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From the 9/10/2021 release of VAERS data:

Found 686,636 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 124 out of 6,867

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VAERS ID: 1577656 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939676 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Nausea, Syncope, Unresponsive to stimuli, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Fainting / Unresponsive-Mild, Systemic: Nausea-Mild, Systemic: Vomiting-Mild


VAERS ID: 1577658 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Hypotension
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Hypotension-Medium, Additional Details: Pt started feeling lightheaded and dizzy 3 mins post injection. He has a phobia of needles and this happens each time he gets a vaccine or blood drawn. Pt reported feeling "whoozy and felt like he was going to pass out". I had the patient put his head between his legs and took his vitals Q5mins until he stablized. He remained seated in the post vaccine area for 30 mins until his vitals were normal and he felt fine to go home! Vitals @ 4:05 pm BP: 79/56 mmHg, HR 156 bpm, O2 98%


VAERS ID: 1577659 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / IM

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

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

Write-up: Error: Incorrect Reconstitution-


VAERS ID: 1577841 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-07
Onset:2021-08-16
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, Decreased appetite, Diarrhoea, Fall, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented to the ED on 8/16/21 for a 5 day history of nonproductive cough and anorexia. Over the past two days he developed fevers, generalized weakness and non-bloody diarrhea. Had two falls prior to hospital admission due to weakness. No prior COVID-19 infections but tested positive upon arrival to the hospital. COVID-19 vaccination received July 7, 2021. Not requiring oxygen at time of admission, saturations $g94%.


VAERS ID: 1577848 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Hypoaesthesia oral
SMQs:, Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

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

Write-up: SHORTLY AFTER THE ALLOTTED 15 MIN OBSERVATION TIME, I LEFT PHARMACY TO GO HOME AND BEGAN HAVING A FEELING OF NUMBNESS IN MY UPPER LIP AND NOSE AREA. THIS CONTINUED THROUGHOUT THE EVENING AND EVEN STILL TODAY THE LOWER PORTION OF ONE NOSTRIL STILL FEELS NUMB AS THOUGH I HAVE BEEN THROUGH A DENTAL PROCEDURE (WHICH I HAVE NOT) THERE ARE NO OTHER SYMPTOMS EXPERIENCED OR ISSUES WITH BREATHING, ETC. I''M NOT OVERLY CONCERNED BUT WANTED TO REPORT THIS REGARDLESS.


VAERS ID: 1577850 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-07
Onset:2021-08-16
   Days after vaccination:131
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: 8/16/21 COVID-19/SARS-COV2, NAAT POSITIVE
CDC Split Type:

Write-up: COVID 19 positive $g14 days post vaccine completion.


VAERS ID: 1577861 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-07-27
Onset:2021-08-16
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Dysstasia, Fall, Joint injury, Pain, SARS-CoV-2 test positive, Somnolence, Speech disorder
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), 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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: He comes to the hospital today after sustaining a fall. Information from the ER physician is that the patient states he was getting out of bed, slipped onto his left hip and was unable to stand up again secondary to the pain and was on the floor for a prolonged amount of time. Eventually EMS was called and brought the patient to the emergency department. He is a very poor historian when I evaluated him in the emergency department. In fact he was fairly somnolent, he did have some morphine earlier. He would open his eyes but just mumbled answers to my questions. He was able to tell me who he was, where he was, and what year it was, and that he hurt his left hip but other than that he was really not able to give any other information with regards to his HPI. I told him that he was positive for Covid, asked him if he had any respiratory symptoms and he denied. I asked him if he knew how he contracted it and he shook his head no.


VAERS ID: 1577865 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-18
Onset:2021-08-16
   Days after vaccination:90
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ASA Lipitor Buspar Calcium with D COreg Digoxin docusate Aricept ferrous sulfate levothyroxine Linzess lisinopril meclizine MVI potassium primodine sertraline torsemide warfarin
Current Illness: unknown other then chronic conditions
Preexisting Conditions: A Fib CHF HTP COPD CAD h/o DVT
Allergies: cephalosporins (Rash) Ciprofloxacin (Rash) Gatifloxacin (Rash) Levofloxacin (Rash) Morphine (Rash) adhesive tape (Rash)
Diagnostic Lab Data: + covid test 8/16/2021
CDC Split Type:

Write-up: Patient vaccinated in 5/2021 and then developed + covid test and symptoms requiring admission to hospital 8/16/2021


VAERS ID: 1577867 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 2 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Abdominal pain, Dysgeusia, Headache, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Taste and smell disorders (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Patient pretreated with diphenhydramine. Patient expressed nausea and abdominal cramping along with need to vomit. Cramping and nausea subsided by 09:29am. Patient treated with diphenhydramine 25mg/10ml cup. Patient ate package of graham crackers to subside nausea. Expressed metallic taste in mouth. Patient notes GI side effects have subsided but now has headache at 9:33am- pain at a 5 on a scale of 1-10 with 10 being worst. Patient monitored until 9:46am with no other noted effects. Patient provided 4x10ml diphenhydramine cups (25mg/10ml, NDC 68084-0024-59, Lot 502935, EXP 02/28/22)upon discharge from clinic


VAERS ID: 1577874 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-15
Onset:2021-08-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

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

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

Write-up: 101.5 fever started at 3am for 24 hours. Also severe body aches and flu like symptoms.


VAERS ID: 1577879 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Janssen Covid-19 Vaccine
Current Illness: None
Preexisting Conditions: None
Allergies: No
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: On 8/16/2021, the patient received Janssen covid-19 vaccination and was advised to wait for 15 minutes. Patient stood up around 4 minutes after vaccination & informed pharmacist that he was having a panic attack. Pharmacist went to assist patient & caught him as he fainted. Pharmacist technician called 9-1-1 immediately & they arrived within 10 minutes of the phone call. The patient was awake & conscious when they arrived & declined EMS care. The patient walked out & left with his girlfriend around approximately 2:35 pm.


VAERS ID: 1577883 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 RA / IM

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

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

Write-up: AFTER GIVE THE VACCINE, PT WAS TOLD TO SIT FOR 15 MINUTES TO WATCH FOR SIDE EFFECTS. AFTER ABOUT 2-3 MINUTES PT GOING TO BATHROOM PASED OUT AND FELL TO FLOOR HITTING BACK OF HEAD. PT WAS AWAKE AND EYES OPEN AS SOON AS RPh GOT TO HER WITHIN A COUPLE OF SECONDS. 911 WAS CALLED ICE PLACED ON BACK OF HEAD OF PT, AND TALKED TO PT TO MAINTAIN ALLERTNESS TILL PAREMETICS GOT THERE. WHEN PAREMETICS ARIVED THEY SAT PT UP, EXAMINED BACK OF HEAD, CHECKED HER TO BE ABLE TO STAND,. SHORTLY AFTER THE PT LEFT STORE WITH MOTHER.


VAERS ID: 1577892 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Patient was given a 3rd dose of Covid-19 vaccine. It should have been Moderna that was given but Pfizer was given in error. Patient was notified immediately. No adverse effects reported. Patient understands and was not worried about the dose of Pfizer that was given.


VAERS ID: 1577915 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heavy menstrual bleeding
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Daily birth control Noreth-ee-fe 1.5-.03MG (21)-75. Ibuprofen at 8pm on Monday 8/16/21 for injection site cramping and pain. I stopped taking prescribed Dextroamphetamine on 8/7/21.
Current Illness: None
Preexisting Conditions: Kidney Stones, irregular menstruations
Allergies: Codeine & anything in it''s family.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Heavy menstrual bleeding outside of normal cycle


VAERS ID: 1577921 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

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

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

Write-up: Approximately 30 to 60 seconds after receiving the vaccine, the patient blacked out, his eyes rolled back and he slumped over in his chair. He was extremely diaphoretic. After a few seconds, he came to and was transported by wheelchair to clinic room table where ice was applied to back of his neck and fan was turned on. EMS was called for evaluation. Pt was not transported, vitals were stable.


VAERS ID: 1577958 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-15
Onset:2021-08-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 2 LA / IM

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

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

Write-up: Pt. states that after receiving the 2nd dose of Moderna 08/15/2021, started experiencing symptoms 08/16/2021 of body aches, joint pain, and a rash throughout the left arm forming overnight 08/16/2021 into 17th. Still continuing to experience the rash, but body aches and joint are subsiding. No noted Primary visit.


VAERS ID: 1577960 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-07
Onset:2021-08-16
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D3 2,000 unit Neurontin 600 mg Methenamine hippurate 1 g Zoloft 100 mg Oravastatin 20 mg Acetaminophen SR 650 mg Calcium carbonate-vitamin D3 600 mg Cranberry 500 mg Cyanocobalamin 500 mcg Diphenhydramine 25 mg Omega 3 Vitron-C 65 m
Current Illness:
Preexisting Conditions: Hyperlipidemia A Fib with RVR Closed fracture of olecranon process of ulna Hypertension GERD Intestinal malabsorption Kidney injury without mention of open wound into cavity Morbid obesity Neuropathy Osteoarthrosis Reactive hypoglycemia Rhabdomyolysis Sleep apnea Type II diabetes
Allergies: Sulfa
Diagnostic Lab Data: Positive for SARS-CoV-2 RNA by PCR Abnormal E Gene Ct cycles 14.5 Comment: Cycle threshold (Ct) values are not comparable between tests and may not be comparable between different lots of the same test. Currently there is no consensus as to whether or not particular Ct values correlate with a person being or not being infectious or risk level for disease severity. So, appropriate care should be taken with interpretation of Ct values. N2 Gene Ct cycles 16.3 Comment: Cycle threshold (Ct) values are not comparable between tests and may not be comparable between different lots of the same test. Currently there is no consensus as to whether or not particular Ct values correlate with a person being or not being infectious or risk level for disease severity. So, appropriate care should be taken with interpretation of Ct values. Resulting Agency Specimen Collected: 08/16/21 18:13 Last Resulted: 08/16/21 19:13
CDC Split Type:

Write-up: Noted to be asymptomatic.


VAERS ID: 1577961 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 3 LA / IM

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

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

Write-up: Pt requested Moderna Vaccine , when asked whether or not this was her first dose pt stated she has not received a Covid vaccination this was stated to the intake worker as well as the vaccinator. Pt ended up receiving a third Covid vaccination of Moderna. When her paperwork was filed it was noticed by a team member that she had already received 2 doses of Pfizer back in December earlier this year.


VAERS ID: 1577962 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-02-10
Onset:2021-08-16
   Days after vaccination:187
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 AR / IM

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

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

Write-up: COVID positive after vaccination


VAERS ID: 1577985 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Nausea, Pain, Pyrexia, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: 9 hours after the shot I got a fever , my body started shaking uncontrollably, my whole body hurt everywhere , I was nauseated and dizzy .


VAERS ID: 1577991 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-18
Onset:2021-08-16
   Days after vaccination:151
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Transient ischaemic attack
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow)

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

Write-up: TIA


VAERS ID: 1578012 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Paraesthesia oral, Sensation of foreign body, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lorazepam, Hydrocodone-acetaminophen, gabapentin, ropinirole, clotrimazole-bethamethasone, meclizine, allegra D, fluticasone propionate, benadryl
Current Illness: knee pain, multiple sclerosis, prediabetes, relapsing remitting multiple sclerosis, vitamin D deficiency
Preexisting Conditions: knee pain, multiple sclerosis, prediabetes, relapsing remitting multiple sclerosis, vitamin D deficiency
Allergies: demerol, povidone-iodine, rebif, shellfish derived
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Pt received second COVID vaccination at 11:01, pt observed for mandatory 15 minutes, after the observation period (around 30 mins after vaccination), pt c/o narrowing of airway, "lump" in throat, and tingling lips. Pt was assessed by physician and nurse. Pt compared her symptoms to her symptoms when she has shellfish (pt has active shellfish allergy). Due to pt sxs not improving, EMS was activated and epinephrine auto injection pen was administered (at 11:40). Vitals were obtained and WNL, pt was a&oX4, airway non-obstructed. EMS arrived to facility around 11:50 and transported pt to local ED. Pt returned to facility later in the day to schedule f/u appt from ED, pt stated sxs resolved prior to leaving ED and was feeling much better.


VAERS ID: 1578037 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 RA / IM

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

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

Write-up: Patient was given the wrong MFG. first Covid vaccine was Moderna, I gave Pfizer as his 2nd vaccine. First vaccine (Moderna) 7/14/21, second vaccine (Pfizer) 8/16/21 Pt was informed of error and instructed that this would be counted as his second dose, would not need a second dose of Moderna. Pt verbalized understanding.


VAERS ID: 1578046 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-15
Onset:2021-08-16
   Days after vaccination:213
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ACETAMINOPHEN (TYLENOL ORAL) atorvastatin (LIPITOR) 20 mg oral tablet levothyroxine (SYNTHROID) 100 mcg oral tablet oxyCODONE, immediate release, (ROXICODONE) 5 mg oral tablet
Current Illness:
Preexisting Conditions: Past Medical History: Diagnosis Date ? Thyroid cancer treated with partial thyroidectomy and iodine ablation Patient Active Problem List Diagnosis Code ? Thyroid cancer? Postoperative hypothyroidism? Painful orthopaedic hardware
Allergies: Patient has no known allergies.
Diagnostic Lab Data: Positive for SARS-CoV-2 RNA by PCR Abnormal E Gene Ct cycles 0.0 Comment: Cycle threshold (Ct) values are not comparable between tests and may not be comparable between different lots of the same test. Currently there is no consensus as to whether or not particular Ct values correlate with a person being or not being infectious or risk level for disease severity. So, appropriate care should be taken with interpretation of Ct values. N2 Gene Ct cycles 44.2 Comment: Cycle threshold (Ct) values are not comparable between tests and may not be comparable between different lots of the same test. Currently there is no consensus as to whether or not particular Ct values correlate with a person being or not being infectious or risk level for disease severity. So, appropriate care should be taken with interpretation of Ct values. Resulting Agency Specimen Collected: 08/16/21 21:00 Last Resulted: 08/16/21 21:59
CDC Split Type:

Write-up: Patient is noted to be asymptomatic.


VAERS ID: 1578063 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Blood test, Cardiac flutter, Chest X-ray, Chest discomfort, Dyspnoea, Electrocardiogram, Hypertension
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (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: ekg chest xray bloodwork
CDC Split Type:

Write-up: shortness of breath, fluttering of the heart, high blood pressure, very weak, chest tightness


VAERS ID: 1578075 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Aphasia, Disorientation, Dyskinesia, Gait inability
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dyskinesia (narrow), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: The evening after getting my second dose, i became disoriented and lost my ability to walk. Had to lay down in the garage as I was unable to make it inside. Was there between 15-30 minutes, (couldn''t tell how long) had problems speaking and had uncontrollable limb movement. It felt like what I would think a seizure or stroke would be like. NO pain, just told my husband i was dying and to call the kids.


VAERS ID: 1578078 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Dysgeusia, Eye irritation, Fatigue, Injection site reaction, Muscle tightness, Neck mass, Ocular hyperaemia, Vulvovaginal burning sensation
SMQs:, Anaphylactic reaction (narrow), Taste and smell disorders (narrow), Dystonia (broad), Glaucoma (broad), Corneal disorders (broad), Sexual dysfunction (broad)

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

Write-up: Metallic taste in mouth after receiving vaccination, in the corner of the eye the skin in crease began to become irritated, eye became pinkish, fatigue, lump on neck on the left side (golf ball size), injection site is tense, warmth feeling in vaginal area, heaviness in chest area.


VAERS ID: 1578080 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-09
Onset:2021-08-16
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Azotaemia, Blood lactic acid, COVID-19, Condition aggravated, Decreased appetite, Electrolyte imbalance, Endotracheal intubation, General physical health deterioration, Hypotension, Intensive care, Leukocytosis, Mechanical ventilation, Mental status changes, Respiratory distress, SARS-CoV-2 test positive, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: 70-year-old female from an assisted facility tested positive today for COVID-19 was brought in by EMS with worsening altered mental status, hypotensive and respiratory distress. The nursing facility stated she has been declining for two weeks, anorexia, bed bound and not participating, but was COVID negative. They test them every 2 days. They reported 2 days of worsening symptoms prior to arrival and a positive COVID-19 (8/16/2021) swab at her facility. Pfizer vaccination dates were 1/19 and 2/9. The patient was intubated immediately on arrival placed on mechanical ventilation and is not requiring sedation. She tested positive for COVID-19 and was found to be in acute renal failure, hypernitremia, leukocytosis, with elevated lactic acid, electrolyte abnormality and elevated troponin. The patient presented to the ICU intubated and on vasopressors. Husband is at home, and the daughter, is listed as the emergency contact and is the first call. She is communicating with husband and sister and will be the person communicating with the critical care team. She states her husband said the patients wishes would be to be a DNR, a partial DNR was completed since the patient is already intubated.


VAERS ID: 1578096 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-02-13
Onset:2021-08-16
   Days after vaccination:184
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Chronic renal failure, stage 3; coronary disease, hypertension, hyperlipidemia
Allergies:
Diagnostic Lab Data: Positive COVID-19 PCR 8/16/2021
CDC Split Type:

Write-up: Hospitalization and Positive COVID test on 8/16/2021


VAERS ID: 1578106 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-01-28
Onset:2021-08-16
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 2 AR / IM

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

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

Write-up: COVID positive after vaccination


VAERS ID: 1578115 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

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

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

Write-up: Felt tingling in left arm minutes after vaccination. Got dizzy and began sweating. Passed out. NP in clinic stated I was out for more than 30 seconds and was having a seizure.


VAERS ID: 1578133 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-10
Onset:2021-08-16
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019B21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan 50 mg daily. Vitamin D 1000 IU daily
Current Illness:
Preexisting Conditions: hypertension, leukocytosis, positive ANA, Vitamin D deficiency; elevated ALT.
Allergies: lisinopril-- cough
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt says she had itching after the vaccine was administered. One week later, 8/16/2021 she had facial redness and facial swelling-- face felt tight; swollen appearance noted by husband around 5 pm.


VAERS ID: 1578152 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Fatigue, nausea, vomiting 4x in 24 hours


VAERS ID: 1578164 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None know.
Current Illness: None know.
Preexisting Conditions: None know.
Allergies: Not known but was seen in clinic for hives in 2019 and reports other past episodes with unknown triggers.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Urticarial rash starting about 6 hours after vaccination, treated with antihistamine and steroid. Mom also notes a mild fever the morning of 8/17/2021.


VAERS ID: 1578166 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E21A / 3 RA / IM

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

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

Write-up: Patient received 1st and 2nd dose of Pfizer at another location. He received 3rd covid vaccine (Moderna).


VAERS ID: 1578181 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-05
Onset:2021-08-16
   Days after vaccination:164
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Bilevel positive airway pressure, COVID-19, Hypoxia, Intensive care
SMQs:, Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Allopurinol, Tadalafil, Zocor, Toprol XL, Metformin, Singulair, Lamisil
Current Illness: none
Preexisting Conditions: HTN, high cholesterol, CABG, diabetes,
Allergies: Sulfa
Diagnostic Lab Data: patient was just admitted yesterday. further testing will be happening.
CDC Split Type:

Write-up: patient received Janssen vaccination in March of 2021. On 8/16/21 he was admitted to our hospital with COVID-19 requiring increasing amount of oxygen. patient is currently is the ICU on bipap with hypoxia.


VAERS ID: 1578192 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-15
Onset:2021-08-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048021A / 3 LA / IM

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

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

Write-up: red itchy rash developed on 8/16/2021 around injection site


VAERS ID: 1578196 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Dysphagia, Erythema, Feeling hot, Interchange of vaccine products, Migraine, Myalgia, Nausea, Peripheral coldness
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Medication errors (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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: Alleric reaction requiring hospitalization. Age 23. Moderna COVID-19 mRNA Vaccine on 03/08/2021.
Other Medications: Zenatane 40mg twice daily. Pepcid 20mg once prior to vaccination. Diphenhydramine 25mg once prior to vaccination.
Current Illness:
Preexisting Conditions:
Allergies: Latex, Compizine, Morphine, Guanfacine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient arrived for COVID-19 vaccination at 14:30 on 08/16/21. Patient had previous serious reaction to Moderna COVID-19 mRNA Vaccine on 03/08/2021 requiring hospitalization. CDC guidelines for use of Janssen COVID-19 vaccine following allergic reaction to mRNA vaccine was utilized. Patient pre-medicated with Pepcid 20mg and diphenhydramine 25mg prior 30 minutes prior to arrival at the pharmacy and the patient''s mother was present. Epi-pen was on hand as well. After recieving the vaccine, patient reported nausea and cold extremities. Patient developed erythema on the chest, back and throat. Patient reported feeling "hot" and experienced diarrehea. Patient reported difficulty swallowing and was transported to ER for further treatment. Epi-pen was not utilized in pharmacy, and patient''s time in the pharmacy was approximately one hour before transit to ER. Patient reported via text message experiencing muscle pain and a migraine. Patient was stable at Hospital and reported receiving diphenhydramine, promethazine, methylprednisolone, magnesium, epinephrine, Toradol, and IV fluids. Patient is currently hospitalized at the time of this report (one day later). Patient was NOT contacted by the VAERS system previously regarding her adverse event on 03/08/2021 with the Moderna COVID-19 mRNA vaccine. Patient''s VAERS for that event is 1247355. I submitted two reports regarding that adverse event.


VAERS ID: 1578230 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-08-11
Onset:2021-08-16
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019B21A / 1 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Lymph node pain, Lymphadenopathy, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan/HCTZ 100/12.5mg 1 tab daily
Current Illness: n/a
Preexisting Conditions: Psoriasis
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: swelling of the right arm pit, swollen lymph nodes of R arm and R breast. Tender to touch and painful when R arm is down


VAERS ID: 1578261 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059E21A / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin 40mg daily; Methotrexate 17.5mg weekly; Folic Acid 1mg daily; Xarelto 20mg daily; Multivitamin daily;
Current Illness: Sciatica right hip/leg
Preexisting Conditions: AFIB permanent; Severe Sleep Apnea (16 years on CPAP device); Inflamatory Arthritis;
Allergies: Diclofenac (rash)
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Mildly sore arm at injection site


VAERS ID: 1578285 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Wrong patient
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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Error: Wrong Patient (documentation in EMR)-


VAERS ID: 1578310 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Dizziness, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: omeprazole, hydroxyzine
Current Illness:
Preexisting Conditions: MDD, anxiety (mild)
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt received vaccine at 1550. As she walked through the clinic on the way to exit, she felt dizzy. Staff brought chair and recorded vital signs. Pt was given water and VS repeated five mins later. Pt stated she felt better so staff assisted pt to sit in waiting area. Pt began to shake and stated she was dizzy again. Vitals recorded, Pt alerted staff that she consumed an energy drink before coming for vaccine. RN monitored pt and pt status did not improve, so RN brought pt to ED in wheelchair accompanied by pt''s family. RN handed pt off to ED staff and gave brief report at 1630.


VAERS ID: 1578319 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chest pain, Dyspnoea, Hypoaesthesia, Injection site hypoaesthesia, Malaise, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine 100 mcg
Current Illness: none
Preexisting Conditions: Hypothyroidism - treated with Levothyoxine
Allergies: none
Diagnostic Lab Data: Currently seeking medical treatment
CDC Split Type:

Write-up: 1) Intermittent sharp chest pain beginning approximately 3 hrs after vaccination. Chest pain severity increasing over time post vaccination. 2) Difficulty breathing, increasing with time post vaccination. 3) Left shoulder to left hand/fingers numbness and loss of strength 4) General malaise / slight nausea


VAERS ID: 1578341 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-05-25
Onset:2021-08-16
   Days after vaccination:83
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Deep vein thrombosis, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

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

Write-up: DVT bilat with shortness of breath .


VAERS ID: 1578379 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-03
Onset:2021-08-16
   Days after vaccination:166
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Pfizer 3/3 and 3/24. Positive on 8/13 admitted on 8/16-current


VAERS ID: 1578418 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 LA / IM

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

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

Write-up: PATIEN FAINTED AFTER ABOUT RECEIVING FIRST DOSE MODERNA COVID-19 VACCINATION. PATIENT REGAINED CONCIOUSNESS FEW MINUTES LATER.


VAERS ID: 1578423 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-08-05
Onset:2021-08-16
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Condition aggravated, Fatigue, Pain, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine in ~ 2012 - Arm swollen and hot to touch x 1 week post injection into arm
Other Medications: Voltaren / zoloft / buspar/ Requip / Trazadone / protonix / Lipitor/ gabapentin / melatonin
Current Illness: Body aches / fatigue (next day) and pain in arm (x2 days after)
Preexisting Conditions: hyperlipidemia
Allergies: Percocet - n/v
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Body aches / fatigue x 1.5 days Itching over arms/legs started about 9 days after injection (8/16/21)


VAERS ID: 1578438 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 RA / IM

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

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

Write-up: Patient received COVID vaccine #1 on 4/9/2021. She received Moderna. We administered COVID vaccine #2 on 8/16/2021- Pfizer. Patient did not have any adverse reactions to the vaccine.


VAERS ID: 1578447 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-01
Onset:2021-08-16
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Hypoaesthesia, Lymphadenopathy, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin xl 300mg wellbutrin 150mg buspar 15mg Vitamin c 100mg Vitamin d 50mg Zinc 25mg Glycerin 25mg
Current Illness: None
Preexisting Conditions: None
Allergies: Penicllin and sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Numbness in center of left hand minutes after injection, pain in elbow of left arm 24 hours after injection. Swollen underarm lymph node on left arm about 6 to 8 inches of swelling about 36 hours after injection. Sore arm and shoulder after injection for 36 hours after injection was given on left side.


VAERS ID: 1578450 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

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

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

Write-up: 5 minutes after giving JJ vaccine. Patient came to counter and said he needed to lie down bc he was feeling faint. I instructed him to lie down and by the time I got to him he had fainted. He was out for a few seconds. He remained lying down and felt dizzy. But was uninjured.


VAERS ID: 1578482 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain
SMQs:, Retroperitoneal fibrosis (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: famotidine 40 mg, triamcinolone 0.1% cream, fioricet 50-325-40 mg, Irbesartan 150 mg, simvastatin 40 mg, alprazolam 1 mg,
Current Illness: N/A
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient started experiencing low back pain about 5 hours after getting the Covid-19 vaccine per his wife. Patient was recommended by pharmacist to go to urgent care or ED.


VAERS ID: 1578492 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Extra dose administered, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies: Amoxicillin, pediazole (erythromycin ehylsuccinate and sulfisoxazole)
Diagnostic Lab Data: None
CDC Split Type:

Write-up: No Adverse event, patient was given 2 doses of Pfizer vaccine during same visit encounter. Patient monitored for adverse reaction, patient did not have any issues while in observation. Patient was scheduled with telephone visit with PA to discuss any issues or conerns.


VAERS ID: 1578518 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A218 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: history of fainting
Other Medications: none that I am aware of
Current Illness: none that we are aware of
Preexisting Conditions: none
Allergies: nka
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Prior to shot pt was anxious and expressing his anxiety towards needles. He appeared a little sweaty and anxious but able to respond to me as I was talking to him to keep him distracted as the pharmacy student was administering the vaccine. The shot was administered and I was acknowledging it was over patient''s head leaned back and he shut his eyes but then his body kind of jerked almost like he was awaking abruptly from sleep, but then he would go back out of conscious-this happened repeatedly. According to the student the patient had described it as feeling like he was on a roller coaster and that''s definitely the way his body was moving. This didn''t persist longer than a minute but close to. Following patient very pale and sweaty but was able to drink fluids and responsive-we applied the ice pack and he physically started to come around. Patient refused an ambulance but did agree to have a family member pick him up.


VAERS ID: 1578536 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-02-23
Onset:2021-08-16
   Days after vaccination:174
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Cough, Fatigue, Myalgia, Nasal congestion, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Rapid Test completed on 8-17-2021 at medical facility, resulted as Positive.
CDC Split Type:

Write-up: Symptoms started on 8-16-2021 with nasal congestion, cough, fatigue, muscle aches.


VAERS ID: 1578564 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-14
Onset:2021-08-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Joint noise, Joint swelling, Muscle tightness, Musculoskeletal stiffness, X-ray limb abnormal
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Osteonecrosis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: Spondylolisthesis, Degenerative Disc Disease (S1,L5,L4)
Preexisting Conditions: Spondylolisthesis, Degenerative Disc Disease (S1,L5,L4)
Allergies: none
Diagnostic Lab Data: Blood work and x-ray today 08/17/21. I have not received the results yet.
CDC Split Type:

Write-up: I woke up this morning 8/17/21 and could not open or move my left hand. I soaked in warm water and pried it open. Once I got it open the joints in my fingers popped in and out of place repeatedly. My wrists are also swollen. I am also experiencing tightness in my neck and shoulders. I went to my primary care doctor today and she took blood work and then provided me with a Toradol injection to see if that would reduce the swelling. She also ordered an x-ray of my left hand where the joints are visibly the most swollen.


VAERS ID: 1578569 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Dizziness, Fatigue, Injection site pain, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Arthritis (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: Omeprazole. Syeda. Amlodipine
Current Illness: Diabetes
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Body aches. Joint pain. Fatigue. Diarrhea. Nausea. Injection site pain. Dizziness


VAERS ID: 1578572 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-01-21
Onset:2021-08-16
   Days after vaccination:207
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

Write-up: 12/23/20 Covid Moderna 1/21/21 Covid Moderna 8/2-8/7 Traveled 8/12/21 Dtr tested + Covid, Employee tested Neg with PCR test 8/16/21 asymptomatic, tested + with Covid PCR 8/17/21 ill 8/27


VAERS ID: 1578580 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-08-13
Onset:2021-08-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Brain natriuretic peptide normal, C-reactive protein increased, Chest pain, Echocardiogram normal, Electrocardiogram normal, Headache, Immunoglobulin therapy, Intensive care, Myocarditis, Palpitations, Pyrexia, Troponin increased
SMQs:, Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: No known allergies
Diagnostic Lab Data: Initial troponin at presentation 2943 ng/L (8/16 at 20:30) and currently at 6651 ng/L (8/17 at 12:04). EKG (8/17): normal sinus ECHO (8/17): structurally normal heart, normal biventricular size and systolic function. no pericardial effusion. nl echo BNP (8/16): 5 pg/mL CRP (8/16): 2 mg/dL
CDC Split Type:

Write-up: Chest pain 24hrs post COVID vaccine that progressed x 48hrs. He received his second dose of the Pfizer COVID-19 vaccine 3 days ago. Since the vaccine he has been having low grade tactile fevers and headache that mom has been treating with Tylenol as needed. His chest pain is central and does not radiate. He denies syncope, shortness of breath or dizziness, and lower extremity edema. He does feel like his heart is racing at times and occasionally skips a beat. The pain is worse with exercise and with lying flat, he prefers to lean forward. Admitted for acute myocarditis post Covid vaccine. Toradol q8hr. IVIG and 1 dose of solumedrol being given. Following serial troponins


VAERS ID: 1578602 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-19
Onset:2021-08-16
   Days after vaccination:150
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: aspirin 325mg HS dulaglutide 0.75mg/0.5mL subcutaneous q7days furosemide 20mg daily insulin aspart TIDAC insulin glargine 64 units subcutaneous HS levothyroxine 100mcg IV daily lisinopril 20mg daily metformin 1000mg BID pioglitazone 45mg TI
Current Illness: None documented
Preexisting Conditions: None documented in our EHR
Allergies: Penicillin - Anaphylaxis
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient tested positive for COVID-19 after being fully vaccinated


VAERS ID: 1578649 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

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

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

Write-up: unauthorized age group


VAERS ID: 1578661 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: Medication error, Pt 13 years old, was given Moderna vaccine instead of Pfizer vaccine. Pt has no adverse reaction to the Moderna vaccine.


VAERS ID: 1578664 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-02-16
Onset:2021-08-16
   Days after vaccination:181
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Immunized with Moderna at facility in Fab 2021, missed second dose. Immunized with Pfizer product by Healthcare ER in Aug 2021


VAERS ID: 1578672 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 LA / IM

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

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

Write-up: Patient mistakenly received Moderna Vaccine and is 17 years and 6 months of age. Moderna is used for 18 years and up


VAERS ID: 1578701 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045L21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Cough, Fatigue, Headache, Myalgia, Pyrexia, Sneezing
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: cellcept, mirofinalate, calcium w/vit d
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: Got chills, very fatigue had a fever of 100.0, sneezing, headache and coughing also experiencing weakness and muscle pains


VAERS ID: 1578715 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Paraesthesia, Pruritus
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Seafood
Diagnostic Lab Data: EMS took vitals at 9:00pm: Blood pressure: 150/90 Heart rate: 128 SaO2: 98%
CDC Split Type:

Write-up: Patient develop paresthesia in hands within 5 minutes of administration, which then led to widespread itching about 10 minutes post administration. Patient also develop intermittent and widespread erythema. Patient took diphenhydramine 50mg at 8:09pm, was administered epinephrine at 8:47pm, EMS arrived at 8:55pm. Patient was advised to go to the hospital, patient declined. Advised to take diphenhydramine at scheduled intervals to continue treating itching and erythema.


VAERS ID: 1578734 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Joint stiffness, Mobility decreased, Muscle spasms, Musculoskeletal stiffness
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Muscles spasms causing stiff painful joints, more severe on left side of body. Predominantly neck, shoulders and hips . Massage helps slightly to be able to start moving. Standing, walking or lifting 5 lbs or more increases pain and triggers spasms. Can only walk 10-15 steps at a time.


VAERS ID: 1578960 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-15
Onset:2021-08-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 3 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydroxy urea, calcium, vitamins, Florajen,
Current Illness:
Preexisting Conditions: ET, Osteoporosis
Allergies: Sulfa, levaquin, lactose intolerant
Diagnostic Lab Data: None yet
CDC Split Type:

Write-up: Lymph node under arm involvement, strawberry rash about 3 inches circumference, bumpy under skin, painful


VAERS ID: 1578976 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Deafness, Hyperacusis, Sensory disturbance, Tinnitus
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None that were mentioned
Current Illness: None that were mentioned
Preexisting Conditions: None that were mentioned
Allergies: None that were mentioned
Diagnostic Lab Data: Patient has been advised to go to her primary care physician or even a specialist. When questioned regarding her ears she did state that she is prone to infections and that her ear canals are narrow.
CDC Split Type:

Write-up: Patient stated that a couple of hours after receiving the vaccine she lost almost all of her hearing. She stated it sounded like her head was under water. A few hours later once her hearing came back everything sounded very loud. This morning when she woke up she started hearing ringing in her ears. She stated that she started feeling much better around 11am this morning, however, wanted to make the pharmacy aware.


VAERS ID: 1579212 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, No adverse event, Product administration 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: administration error: pt was given dose that was expired, approximately 24 hours past first puncture. no known adverse reactions.


VAERS ID: 1579223 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-15
Onset:2021-08-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthma, Chest pain, Condition aggravated, Dizziness, Fatigue, Feeling abnormal, Injection site pain, Lymphadenopathy, Pain, Spirometry abnormal, Syncope, Vaccination complication
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Advair Diskus, Paxil, Albuterol, Zrytec, Magnesium, Prenatal Supplements
Current Illness: none
Preexisting Conditions: asthma, syncope
Allergies: Sulfa drugs, oxycontin, clindamycin
Diagnostic Lab Data: spirometry test at allergist. lung function showed 91%
CDC Split Type:

Write-up: I got the vaccine at 3:20pm on Sunday 8/15/21. Woke up with body aches at 1 am Monday 8/16/21. Went downstairs for water and medicine at 2 am. Felt off, went back upstairs, laid in bed, woke up my husband in time to tell him I was going to pass out and then immediately fainted while laying on my bed. I came too, ate bread, took ibuprofen, and went back to sleep. 8/16/21 I experienced normal fatigue, injection site soreness, lymph nodes swollen under injection site arm, body aches. I took ibuprofen every 4-6 hours. Tuesday 8/17/21 around 9 am I started experiencing shortness of breath and mild chest pain. At 10 am I noticed redness and swelling at injection site. I contacted my primary care physician who wanted me to go the the ER. I called my Allergist who was able to see me at 2pm. At 11am I took my albuterol inhaler which improved the symptoms. The appointment with the allergist proved that the albuterol did improve my air way function after a spirometry test. Dr concluded it was asthma exacerbation as a reaction to the COVID-19 vaccine received on 8/15/21. She prescribed albuterol inhaler 3-4x a day.


VAERS ID: 1579390 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: No
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient''s mom lied to us that her daughter is 12 years old and didn''t not show us any proof of date of birth. So I gave Pfizer COVID vaccine to the patient. Then we found out that patient was only 11 years old. Called mother back to confirm little girl''s age and the mother said 11 years old. Patient did not have any adverse reaction from the vaccine.


VAERS ID: 1579742 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-01
Onset:2021-08-16
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Lymphadenopathy, Pain
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: not on file. stated she takes percocet.
Current Illness: degenerative disc disease, hashimotos disease, gallbladder cancer per pt
Preexisting Conditions: degenerative disc disease
Allergies: unknown
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient stated that late in the evening the day she received the shot, she awoke with numbness in her arm and pain in her neck. She stated her "right lymphnode was swollen" and that she was in a great amount of general pain. She stated that she is much improved today.


VAERS ID: 1580976 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-14
Onset:2021-08-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: Hot red skin at injection site with painful nodule under skin


VAERS ID: 1580977 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Burning sensation, Chills, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever & chills began at 11:30pm the same day. Beginning 24 hours after the vaccine, I began getting burning in both knees and my left hip. That lasted for about 12 hours and seems to have subsided as of now.


VAERS ID: 1582115 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Headache, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Headache and vomiting


VAERS ID: 1582156 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Headache, Hyperhidrosis, Nausea, Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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: Fever, chills, body aches, headache at 25 years old on July 19, 2021 from the first Moderna COVID-19 vaccine.
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies: Allergic to sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, chills, sweating, body aches, headache, nausea, vomiting.


VAERS ID: 1582163 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 1 LA / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too High-


VAERS ID: 1582332 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-01-23
Onset:2021-08-16
   Days after vaccination:205
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, COVID-19, Chills, Dehydration, Fatigue, SARS-CoV-2 test positive
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Guillain-Barre syndrome (broad), Infective pneumonia (broad), Dehydration (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Not specified
Current Illness: Not specified
Preexisting Conditions: Diabetes Mellitus
Allergies: Not specified
Diagnostic Lab Data: 8/16/21 RT-PCR positive via upper respiratory sample
CDC Split Type:

Write-up: Received notification that patient was admitted to the hospital for weakness, fatigue, and chills. Positive COVID 19 test result at the Hospital. Reported that patient was admitted for 1 day d/t dehydration and has been discharged home.


VAERS ID: 1582333 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-04
Onset:2021-08-16
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / UNK - / -

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

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

Write-up: Breakthru COVID


VAERS ID: 1582337 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-15
Onset:2021-08-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Electrocardiogram normal, Electroencephalogram normal, Fall, Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Fell to the floor and had a seizure


VAERS ID: 1582403 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Bone pain, Chills, Fatigue, Impaired self-care, Impaired work ability, Injection site swelling, Injection site warmth, Lymph node pain, Lymphadenopathy, Mobility decreased, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Osteonecrosis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: I called my local doctor''s office and they suggested just "waiting it out."
CDC Split Type:

Write-up: Began feeling weak, fatigued within 3 hours of injection. At 5 hours began running a fever of 105 degrees F; full body chills, severe muscle, joint and bone pain. Fever would not respond to OTC medications until about 24 hours post injection. Still feverish (but does respond to OTC) at nearly 48 hours post injection. Could not get out of bed the first 24 hours; unable to work or perform self care activities. Injection site very swollen, hot to the touch. Numerous lymph nodes adjacent to the injection site are swollen and painful.


VAERS ID: 1582421 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 1 LA / 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? 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: Developed hives on left side of neck approximately 3 to 4 hours after receiving shot , took Benadryl, hives disappeared after 1 hour of taking medicine.


VAERS ID: 1582424 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-22
Onset:2021-08-16
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: pt came back with a bump on the arm


VAERS ID: 1582433 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-08-14
Onset:2021-08-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest X-ray normal, Chest discomfort, Chills, Dizziness, Dyspnoea, Feeling cold, Headache, Nausea, Pain, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Migraines and tested positive for covid-19 on two separate occasions with nasopharyngeal documentation on record.
Allergies: Trazadone, Tramadol and Amoxicillin.
Diagnostic Lab Data: X-Ray of Chest
CDC Split Type:

Write-up: On 08/15/2021 I experienced strong head pain, dizziness, nausea, body aches, fever and cold chills. On 08/16/2021 at 10:00 pm I felt right sided chest tightness, discomfort and shortness of breath. The symptoms continued into 08/17/2021 and at 11:00 am I went into the Clinic. I saw Dr and she assessedme. She ordered an X-Ray and it did not show any abnormalities. Due to financial constraints, I was unable to receive further testing and was told to contact the facility if anything changes or go to the hospital if condition worsens. I was given a prescription of Diclofenac Potassium 50 mg. I was unable to this medication, due to vomiting. Currently, shortness of breathe has improved without and taking OTC Tylenol.


VAERS ID: 1582447 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-15
Onset:2021-08-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diplopia, Dizziness, Dyspnoea, Heart rate increased, Injection site pain, Mobility decreased, Muscle tightness, Pain, Peripheral swelling, Syncope, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Ocular motility disorders (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Propranolol, lamotrigine, motillium, fluoxetine, zofran, aripprazole, forteo, remicade
Current Illness: None
Preexisting Conditions: Ulcerative colitis, gastroparesis, osteoporosis
Allergies: No
Diagnostic Lab Data: Went to ER. Spent 6 hours there. All records can be obtained from them. Elevated white blood fell count
CDC Split Type:

Write-up: Swollen arm, pain in injection site, unable to move arm, high heart rate, difficulty breathing, body aches, dizziness, muscle tightness then falling over, double vision


VAERS ID: 1582471 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-15
Onset:2021-08-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

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

Write-up: 12 hours after vaccine- chills and body aches relief with Tylenol 15 hours after vaccine - fatigue, slept on and off for over 24 hours, alternating Tylenol and Advil when awake for body aches 36 hours after vaccine - nausea and fatigue 72 hours after vaccine - slight fever 99.5 orally and fatigue, nausea and food aversions


VAERS ID: 1582487 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

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

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

Write-up: Slight lip swelling noted 5 min after vaccine adm. Doctor informed, rec''d advise to have pt transfer to urgent care. Pt in stable condition, no respiratory distress.


VAERS ID: 1582490 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-14
Onset:2021-08-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Breast pain, Breast swelling, Pyrexia, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Lipodystrophy (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: Seizure Med Allergy pill Synthroid pill
Current Illness: No
Preexisting Conditions: Complex Partial Seizures Hypothyroid Seasonal Allergies
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pain/Swelling side of Left Breast Pain and Swelling left underarm / pit area Low-Grade fever, no higher then 100.1


VAERS ID: 1582516 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-15
Onset:2021-08-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 3 RA / IM

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

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

Write-up: Rash under right arm pit with redness and pain


VAERS ID: 1582530 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: No adverse event, 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: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 8/16/21 @0815, patient was given COVID19 Moderna vaccine dose #1 from vial that was past the beyond use dating (12 hours from 1st puncture). The vial was initially punctured on 8/15/21 @1034AM with BUD of 8/15/21 @1034PM. Patient was notified in the afternoon on 8/16/21 regarding the error and did not report any adverse effects. Patient was referred and has reached out to worker''s compensation. Moderna was contacted on 8/16/21 inquiring if the dose will need to be replaced. On 8/18/21, Moderna''s response was received and recommended that no additional dose is needed to replace the initial dose.


VAERS ID: 1582587 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-06
Onset:2021-08-16
   Days after vaccination:222
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: positive COVID PCR test on 8/16
CDC Split Type:

Write-up: Patient became ill on 8/14 with coughing and congestion


VAERS ID: 1582596 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-15
Onset:2021-08-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 2 LA / SYR

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

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

Write-up: Woke up 3:30am with severe fatigue and chills. Fainted while trying to get medication. Mother woke up from sleep when she heard patient hit a wall while fainting. Called 24hr nurse hotline. They recommended being seen by a doctor. We were able to get water, ibuprofen and Tylenol in her by 4:00am and waited 30-40 minutes. The medication lessened symptoms so we chose not to seek further treatment. Staying on both Tylenol and ibuprofen kept symptoms at bay for the next 36 hours.


VAERS ID: 1582609 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-10
Onset:2021-08-16
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 09D21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Feeling cold, Hypoaesthesia, Injection site induration, Injection site inflammation, Injection site pain, Injection site warmth, Sensory disturbance, Skin reaction
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Tetnus Shot, Similar reaction.
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: What is known as Covid Arm. Current and active pain and inflammation at injection site. "Tight, hard skin" similar to a bee sting. Hot around area. No treatment. Numbness from top of shoulder to just below the elbow. Since it has started, I have had fast internal "blasts of cold" almost like a cold chill but much slower from head to toe. Extreme sensitivity to temperature, not just my arm, but my body as a whole.


VAERS ID: 1582615 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-06
Onset:2021-08-16
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Uterine haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: Abnormal uterine bleeding. I take my OCP continuously and on time daily and never have periods or break through bleeding. I have been on OCP form 19 years and taking continuously for 10 with no issues until 8/16/21. I am having a full blown heavy period for now 3 days where I am bleeding through tampons within 4-6 hours.


VAERS ID: 1582639 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-21
Onset:2021-08-16
   Days after vaccination:207
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: 8/17/21 COVID-19/SARS-COV2, PCR Positive
CDC Split Type:

Write-up: COVID positive $g14 days post vaccine series.


VAERS ID: 1582652 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

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

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

Write-up: Patient had a syncopal episode after receiving the J&J vaccine. Patient stated before getting vaccinated that she passes out with shots and blood draws. Did ok right after the vaccine but few minutes later she had a syncopal episode for less than a minute and came back to. Laid her down in exam room 8 and checked vital was 125/83. Stayed in the room with her and did start to feel better was given a cool towel and a juice to drink. Patient was slowly moved to a sitting position and was able to ambulate after 20 minutes.


VAERS ID: 1582663 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-05
Onset:2021-08-16
   Days after vaccination:164
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Pfizer on 3/5 and 4/2. Positive 8/8. admitted on 8/16/21 to current. in ICU


VAERS ID: 1582664 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-18
Onset:2021-08-16
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 8/17/21 COVID-19/SARS-COV2, NAAT POSITIVE
CDC Split Type:

Write-up: COVID-19 positive $g 14 days post vaccine series.


VAERS ID: 1582669 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-01-06
Onset:2021-08-16
   Days after vaccination:222
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Dyspnoea, Hyporesponsive to stimuli, SARS-CoV-2 test positive, Somnolence
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (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: Ttrazadone, Amlodipine, Nu-Iron, Vit D3, Nystatin topical, Mul
Current Illness: Unkown
Preexisting Conditions: HLD, UTI Dementia, anemia, HTN
Allergies: No known allergies
Diagnostic Lab Data: SARS COV2 COVID19 PCR 08/16/2021
CDC Split Type:

Write-up: pt comes from the cove- diagnosed with covid 7/29/21. 84-year-old male presents to ED via EMS for change in responsiveness; diagnosed with COVID-19 virus on 7/29/2021. PMHx dementia, HLD, UTI. Reportedly, patient has been weak and sleepy, which is normal from his alert, talkative baseline. While in ED, patient was having respiratory difficulty which improved with NRB. Further history limited secondary to current clinical condition. No family at bedside. Patient was still admitted when form was submitted


VAERS ID: 1582694 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-01
Onset:2021-08-16
   Days after vaccination:137
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 02M2008 / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B218 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hypertension, diabetes, heart disease
Allergies:
Diagnostic Lab Data: SARS- Antigen F/A - Nasopharyngeal
CDC Split Type:

Write-up: Tested positive for COVID19 on 8/16/2021


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