothermia, Leukopenia, Neutropenia, Oxygen saturation decreased, SARS-CoV-2 test positive
SMQs:, Acute renal failure (narrow), Anaphylactic reaction (broad), Agranulocytosis (broad), Haematopoietic leukopenia (narrow), Systemic lupus erythematosus (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (broad), Cardiomyopathy (broad), Chronic kidney disease (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amLODIPine (NORVASC) 5 MG tablet aspirin 81 MG enteric coated tablet Lactobacillus (PROBIOTIC ACIDOPHILUS) CAPS metoprolol succinate-XL (TOPROL-XL) 50 MG 24 hr tablet midodrine (PROAMATINE) 5 MG tablet Misc. Devices MISC Respiratory Therapy
Current Illness:
Preexisting Conditions: OSA (obstructive sleep apnea) Chronic obstructive pulmonary disease, unspecified COPD type Permanent atrial fibrillation Tachy-brady syndrome Presence of Watchman left atrial appendage closure device Essential hypertension Sigmoid diverticulosis Stage 5 chronic kidney disease on chronic dialysis Current smoker Status post placement of cardiac pacemaker
Allergies: Adhesive bandages Allopurinol Ace Inhibitors
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized 12/29/2021; COVID-19 positive 12/29/2021; fully vaccinated BRIEF OVERVIEW: Discharge Provider: MD Primary Care Provider: PA-C Admission Date: 12/29/2021 Discharge Date: Jan 7, 2022 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: COPD exacerbation [J44.1] COVID [U07.1] HOSPITAL COURSE: Patient is a 79 y.o. female with pmhx of tobacco use, COPD not on oxygen at baseline, afib s/p watchman, SSS s/p DCPPM, ESRD on peritoneal dialysis, OSA, frequent falls, and diverticulosis who presented with a chief complaint of SOB from senior living. During her stay, she became leukopenic, neutropenic and developed hypothermia, otherwise hemodynamically stable and on room air. Precautions taken and started on cefepime. Warming device used to maintain normothermia. Blood cultures remained negative at 48 hours and once 24 hours with normothermia without warming device, antibiotics were discontinued. Neutropenia resolved. She was treated for a COPD exacerbation, suspected related to COVID, she did not require oxygen. She had an episode of desat to 87% in the ED but recoved without oxygen. She was treated with steroids, switched from prednisone to decadron in light of COVID infection. She was previously vaccinated with two doses of Moderna. She persistently refused chemical DVT prophylaxis due to history of GI bleed. She accepted risk of PE. Hematology performed dialysis on patient while at the hospital. She was medically stable for discharge, but due to Covid protocols, was not able to obtain transportation from her facility to her dialysis clinic. Thus she remained in hospital until 1/7/22 and discharged back to her facility with nursing, PT and OT home health care.


VAERS ID: 2024944 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-12-27
Onset:2021-12-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2022-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 070HZIH / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest X-ray, Deep vein thrombosis, Differential white blood cell count, Echocardiogram, Full blood count, Metabolic function test
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/a
Current Illness: N/a
Preexisting Conditions: N/a
Allergies: N/a
Diagnostic Lab Data: Basic Metabolic Panel (Abnormal) - Blood/Venous- 1/04/2022 CBC and Differential (Abnormal) - Blood/Venous - 1/04/2022 X-ray Chest - Impression - no active disease in chest - 01/04/2022 US Venous Arm, LU Extremity - Impression- extensive left upper extremity thrombus predominantly involving the subclavican, axillary, and to lesser extent involving the brachial vein within the upper left extremity Clinical Indication - Left upper extremity redness and swelling since 12/29. Covid posterior on the left on 12/27 Comment - Duplex/color Doppler evaluation of the deep venous system of left upper extremity performed Left Internal Jugular Vein - Normal compression Left innominate vein - Patent by color Doppler Subclavian Vein - noncompressible with heterogenous thrombus within the left subclavian vein predominantly involving the proximal to mid vessel Axillary Vein - occluded Brachial Vein - one of the brachial veins is occluded however the other vein appears patent distally. The cephalon vein appears partially patent. The basilic vein is occluded
CDC Split Type:

Write-up: Developed Upper Extremity Deep Vein Thrombosis in Left Arm


VAERS ID: 2025053 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Product storage error
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: PREVIDENT 5000 BOOSTER PLUS 1.1 % PSTE conjugated estrogens (PREMARIN) vaginal cream metoprolol succinate-XL (TOPROL XL) 25 MG 24 hr tablet mupirocin (BACTROBAN) 2 % ointment
Current Illness: Osteopenia Postablative hypothyroidism
Preexisting Conditions: Osteopenia Postablative hypothyroidism
Allergies: Cephalosporins-Skin Rashes/Hives Environmental-Sneezing Penicillins-Other Sulfa Drugs-Skin Rashes/Hives Bee Venom- Swelling
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received expired dose of vaccine after it was first drawn


VAERS ID: 2025173 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067H21A / 2 LA / IM

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

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

Write-up: Client was given his second Moderna too early. 1st dose was 12/07/2021.


VAERS ID: 2025182 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Electrocardiogram normal
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: C/O lightheadedness and dizziness. Skin moist and clammy. Client stated he had similar reaction to dose #1 and dose #2 of COVID-19 (Pfizer) vaccines. Medics on site evaluated client. Client has hx of anxiety and stated he didn''t take his medication for this condition today. Client evaluated and released by medics.O2 Sat 100% on room air, B/P 130/90 and Pulse 57.


VAERS ID: 2025337 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-12-28
Onset:2021-12-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041J21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Chest pain, Dyspnoea, Dyspnoea exertional, Eye pain, Fatigue, Headache, Loss of consciousness, Myalgia, Pulmonary pain
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Second COVID 19 MODERNA DOSE LOT #022M20A (03/03/2021)
Other Medications: No prescriptions
Current Illness: none
Preexisting Conditions: None
Allergies: Allergies to weather and thats it
Diagnostic Lab Data: STILL GOING THROUGH THEM. CARDIOLOGIST TO BE VISITED TOMORROW GETTING BETTER NOW
CDC Split Type:

Write-up: CHEST PAIN SHORT BREATH LUNGS HURT MUSCLE ACHES EXTREME TIREDENESS HEADACHE EYES ACHE LOWER BACK ACHE COUNDT SPEAK WITHOUT BEING TIRED PASSED OUT OTHERS THIS LASTED FROM 10-12 DAYS


VAERS ID: 2025439 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-12-28
Onset:2021-12-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3313081A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Arthritis, Back pain, Contusion, Heavy menstrual bleeding, Menstruation irregular, Tenderness
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Accidents and injuries (narrow), Fertility disorders (broad), Arthritis (narrow), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Jaw and rough of mouth felt bruised, hip pain, lower back pain, ovaries and uterus felt bruised, left arm shoulder felt very tender and bruised, left hand felt arthritic and bruised, and it was hard to open and shut, left foot, ball of foot, felt bruised, could see bruise. Period started suddenly, heavy bleeding, came out in clots, soaked pads, period lasted longer than usual, 9 days.


VAERS ID: 2025943 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-12-20
Onset:2021-12-29
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2022-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test normal, Chest X-ray, Chest pain, Dizziness, Dyspnoea, Electrocardiogram, Fatigue, Fibrin D dimer, Full blood count, Headache, Heart rate abnormal, Human chorionic gonadotropin, Hypertension, Influenza virus test, Metabolic function test, Musculoskeletal pain, Nausea, Pain, Palpitations, Respiratory syncytial virus test, SARS-CoV-2 test negative, Troponin, Urine analysis, X-ray
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Tramadol, Savella, Metoprolol, Lunesta
Current Illness: Fibromyalgia
Preexisting Conditions: Fibromyalgia
Allergies: N/A
Diagnostic Lab Data: 1/7/22 Chest X-Ray, CBC, Troponin, D-Dimer, Urine Analysis, CMP, HCG, Covid/Flu/RSV, and EKG. 1L IV fluids.
CDC Split Type:

Write-up: 12/20/21 got the first dose. 12/29/21 started having chest pain, shortness of breath, pain radiating between shoulder blades, heart rate was bouncing between low 40''s and upper 180''s, headaches, dizziness, and nausea. 12/31/21 contacted cardiologist due to persistent symptoms and was told to take a Covid test, negative. 1/3/22 contacted cardiologist again due to symptoms not resolving, was told to monitor at home. 1/7/22 cardiologist advised to call PCP to start a work up for a clot. PCP then advised I go to the ER. Went to the ER and was started on IV fluids, had blood work drawn, urine analysis, EKG and an X-Ray. They stated the blood work did not indicate a clot and I was discharged home. 1/10/22 I contacted PCP again for continued chest pain, shortness of breath, exhaustion, racing heart rate, high blood pressure, and pain between my shoulders. Was advised that this may be indicative of a vaccine reaction but he was unsure.


VAERS ID: 2027721 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33030910 / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acarodermatitis, Condition aggravated, Dry skin, Electrocardiogram normal, Haemorrhage, Headache, Infection, Neck pain, Pain, Pain in extremity, Pericardial effusion, Pruritus, Rash, Scar, Skin exfoliation, Skin irritation
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Azithromycin 250 mg tablet
Current Illness:
Preexisting Conditions: pericardial effusion; no smoking, no alcohol use
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: I had a COVID-19 vaccine (Pfizer, first dose) on December 29th. Felt pain in the left arm next day, very strong pain in my neck, and a Strong headacke that would not stop and worsened since I started antibiotic treatment. I am currently on antibiotic treatment Azithromycin tablets, 250 mg. I also had scabies/other parasite infection that was ongoing for a year since last January. It never stopped. Ivermectin and permethrin did not work;they did not eliminate the infestation. My skin is very irritated and itchy. I continue to have scars, eruptions, with blood or fluid. Very dry skin that is sererily flaking. I may have a nurve damage due to drugs I was prescribed by different Doctors. I also have a pericardial effusion: never was treated for it. I did not see a cardiologist as I was not reffered by thr PCP and NP. I had two recent electrocardiograms;according to doctors they were normal. I saw a NP recently on 01/06/2022. I am still in pain and have a fever. I need your help!


VAERS ID: 2027178 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-12-27
Onset:2021-12-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041J21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Erythema, Fatigue, Myalgia, Rash
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20224

Write-up: face getting red; little red rash on his face that started to grow; tiredness; sore arm; This spontaneous case was reported by a non-health professional and describes the occurrence of ERYTHEMA (face getting red), RASH (little red rash on his face that started to grow), FATIGUE (tiredness) and MYALGIA (sore arm) in a 48-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 041j21a) for COVID-19 vaccination. No Medical History information was reported. On 27-Dec-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 29-Dec-2021, the patient experienced ERYTHEMA (face getting red), RASH (little red rash on his face that started to grow), FATIGUE (tiredness) and MYALGIA (sore arm). At the time of the report, ERYTHEMA (face getting red), RASH (little red rash on his face that started to grow), FATIGUE (tiredness) and MYALGIA (sore arm) had not resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant Medication was reported as none. Treatment information was reported as none.


VAERS ID: 2027417 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-12-29
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20211229; Test Name: Rapid test; Test Result: Positive
CDC Split Type: USPFIZER INC202101878659

Write-up: positive for Coronavirus; positive for Coronavirus; His wife is still ill; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non-HCP) for a Pfizer sponsored program (159558). A female patient received bnt162b2 (BNT162B2), administration date 2021 (Batch/Lot number: unknown) as dose number unknown, single for covid-19 immunisation. The patient''s relevant medical history and concomitant medications were not reported. The following information was reported: COVID-19 (medically significant), DRUG INEFFECTIVE (medically significant) all with onset 29Dec2021, outcome "unknown" and all described as "positive for Coronavirus"; ILLNESS (non-serious) with onset 2021, outcome "not recovered", described as "His wife is still ill". The patient underwent the following laboratory tests and procedures: sars-cov-2 test: (29Dec2021) positive. Additional information: Reporter (patient''s husband) mentioned that he had an appointment at 12:30 for his second dose and wanted to reschedule it. His wife is still ill, and his wife was exposed to coronavirus. He wants information. His wife took a rapid test this morning and she got results back just now. She is positive for Coronavirus. She had Pfizer COVID vaccine months back. Caller declined to proceed with a report for himself and his wife and states he just wanted to reschedule his appointment. The lot number for bnt162b2 was not provided and will be requested during follow up.


VAERS ID: 2027426 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-20
Onset:2021-12-29
   Days after vaccination:312
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20211229; Test Name: COVID-19; Test Result: Positive ; Comments: she was just diagnosed with COVID
CDC Split Type: USPFIZER INC202101882310

Write-up: She mentioned that she was just diagnosed with COVID yesterday; She mentioned that she was just diagnosed with COVID yesterday; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP) from medical information team. The reporter is the patient. A 54 year-old female patient received bnt162b2 (BNT162B2), administration date 20Feb2021 (Batch/Lot number: unknown) as dose 2, single and administration date 30Jan2021 (Batch/Lot number: unknown) as dose 1, single for covid-19 immunisation. The patient''s relevant medical history and concomitant medications were not reported. The following information was reported: VACCINATION FAILURE (medically significant), COVID-19 (medically significant) all with onset 29Dec2021, outcome "unknown" and all described as "She mentioned that she was just diagnosed with COVID yesterday". The patient underwent the following laboratory tests and procedures: sars-cov-2 test: (29Dec2021) positive, notes: she was just diagnosed with COVID. The lot number for bnt162b2 was not provided and will be requested during follow up.


VAERS ID: 2027441 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-12-29
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Drug ineffective, Immunisation, Interchange of vaccine products, Off label use, SARS-CoV-2 test
SMQs:, Lack of efficacy/effect (narrow), Medication errors (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20211229; Test Name: Covid -19 test; Test Result: Positive
CDC Split Type: USPFIZER INC202101883871

Write-up: she received Moderna initially but did receive the Pfizer booster/ tested positive too last night (29Dec); she received Moderna initially but did receive the Pfizer booster; she received Moderna initially but did receive the Pfizer booster; she received Moderna initially but did receive the Pfizer booster/ tested positive too last night (29Dec); she received Moderna initially but did receive the Pfizer booster/ tested positive too last night (29Dec); This is a spontaneous report received from a contactable reporter(s) (Consumer or other non-HCP). A female patient received bnt162b2 (BNT162B2) (Batch/Lot number: unknown) as dose 3 (booster), single for covid-19 immunisation. The patient''s relevant medical history and concomitant medications were not reported. Vaccination history included: Moderna (she received Moderna initially, DOSE 1), for Covid-19 immunization; Moderna (she received Moderna initially, DOSE 2), for Covid-19 immunization. The following information was reported: IMMUNISATION (medically significant), outcome "unknown", DRUG INEFFECTIVE (medically significant), COVID-19 (medically significant) all with onset 29Dec2021, outcome "unknown" and all described as "she received Moderna initially but did receive the Pfizer booster/ tested positive too last night (29Dec)"; OFF LABEL USE (medically significant), INTERCHANGE OF VACCINE PRODUCTS (non-serious), outcome "unknown" and all described as "she received Moderna initially but did receive the Pfizer booster". The patient underwent the following laboratory tests and procedures: sars-cov-2 test: (29Dec2021) positive. The patient son tested positive for Covid with a home test on 24Dec and his wife had now tested positive too last night that was 29Dec and filling another AE report today (that his wife moderna initially but did received the Pfizer booster). Regarding the report for withheld, the patient intended to file his report within 24 hours but candidly with everything happening in his home and with Christmas holiday it inadvertently slipped. The lot number for bnt162b2 was not provided and will be requested during follow up.


VAERS ID: 2027620 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-12-29
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211D21A / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, Diarrhoea, Haematochezia, Nausea, Pain in extremity
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: The patient had no medical history.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20220113776

Write-up: STOMACH IS HURTING; NAUSEA; DIARRHEA; BLOOD IN STOOL/BLEEDING WITH DEFECATION/POOPING BLOOD FOR THE PAST FEW DAYS; ARM IS HURTING; This spontaneous report received from a patient concerned a 35 year old male. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included: The patient had no medical history. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 211D21A, and expiry: UNKNOWN) 1 total, dose was not reported, administered on 29-DEC-2021 for prophylactic vaccination (Dose number in series 1). No concomitant medications were reported. The patient claimed that his arm hurt after taking the vaccine (29-Dec-2021). Patient experienced some nausea and diarrhea afterwards. On 09-JAN-2022, the patient experienced blood in stool/bleeding with defecation/ pooping blood for the past few days. This prompted him to go to the emergency room. The patient was in perfect health before the vaccine. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from blood in stool/bleeding with defecation/pooping blood for the past few days, and the outcome of nausea, diarrhea, stomach is hurting and arm is hurting was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0 20220113776-COVID-19 VACCINE AD26.COV2.S-blood in stool/bleeding with defecation/pooping blood for the past few days. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).


VAERS ID: 2027644 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-12-29
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Drug ineffective, Immunisation, Interchange of vaccine products, Off label use, SARS-CoV-2 test
SMQs:, Lack of efficacy/effect (narrow), Medication errors (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20211229; Test Name: Covid; Test Result: Positive
CDC Split Type: USPFIZER INC202200016386

Write-up: off label use; Interchange of vaccine products; Despite 2 shots of Moderna +Pfizer booster-last Wednesday I tested positive for Covid; Despite 2 shots of Moderna +Pfizer booster-last Wednesday I tested positive for Covid; Despite 2 shots of Moderna +Pfizer booster-last Wednesday I tested positive for Covid; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP). A male patient received bnt162b2 (BNT162B2) (Batch/Lot number: unknown) as dose 3 (booster), single for covid-19 immunisation. The patient''s relevant medical history and concomitant medications were not reported. Vaccination history included: Moderna covid-19 vaccine (Dose: 1), for COVID-19 immunization; Moderna covid-19 vaccine (Dose: 2), for COVID-19 immunization. The following information was reported: OFF LABEL USE (medically significant), outcome "unknown", described as "off label use"; INTERCHANGE OF VACCINE PRODUCTS (medically significant), outcome "unknown", described as "Interchange of vaccine products"; IMMUNISATION (medically significant), outcome "unknown", DRUG INEFFECTIVE (medically significant), COVID-19 (medically significant) all with onset 29Dec2021, outcome "unknown" and all described as "Despite 2 shots of Moderna +Pfizer booster-last Wednesday I tested positive for Covid". The patient underwent the following laboratory tests and procedures: sars-cov-2 test: (29Dec2021) positive. Additional information: The symptoms were minimal-mostly scratchy throat that disappeared in hours-never any fever or loss of taste. The patient was isolating and wearing mask and thankfully neither wife nor daughter was positive. The lot number for bnt162b2 was not provided and will be requested during follow up.


VAERS ID: 2027653 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1611 / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chest discomfort, Lymph node pain, Lymphadenopathy, Musculoskeletal stiffness, Nausea, Pain, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None.
Allergies:
Diagnostic Lab Data: Test Date: 20220103; Test Name: SARS-COV-2 Test; Test Result: Negative ; Comments: Nasal Swab.
CDC Split Type: USPFIZER INC202200019693

Write-up: This Tuesday (6 days after getting the shot) the pain between "my" shoulder blades came back and the lymph node on the right side of "my" neck became tender and swollen and is still tender and swollen today. This Tuesday (6 days after getting the shot) the pain between "my" shoulder blades came back and the lymph node on the right side of "my" neck became tender and swollen and is still tender and swollen today.; The next day "I" still felt nauseous, felt stiff/achy, "my" chest felt tight and had a sharp pain between "my" shoulder blades on the right side. Those went away within 2 days.; The next day "I" still felt nauseous, felt stiff/achy, "my" chest felt tight and had a sharp pain between "my" shoulder blades on the right side. Those went away within 2 days.; The next day "I" still felt nauseous, felt stiff/achy, "my" chest felt tight and had a sharp pain between "my" shoulder blades on the right side. Those went away within 2 days.; The next day "I" still felt nauseous, felt stiff/achy, "my" chest felt tight and had a sharp pain between "my" shoulder blades on the right side. Those went away within 2 days.; Immediately after the shot "I" felt nauseous. The next day "I" still felt nauseous.; This is a spontaneous report from a contactable reporter (consumer or other non-HCP). The reporter is the patient. A 53-year-old female patient (not pregnant) received bnt162b2 (BNT162B2), administered in arm right, administration date 29Dec2021 at 12:00 (Lot number: FJ1611) at the age of 53 years as dose 1, single for COVID-19 immunisation. The patient''s relevant medical history and concomitant medications were not reported.The following information was reported: NAUSEA (non-serious) with onset 29Dec2021, outcome "recovered" (31Dec2021), described as "Immediately after the shot "I" felt nauseous. The next day "I" still felt nauseous"; MUSCULOSKELETAL STIFFNESS (non-serious), PAIN (non-serious), CHEST DISCOMFORT (non-serious) all with onset 30Dec2021, outcome "recovered", and all described as "The next day "I" still felt nauseous, felt stiff/achy, "my" chest felt tight and had a sharp pain between "my" shoulder blades on the right side. Those went away within 2 days"; ARTHRALGIA (non-serious) with onset 30Dec2021, outcome "unknown", described as "The next day "I" still felt nauseous, felt stiff/achy, "my" chest felt tight and had a sharp pain between "my" shoulder blades on the right side. Those went away within 2 days"; LYMPH NODE PAIN (non-serious), LYMPHADENOPATHY (non-serious) all with onset 04Jan2022, outcome "not recovered", and all described as "This Tuesday (6 days after getting the shot) the pain between "my" shoulder blades came back and the lymph node on the right side of "my" neck became tender and swollen and is still tender and swollen today". Relevant laboratory tests and procedures are available in the appropriate section. Therapeutic measures were not taken as a result of nausea, musculoskeletal stiffness, pain, chest discomfort, arthralgia, lymph node pain and lymphadenopathy.Additional information: It was unknown whether the patient had any known allergies. Prior to vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within 4 weeks prior to the vaccination. Since the vaccination, the patient had been tested for COVID-19. The events did not result in doctor or other healthcare professional office/clinic visit, emergency.


VAERS ID: 2027910 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-26
Onset:2021-12-29
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Vaccination site pain
SMQs:

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

Write-up: A continuing stinging pain in my arm at the vaccination spot.


VAERS ID: 2027932 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001J212A / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

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

Write-up: Patient reports having chest pain and involuntary tremors. Evaluation is carried out S/V. Patient is well oriented at this time of place and herself/person. A consultation with Doctor is made, which indicates that she remains under observation then contacted the ambulance to transport the patient to the nearest hospital. After evaluation of the ambulance staff. Vital signs are reassessed and an EKG is performed.


VAERS ID: 2028082 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Diarrhoea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: She experienced fever, vomiting and diarrhea.


VAERS ID: 2028312 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-12-28
Onset:2021-12-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA ER8735 / 3 LA / SC

Administered by: Private       Purchased by: ?
Symptoms: Chills, Fatigue, 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: Synthroid, lipitor, meloxicab
Current Illness: none
Preexisting Conditions: none
Allergies: paxil, levaquin, tape, codiene
Diagnostic Lab Data:
CDC Split Type:

Write-up: High fever, chills, fatigue, severe muscle aches


VAERS ID: 2028375 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-10-14
Onset:2021-12-29
   Days after vaccination:76
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest X-ray, Cough, Discharge, Fatigue, Oropharyngeal pain, SARS-CoV-2 test positive, Throat clearing
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pravastatin, Valsartan, Omeprazole, Sildenafil.
Current Illness: None
Preexisting Conditions: Hypertension
Allergies: Lisinopril
Diagnostic Lab Data: Covid (12/30/21), Chest X-ray (01/7/22)
CDC Split Type: vsafe

Write-up: 12/29/2021 my Covid-19 symptoms started with sore throat, drainage, and cough. I did a virtual visit with the NP to get tested and on 12/30/21 I did a test that was positive. I did another virtual visit for increasing cough and drainage on 01/07/22 and they also did a chest x-ray and I received an albuterol inhaler and was instructed to continue taking the over the counter medications such as the Sudafed and Fluphenazine. Right now I just have fatigue and a slight cough, but the cough is not nearly as bad and is more like a clear my throat kind of cough.


VAERS ID: 2028380 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 2 LA / IM

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

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

Write-up: Patient received vaccine after beyond use date of 12/22/21.


VAERS ID: 2028398 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 LA / IM

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

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

Write-up: Patient received vaccine after beyond use date of 12/22/21.


VAERS ID: 2028405 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 RA / IM

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

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

Write-up: Patient received vaccine after beyond use date of 12/22/21.


VAERS ID: 2028409 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 RA / IM

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

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

Write-up: Patient received vaccine after beyond use date of 12/22/21.


VAERS ID: 2028417 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 LA / IM

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

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

Write-up: Patient received vaccine after beyond use date of 12/22/21.


VAERS ID: 2028421 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 RA / IM

Administered by: Other       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: Patient received vaccine after beyond use date of 12/22/21.


VAERS ID: 2028428 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 RA / IM

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

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

Write-up: Patient received vaccine after beyond use date of 12/22/21.


VAERS ID: 2028434 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 LA / IM

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

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

Write-up: Patient received vaccine after beyond use date of 12/22/21.


VAERS ID: 2028442 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 LA / IM

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

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

Write-up: Patient received vaccine after beyond use date of 12/22/21.


VAERS ID: 2028447 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 RA / IM

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

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

Write-up: Patient received vaccine after beyond use date of 12/22/21.


VAERS ID: 2028450 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 RA / IM

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

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

Write-up: Patient received vaccine after beyond use date of 12/22/21.


VAERS ID: 2028452 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 LA / IM

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

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

Write-up: Patient received vaccine after beyond use date of 12/22/21.


VAERS ID: 2028455 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 RA / IM

Administered by: Other       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: Patient received vaccine after beyond use date of 12/22/21.


VAERS ID: 2028462 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 RA / IM

Administered by: Other       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: Patient received vaccine after beyond use date of 12/22/21.


VAERS ID: 2028467 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 LA / IM

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

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

Write-up: Patient received vaccine after beyond use date of 12/22/21.


VAERS ID: 2028472 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 LA / IM

Administered by: Other       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: Patient received vaccine after beyond use date of 12/22/21.


VAERS ID: 2028476 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 RA / IM

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

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

Write-up: Patient received vaccine after beyond use date of 12/22/21.


VAERS ID: 2028487 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 LA / IM

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

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

Write-up: Patient received vaccine after beyond use date of 12/22/21.


VAERS ID: 2028493 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 LA / IM

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

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

Write-up: Patient received vaccine after beyond use date of 12/22/21.


VAERS ID: 2028502 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 LA / IM

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

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

Write-up: Patient received vaccine after beyond use date of 12/22/21.


VAERS ID: 2028509 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 LA / IM

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

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

Write-up: Patient received vaccine after beyond use date of 12/22/21.


VAERS ID: 2028510 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-12-26
Onset:2021-12-29
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Erythema, Palpitations, Peripheral swelling, Supraventricular tachycardia, Tachycardia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

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

Write-up: Tachycardia. Patient had SVT prior to. She underwent ablation had had resolution of symptoms. 5 days after her procedure she got her second dose and has had tachycardia and racing of the heart since with HR ranging from 50s-13-s. Her hands have been turning red and has to sit down due to feeling dizzy. She also now has swelling in her hands and feet.


VAERS ID: 2028528 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 RA / IM

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

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

Write-up: Patient received vaccine after beyond use date of 12/22/21.


VAERS ID: 2028532 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 LA / IM

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

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

Write-up: Patient received vaccine after beyond use date of 12/22/21.


VAERS ID: 2028534 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 RA / IM

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

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

Write-up: Patient received vaccine after beyond use date of 12/22/21.


VAERS ID: 2028541 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 LA / IM

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

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

Write-up: Patient received vaccine after beyond use date of 12/22/21.


VAERS ID: 2028543 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 LA / IM

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

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

Write-up: Patient received vaccine after beyond-use-date of 12/22/2021.


VAERS ID: 2028545 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 LA / IM

Administered by: Other       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: Patient received vaccine after beyond use date of 12/22/21.


VAERS ID: 2028552 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 RA / IM

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

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

Write-up: Patient received vaccine after beyond use date of 12/22/21.


VAERS ID: 2028555 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 LA / IM

Administered by: Other       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: Patient received vaccine after beyond use date of 12/22/21.


VAERS ID: 2028558 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 RA / IM

Administered by: Other       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: Patient received vaccine after beyond use date of 12/22/21.


VAERS ID: 2028562 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 LA / IM

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

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

Write-up: Patient received vaccine after beyond use date of 12/22/21.


VAERS ID: 2028567 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 RA / IM

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

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

Write-up: Patient received vaccine after beyond use date of 12/22/21.


VAERS ID: 2028570 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 LA / IM

Administered by: Other       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: Patient received vaccine after beyond use date of 12/22/21.


VAERS ID: 2028573 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 RA / IM

Administered by: Other       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: Patient received vaccine after beyond use date of 12/22/21.


VAERS ID: 2028583 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-12-29
Onset:2021-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 RA / IM

Administered by: Other       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: Patient received vaccine after beyond use date of 12/22/21.


VAERS ID: 2028629 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-05
Onset:2021-12-29
   Days after vaccination:238
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, COVID-19, Cough, Myalgia, Respiratory tract congestion, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: HEART DISEASE, CAD, PEYRONIE''S, DIABETES
Allergies: UNKNOWN
Diagnostic Lab Data: POSITIVE COVID PCR TEST
CDC Split Type:

Write-up: HOSPITALIZED BREAKTHROUGH CASE VACCINATED WITH MODERNA ON 4-5-21 AND 5-5-21. SYMPTOMS-COUGH, CONGESTION, BACK PAIN, MUSCLE ACHES.


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