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

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



Case Details (Reverse Sorted by Onset Date)

This is page 124 out of 3,524

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VAERS ID: 1354379 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site induration, Injection site pruritus, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (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 Linzess Vit D Estrovers
Current Illness: Stomach Flu end of April
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Injection site warm to touch, large induration at injection site. Extremely itchiness at injection site.


VAERS ID: 1354407 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-14
Onset:2021-05-20
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Atelectasis, Bronchitis, Chest X-ray abnormal, Chest pain, Computerised tomogram thorax, Dyspnoea, Echocardiogram, Emphysema, Lung infiltration, Pericardial fibrosis, Spinal compression fracture
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Osteoporosis/osteopenia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen 500 mg, atorvastatin 40 mg, vitamin D3 10,000 u, gabapentin 300 mg, ibuprofen 600 mg, insulin lispro 100u/ml, humulin N NPH 100 u/ml, lisinopril 5 mg, metoprolol tartrate 25 mg, omeprazole, 40 mg, and Creon 24,000-76,000-120,0
Current Illness: none known
Preexisting Conditions: pulmonary emphysema, sinus tachycardia, hypercholesterolemia, essential hypertension, GERD, pancreatic necrosis, gastric varices, hypothyroidism, Diabetes II, vitamin D deficiency, splenic infarction, lung nodule
Allergies: Sulfa
Diagnostic Lab Data: Chest xray-Bronchitis with suspected developing left basilar infiltrate versus atelectasis. CT pulmonary arteries-1. Likely acute-to-subacute compression deformities of the T11 and T12 vertebral bodies and age-indeterminate compression deformities of the T8 and T10 vertebral bodies without bony retropulsion. These are new compared to 10/19/2020. MRI could provide better insight into the acuity of these fractures. 2. There is new pericardial thickening with subtle infiltrative changes of the adjacent fat possibly related to an underlying pericarditis. No significant pericardial effusion. 3. No evidence for acute pulmonary thromboembolic disease. No thoracic aortic aneurysm or dissection. 4. Moderate upper lobe predominant centrilobular emphysema. No acute pulmonary parenchymal process. echocardiogram-pending results
CDC Split Type:

Write-up: Developed chest pain and shortness of breath. Went to the emergency department.


VAERS ID: 1354410 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-13
Onset:2021-05-20
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

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

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

Write-up: Chest pain


VAERS ID: 1354441 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Hyperhidrosis, Nasopharyngitis, Nausea, Pallor, Paraesthesia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient c/o dizziness and nausea 3:25 PM Vitals: BP 102/56 HR 71 Resp 16 O2Sat 90 Skin Signs: Cool, clammy, diaphoretic, other - pale Initial Treatment: 3:24 PM patient states he feels tingling sensation in his hand bilaterally. Patient presents very pale, diaphoretic, and cool. Denies previous medical hx. 3:27 PM patient continues to improve, denies emesis but continues to present pale and diaphoretic. 3:40 PM Vitals: BP 102/62 HR 68 O2Sat 96 Skin Signs: Diaphoretic, other - pale Follow up Treatment: Continue to monitor patient. Advised patient to drink water and provided patient with juice. 3:55 PM Vitals: BP 116/60 HR 52 O2Sat 97 Skin Signs: Warm and dry Follow up Treatment: Patient continues to improve both in presentation and vitals. He stated he feels better and is ready to go home. Home with SO driver.


VAERS ID: 1354465 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 2 LA / IM

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

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

Write-up: No adverse event. Patient got the vaccine too early. First dose was on 4/29/21 and then again on 5/20/21. Patient traveled from a long distance to get the vaccine. He was a week early. Patient was not on the schedule but when he showed up, the vaccinator gave it to him. Patient was on our schedule today and did not show up. When I went into the state immunization schedule/program I noticed he was several days early to get vaccine (patient was to return on 5/27/21 at 1:30 pm).


VAERS ID: 1354519 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 2 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Disorientation, Dyspnoea, Fatigue, Loss of consciousness, Muscular weakness, Pyrexia
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (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), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations: Moderna Covid Shot 1
Other Medications: PVC Atrial Tachycardia
Current Illness: Adverse effect from first COVID Shot: 4/22/21 (tired, out of breath)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Muscle weakness that lead to passing out multiple times, fever, disoriented, and ended up in the hospital for two days


VAERS ID: 1354522 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-05-17
Onset:2021-05-20
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Chills, Dyspnoea, Echocardiogram normal, Electrocardiogram normal, Fibrin D dimer, Magnetic resonance imaging, Myalgia, Myocarditis, Pleuritic pain, Pyrexia, Tachycardia, Troponin
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: trop 0.39, EKG ECHO MRI
CDC Split Type:

Write-up: Patient is a 30-year-old previously healthy Mediterranean woman complaining substernal squeezing chest pain for 2 days in the setting of 2nd Pfizer COVID vaccine 2 days ago. The chest pain is pleuritic but otherwise has no exacerbating or relieving factors. It does not radiate. She has never had this pain before. The patient is worried about myocarditis or blood clot as she has heard the can be reactions from the vaccine. The pain is associated with shortness of breath. She denies vomiting, diarrhea. She has had some fever, chills and myalgias over the past few days. She denies cough. She denies history of VTE, hemoptysis, history of immobilization or trauma, estrogen birth control. She denies family history of early cardiac death or MI. 38y/o woman with no significant past medical history who had her second Pfizer vaccine on Monday and later that day developed low grade fever/ diffuse myalgias/ pleuritic and positional central dull 5/10 chest pain. On Tuesday and Wednesday she remained bedridden with same sx. Thursday morning felt improved except had persistent chest pain for which she presented to the ED for evaluation. She had tachycardia, +troponins, and +DDimer. EKG was negative for acute changes. She was admitted to the cardiology service for suspected myocarditis. She was started on colchicine, standing ibuprofen, and metoprolol. Echocardiogram complete on 5/21 was normal with an EF of 60%. She was evaluated again after her echo. She continued to feel significantly improved on medical therapy and was discharged home on 05/21/21. She will continue medical therapy as listed. She will follow-up with as arranged on 5/25/21.


VAERS ID: 1354557 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Tinnitus
SMQs:, Hearing impairment (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: Prednisone, olmisartan, rosuvastatin
Current Illness:
Preexisting Conditions: High blood pressure & cholesterol
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tinnitus


VAERS ID: 1354562 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-05-09
Onset:2021-05-20
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adverse reaction, Blood urine present, Differential white blood cell count, Full blood count, Metabolic function test, Pain, Platelet count, Vasculitis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Vasculitis (narrow), Immune-mediated/autoimmune disorders (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: Cialis
Current Illness: none
Preexisting Conditions: kidney stones
Allergies: none
Diagnostic Lab Data: My doctor took blood and urine sample to run 3 tests; urinalysis CSC with differential/platelet comp metabolic panel
CDC Split Type:

Write-up: adverse reactions appears 5/21 after first dose received 5/9. Reactions include peripheral vasculitis, the size of a quarter, appearing above interior of right wrist. Site also has some pain similar to that of a bruise. Also had blood in urine, which did not reoccur after initial incident.


VAERS ID: 1354573 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO175 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Hypothermia, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Accidents and injuries (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Amlodipine 10 mg q d , hydrochlorothiazide 25 mg q d , Valsartan 300 mg qd
Current Illness: none
Preexisting Conditions: htn
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Extreme fatigue , hypothermic 1 week 97.2 . Low grade fever today 99.7 . Nausea . Multiple joint pain .


VAERS ID: 1354680 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 1 RA / IM

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

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

Write-up: Patient states rash began at her right wrist the morning after her injection, slowly progressed up her arm past her elbow 8 days later she stopped in (today) to show me and it is hive-like and broke thru the skin above her elbow on the inside of her arm


VAERS ID: 1354697 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-05-17
Onset:2021-05-20
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nitroglycerin ointment, OTC cetirizine hydrochloride
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None yet
CDC Split Type:

Write-up: Unexplained fainting at approximately 9:00 pm on 5/20/2021; unexplained persistent bruising possibly indicative of low platelet count, first noticed on 5/22/21 at approximately 4:00 pm and continuing to the present


VAERS ID: 1354715 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Pain, Spinal pain
SMQs:, Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine 5mg, Zinc, Vitamin D3, ACV gummies
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Woke up to pain in my middle spine at 5am. Every time I moved I got a shooting pain up my spine. Went back to sleep for 3 hours and it was gone.


VAERS ID: 1354831 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Meloxicam 15mg, Sumatriptan Succ 50mg, Pantoprazole 40mg, Losartan 100mg, Metoprolol Succ 100mg, Mirtazapine 15mg, OTC=One Shot Keto
Current Illness:
Preexisting Conditions: Lyme Disease, MRSA, Hyponatremia
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: 9cm, rough rash, warm to the touch. Patient reports throbbing ache. Used ice as treatment but rash has not resolved for the last 8 days. Recommended that patient see PCP.


VAERS ID: 1354849 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Anticoagulant therapy, Blood test, Chest X-ray, Chills, Computerised tomogram thorax abnormal, Dyspnoea, Fibrin D dimer, Headache, Pain, Pulmonary thrombosis, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Daily Multi vitamin, Losartan 50mg
Current Illness: None
Preexisting Conditions: Afib
Allergies: Penicillin, codeine, sulfa, novocaine, yellow dye #5, bee/wasp/yellow jacket stings/bites
Diagnostic Lab Data: Blood Draw three different tests. (May 24, 2021) : D-Dimer over 2000, all others normal Chest X-Ray (May 24, 2021): Not sure results Chest CT (May 24, 2021): Blood clots in lower lobes of lungs
CDC Split Type:

Write-up: Started with chills, fever, body aches, shortness of breath and headache for about 36 hours. The shortness of breath didn''t subside so went in to see the NP at my family doctors office. She had me go get some blood work and chest x-ray. My d-dimer was over 2000 so she sent me to the ER where they did a CT Scan and found blood clots in my lungs. They then admitted me for the night on a heparin drip and then discharged me with Eliquis blood thinners. Meeting with my family doctor next week for more information.


VAERS ID: 1354887 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 - / IM

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

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

Write-up: patient falsely represented DOB twice during vaccine clinic - once on line questionnaire and once verbally when asked


VAERS ID: 1354894 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 - / IM

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

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

Write-up: patient falsely represented age 2 times during vaccination. once on line questionnaire and once verbally.


VAERS ID: 1355120 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Fatigue, Headache
SMQs:, Anaphylactic reaction (broad)

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

Write-up: Chest pressure, Headache, Fatigue. Lingering minor headache and fatigue every day for more than one week after the vaccine second shot.


VAERS ID: 1355125 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-05
Onset:2021-05-20
   Days after vaccination:76
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Fall, Fatigue
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Cardiomyopathy (broad)

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

Write-up: fall, fatigue, shortness of breath


VAERS ID: 1355133 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA MODERNA / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blister, Headache, Herpes zoster, Pain, Pyrexia, Rash
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril, Amlodipine
Current Illness:
Preexisting Conditions: High blood pressure
Allergies: Sulfur drug, dairy products, sugars, aspirin
Diagnostic Lab Data: none test taken or give to date. I finally was able to get a Dr. Appointment to see my primary care today..
CDC Split Type:

Write-up: Initial Fever, headache, body aches. Then rash, blisters, shingles, chicken pox mixture on my face, chin, chest breast, legs, arms and continues to spread as of today. I went to urgent care, and the emergency room. I was given vistaril, Valcyclovir, an anitbiotic, and steriods


VAERS ID: 1355143 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / IM

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

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

Write-up: Pt came in to get a Janssen covid vaccine, Pre-vaccintation checklist was completed at which time he denied having received any other COVID vaccine. After the Janssen vaccine was administered the patient stated "I have to be honest with you ladies I already got the Moderna Vaccine, when are you giving the Pfizer vaccine I want that one also". i looked in his EHR and he did not receive Moderna vaccine from us.


VAERS ID: 1355348 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-18
Onset:2021-05-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Pruritus, 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: No medications
Current Illness: none
Preexisting Conditions: none
Allergies: No known drug allergies. no food allergies. +environmental allergies
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 5/20 /21 started to feel rash on both her forearms and wrists. It was itchy and red, and has little circles. It lasted 2 days and went away. Then today the rash showed up again. The circles are slightly different. It is more itchy today. She has been taking Zyrtec for 4 days because of seasonal allergies. She was not taking Zyrtec when rash first started.


VAERS ID: 1355351 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-13
Onset:2021-05-20
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Injection site swelling, Pain in extremity, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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: Amlodipine Besylate Tabs 5mg, Esomeprazole Mag DR Caps 40mg, Metoprolol Succinate Er Tabs 25mg, Venlafaxine Hcl Er Caps 75mg. Take all 1 time daily. Arbonne Essentials Omega-3 Plus 1 capsule, Clucosamin HCI with MSM- 2 per day. Milk of
Current Illness: None
Preexisting Conditions: None
Allergies: Bee stings, Demerol,
Diagnostic Lab Data: None
CDC Split Type:

Write-up: One week after the shot, My arm became red and swollen, near where the shot was, and them spread down my arm to my elbow over the course of week. Dr. had given me Clindamycin HCL 300 mg capsule 3 times a day starting on 5/21/21, for what he thought may be an infection from the shot. 1 week later still not better went back to Dr. on 5-27-21 and got Prednisone 20 mg tablets to take 3,3,3,2,2,2,1,1,1, a day in this way for 9 days. He think now it is an allergic reaction to the shot. Hopefully this will take away the swollen, red, pain and at times itchyness that has slide down my left arm below the site of the injection and going to the elbow.


VAERS ID: 1355379 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 2 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Chills, Dehydration, Headache, Pain, Pyelonephritis, Pyrexia, Renal impairment
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Carvedilol, Zyrtec, Prevacid, Vitamin D
Current Illness: Seasonal allergies
Preexisting Conditions: Lupus (remission since 1986), Rheumatoid Fever as a child
Allergies: Penicillin, Aloe vera, latex, bee stings
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient described that approximately 4 hours after receiving second dose, she developed headache, body aches, and chills. She stated that she experienced those symptoms until 2 days after when she developed a fever. She went to Emergency Room where her temperature read 103.9. She was subsequently admitted and diagnosed with decreased kidney function, pyelonephritis, and dehydration. She was discharged 4 days later. This information is all second-hand information received from the patient.


VAERS ID: 1355605 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Chest discomfort, Dyspnoea, Pain, Pruritus
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Asthma, Depression, Tic Disorder, Trichotillomania
Allergies: Red dye, walnuts
Diagnostic Lab Data: Pt brought/monitored in ER. No labs or tests done on day of event.
CDC Split Type:

Write-up: Pt got the COVID vaccine, felt sore right away and itchy all over -itchiness on right arm and left arm and then felt chest tightness and shortness of breath. Was monitored in ED and treated with benadryl, pepcid and then course of prednisone x 5 days. She seems better today but still having lower energy than normal. No vomiting or hives. She felt itchy on right arm, no rash.. Took some benadryl for this. She had COVID last November.


VAERS ID: 1355765 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 4 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: not sure
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Before I administered the vaccine, the mother stated that she sometimes has an issue with fainting, but mainly at the doctor''s office out of fear. She assumed that since this was a different environment, she would be okay. After giving her the shot , she fainted. The mom called 911. I waved an ammonia inhalant under her nose, and she was revived. Her twin brother informed me that she has been in an ambulance 4 times prior after getting shots. Had I known she had a history of fainting, I would have suggested that she receive the vaccine at the pediatrician''s office once it becomes available. The mom refused to go to the hospital once paramedics arrived. She sat for 15 minutes, I applied a cool cloth, she drank water and was able to walk out on her own.


VAERS ID: 1355772 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO187 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angina pectoris, Chest pain, Injection site pain, Myalgia, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Other ischaemic heart disease (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: The first covid vaccine led to milder adverse events than the second, but included a mid to high-grade fever, muscle aches, and
Other Medications: Nothing was taken during this time.
Current Illness: No illnesses at time of vaccination or a month prior.
Preexisting Conditions: No chronic or long lasting health conditions.
Allergies: Presumed allergic to penicillin. Mild sensitivity to lactose
Diagnostic Lab Data: If the heart and chest pains continue it was instructed that a doctor visit will be necessary. This is yet to be completed.
CDC Split Type:

Write-up: The first dose of the vaccine went fairly well aside from fever, muscle aches, and pain in the left arm at the injection site. The second dose was reportedly worse. The fever ranged from 104.8 degrees Fahrenheit as a high and 102 degrees Fahrenheit being low, which receded after 3 days of care. In addition, chest pains and heart pain started at 8:00pm the day of the vaccination which was completed at 11:15am. Pain at the injection site and overall body muscle aches lasted for 3 days. The heart/chest pains have yet to recede. Instead it is occurring more frequently in ?bursts? of pain with a constant aching sensation.


VAERS ID: 1356060 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-17
Onset:2021-05-20
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Erythema, Fatigue, Influenza like illness, Injection site pruritus, Lethargy, Nausea, Peripheral swelling, Pyrexia, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin B, C, D, Quercetin, Sudafed
Current Illness: None
Preexisting Conditions: Chronic back pain
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Started with flu like symptoms, after 3 days my left arm would swell slightly, become red/warm, and itchy at injection site. At 1 week I began feeling extremely worn down, exhausted, short of breath after moving at all, coupled with a slight fever and continuous nausea.


VAERS ID: 1356491 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysmenorrhoea, Heavy menstrual bleeding, Injection site pain, Menopause, Menstruation irregular, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Fertility disorders (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Side effect number 1: Body/muscle aches starting the morning after the injection (approximately 6:00am) which lasted 8--12 hours. Also, soreness in injection site. Side effect number 2: Triggered a period (starting 5/24/21) with heavy flow and cramping. I am in peri-menopause and have not had a period since January.


VAERS ID: 1356529 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Breast swelling, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen lymph nodes in multiple locations including armpits, groin, collarbone, neck, side of breast. Lasted for over a week and still not completely gone


VAERS ID: 1357152 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Injection site pain, Skin discolouration, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CA++ supplements, daily multi vitamin, rarely Ibuprofen for headache or pulled muscle
Current Illness: NONE
Preexisting Conditions: NONE KNOWN
Allergies: NKDA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: pain at site and down most of deltoid....dark bruise enlarged for few days and got more spread out. Purple and 7 days later still size of a penny and starting to absorb and look slight yellow within the purple


VAERS ID: 1357431 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Mississippi  
Vaccinated:0000-00-00
Onset:2021-05-20
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, Asthenia, Body temperature, Chest X-ray, Cold sweat, Computerised tomogram head, Computerised tomogram neck, Dehydration, Diplopia, Dizziness, Dyspnoea, Headache, Loss of consciousness, Pyrexia, Rash erythematous, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Ocular motility disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (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: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 20210520; Test Name: Body temperature; Result Unstructured Data: 103 F; Test Date: 20210524; Test Name: Computerized tomogram neck; Result Unstructured Data: unknown; Test Date: 20210524; Test Name: Chest X-ray; Result Unstructured Data: unknown; Test Date: 20210524; Test Name: Computerised tomogram head; Result Unstructured Data: unknown
CDC Split Type: USJNJFOC20210549340

Write-up: PASSING OUT; SLIGHTLY DEHYDRATED; LITTLE RED SPOTS ON CHEST, BACK, ARM, TORSO AND BELOW BREAST; WEAK; TERRIBLE HEADACHE; FEVER 103; DOUBLE VISION; DIZZY; THREW UP; STOMACH PAINS; HARD COLD SWEATS; COULD NOT BREATH; This spontaneous report received from a patient concerned a 60 year old male. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 043a21a, expiry: UNKNOWN) dose was not reported, administered on 20-MAY-2021 at right arm for prophylactic vaccination. No concomitant medications were reported. After vaccination on 20-MAY-2021, the patient waited in the pharmacy for 20 mins. The patient got into car, the patient could not breath, began to sweat, threw up, experienced double vision and stomach pains. On same day, the patient was dizzy and had fever of 103 F. On 24-MAY-2021, the patient went to the emergency room (ER) by ambulance as the patient had passing out and when patient woke up patient was in ambulance on the way to the ER. The patient continued to have terrible headache, double vision, weak, and sweats which started on the day of vaccination. The patient had cold sweats. The patient still had stomach pains. On 24-MAY-2021, at ER the patient had an X-ray of chest, CT of head and neck. In the ER, patient received Dilaudid for terrible headache and some fluids as patient was slightly dehydrated. The patient had tiny red spots to chest, torso, arm, back an below breast. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from terrible headache, weak, double vision, fever 103, dizzy, little red spots on chest, back, arm, torso and below breast, stomach pains, and hard cold sweats, and the outcome of threw up, could not breath, passing out and slightly dehydrated was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0; 20210549340-covid-19 vaccine ad26.cov2.s-Loss of consciousness. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).


VAERS ID: 1357459 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006Z21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Fatigue, Headache, Myalgia, Nausea, Neuralgia, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor Lorsitan Estradiol Synthroid fish oil vitamin D
Current Illness:
Preexisting Conditions: High cholesterol, high blood pressure, Hashimoto?s thyroid
Allergies: Sulfa penicillin insect/bee stingsPineapple
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, nausea, high fever, muscle pain, nerve pain, diarrhea, vomiting, exhaustion


VAERS ID: 1357604 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Chills, Dizziness, Headache, Injection site pain, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: after 1st vaccine I had chills, pain at injection site, and body aches and pain for about 16 hours starting on day of shot.
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Iodine, shellfish
Diagnostic Lab Data: none
CDC Split Type:

Write-up: nausea started at 1pm day of vaccine and lasted 72 hours, DIARRHEA (severe) started at 2pm day of vaccine and lasted 48 hours, VOMITING (severe) started at 4pm day of vaccine and lasted 13 hours, The following symptoms started at 3pm day of vaccine and continued for 72 hours aches and pain entire body, muscle and joint pain, chills, dizziness, weakness, headache, pain at injection site.


VAERS ID: 1357638 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Chest pain, Electrocardiogram, Epistaxis, Peripheral swelling, Troponin, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi-Vitamin and Concerta
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Omnicef, Pineapples, and Coconuts
Diagnostic Lab Data: EKG and Chest X-Ray, Troponin levels checked In the E.D on May 25, 2021.
CDC Split Type:

Write-up: Hives on arms, left side of face, severe swelling in left leg , nose bleeds, and chest pain.


VAERS ID: 1357642 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-05-13
Onset:2021-05-20
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Eye irritation, Eye swelling, Rash, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Corneal disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Burning eyes. Left eye worse than the right. Left face and eye swelling. Rash on face, neck. Random spots of rash on body


VAERS ID: 1357643 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-22
Onset:2021-05-20
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pruritus
SMQs:

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

Write-up: Site: Itching at Injection Site-Mild, Systemic: Patient came in on 5/20/2021 reporting that she got a bad shot on 04/22/2021. Pharmacist on duty asked patient what reaction did the patient get. Patient refused to answer and left the pharmacy. Pharmacist tried to follow up with the patient but phone num-Mild, Additional Details: Patient came in on 5/20/2021 reporting that she got a bad shot on 04/22/2021. Pharmacist on duty asked patient what reaction did the patient get. Patient refused to answer and left the pharmacy. Pharmacist tried to follow up with the patient but phone number is invalid.


VAERS ID: 1357674 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Condition aggravated, Feeling abnormal, Headache, Psychogenic seizure, Seizure
SMQs:, Systemic lupus erythematosus (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: seizures (average 2-3 per month), anxiety, GERD, depression
Allergies: aspirin, cat dander, risperidone, vancomycin, gabapentin, phenytoin, Elavil, carbamazepine, keppra
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented to vaccine clinic for second covid vaccine. Following first dose, patient had mild side effects in the observation area after the first dose of the covid, where she was observed in our reaction room area more closely, for feeling foggy and "just not right", however patient was fine to be able to be sent home. Patient was encouraged to contact physician to verify they should receive second covid vaccine. When patient was in observation area, after receiving her second covid vaccine shot, she told the observation nurse that she had a headache. The nurse immediately took her to our reaction room area and was closely observed. Patient was talking and acting fine. Within minutes, she started to have a seizure. Documentation in patient''s chart regarding incident. Patient then transferred via ambulance to ED. Per EMS patient had 5-6 seizures requiring 4mg Ativan IM. Patient reports she has seizures, is seen by Neurology and takes Keppra and Depakote. On further documentation review, patient was seen by Neurology and was felt to not have seizures. She was also seen by psychiatry who noted that patient most likely has psychogenic nonepileptic seizure-like activity. Patient observed in the ED without further symptoms or episodes. Discharged to home.


VAERS ID: 1357766 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Nasal congestion, Secretion discharge
SMQs:, Anaphylactic reaction (broad)

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

Write-up: Systemic: nasal congestion, cough, mucus-Medium


VAERS ID: 1357778 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Injection site swelling, Myalgia, Neuralgia, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: She got her 1st Moderna vaccine, within 2 hours she functional neurological symptoms kicked in, and they were worse than usual,
Other Medications: Propranolol.
Current Illness: None.
Preexisting Conditions: Functional neurological disorder, high blood pressure, arthritis, chronic pain all over.
Allergies: Foods: Chick peas. Medicine: Septra, Omeprazole, Lisinopril, Hydralazine, a lot of blood pressure medications, Trospium, Omega red.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Got the vaccine, within 24 hours she started running fever that was 100-101.5 which she took Ibuprofen for and it disappeared. Every part of her body that is normally painful became worse from aching. Both of the vaccine injection sites felt like somebody was stabbing her in the arm. The injection site itself was swollen the majority of the time, sore muscle. After she got over the physical pain of the vaccine, she ended up with sciatic nerve issues and still trying to get over that. She did take Ibuprofen for the pain and aspirin. Everything has calmed down except for the sciatic nerve pain. She is back to her baseline from before the vaccine. She would say that the pain from the vaccine was bad as her mother''s shingles. She did notify her doctor but had power outages and problems, but did take her pain medicine which helped.


VAERS ID: 1357951 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Burning sensation, Chest pain, Feeling abnormal, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: My son developed a fever, brain fog, and his legs felt like they were burning. More worrisome was the heart pain he woke up with in the middle of the night and throughout the day on 5/20. He complained of a sharp stabbing pain on left side of his chest and said it was hard to take a deep breath. I gave him ibuprofen and he rested. I called his doctor and they said not to worry, these side effects were normal. I?m a bit nervous for him to get the second vaccine since he had the chest pain side effects as to why I?m reporting this. I?m surprised they give the same dose to a 80lb child, they do to a 200 lb grown man.


VAERS ID: 1358014 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site erythema, Injection site induration, Injection site pain, Injection site pruritus, Injection site rash, Injection site reaction, Injection site swelling, Injection site urticaria, Injection site warmth, Nausea, Night sweats, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline 100 mg Benadryl/Claritin - recently started within the last 2 months. everyday/every other day.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nasuea and night sweats a day or two after 1st dose - no longer occuring. At injection site - rash, welt, hives - raised, hard, silver dollar sized. round, itchy, painful. Still occuring -- $g getting redder and redder, heat coming off of it.


VAERS ID: 1358066 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Dyspnoea, Refusal of treatment by patient
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

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

Write-up: Pt presented with complaint of mild SOB. Pt denied CP. Full assessment performed and V/S obtained. Pt denied any significant PMH. (+)breath sounds and equal bilaterally, (-)stridor noted. Pt stated that he felt as though it may have been an anxiety reaction. Pt rested in observation area x10 mins. At conclusion of time, pt noted relief of symptoms. Pt stated that he did not want to go to the hospital. Pt informed of risks of refusing, up to and including death. Pt accepted risks and stated he would follow-up with his PCP. Pt signed AMA and released without incident.


VAERS ID: 1358105 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-04-07
Onset:2021-05-20
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Angiogram, Arthralgia, Bell's palsy, Blood test, Facial paralysis, Facial paresis, Neck pain
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad), Arthritis (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, Propranolol, Furosemide, Losartan, Lipitor, Metformin, Tramadol, Prilosec, Zyrtec, Multivitamin, Vitamin D, Calcium, Iron, Niacin, Baby Aspirin
Current Illness: None
Preexisting Conditions: Diabetes (type 2), Obesity, Chronic Kidney Disease, Fatty Liver, Hypertension, Hypothyroidism, Fibromyalgia, Sleep Apnea, Iron Deficiency, Migraine
Allergies: Sulphate, Imitrex
Diagnostic Lab Data: CTA 5/21/21 Labs 5/21/21
CDC Split Type:

Write-up: Bell?s Palay being treated with Prednisone and Valtrex. Right side of face weakness/paralyzed. Presented with neck and shoulder pain at onset. Unsure if the vaccine is the cause.


VAERS ID: 1358145 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Chills, Coordination abnormal, Decreased appetite, Dyspepsia, Dyspnoea, Fatigue, Feeling abnormal, Fine motor skill dysfunction, Grip strength decreased, Heart rate increased, Hyperhidrosis, Hypoaesthesia, Immediate post-injection reaction, Impaired work ability, Joint stiffness, Muscle contractions involuntary, Muscle spasms, Muscle tightness, Musculoskeletal stiffness, Nausea, Pain, Palpitations, Paraesthesia, Pyrexia, Sensory loss, Swelling, Thirst, Tinnitus, Tremor, Vertigo
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hearing impairment (narrow), Vestibular disorders (narrow), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D
Current Illness: Pityriasis Rosea, Dermatitis, Thyroiditis
Preexisting Conditions: Seasonal depression, some anxiety but has never interfered with day-to-day functioning.
Allergies: None, but sensitive to polyester and some synthetic fabrics
Diagnostic Lab Data: Tuesday, May 25: Urine and saliva analysis Thursday, May 27: Cardiogram, chest x-ray, neurological assessment, blood tests at hospital in
CDC Split Type:

Write-up: Immediate numbness following injection. Later that evening ~7:00 p.m. joints and muscles in left arm/shoulder curled and seized-up. Tingling pins and needles with loss of sensation and dexterity. At bed time May 20th - continued pain, stiffness and swelling accompanied by high fever, chills, excessive sweating, and muscle convulsions. Intense ringing in ears. Next morning (May 21st) I had to miss work. Continued fever, chills, loss of appetite, mild nausea, nerve spasms and locked joints throughout entire body. I felt as though my body was poisoned. The weekend consisted of major fatigue and falling asleep during the day intermittently. Numb arms, weakened grip - could barely make a fist, and had a loss of coordination. Brain fog, delayed thoughts and physical responses. CONTINUED MUSCLE WEAKNESS AND NERVE SPASMS. I contacted doctor for help since my PCP''s office was not open until Monday. I began taking Magnesium and B vitamins. I was drinking 1.5 gallons of water daily and still feeling thirsty. Called Doctor on the 24th to report involuntary muscle spasms in neck shoulders and lower back, joint stiffness, numbness, slowed circulation (pins and needles), and a vertigo-like falling sensation at bedtime. Cannot get to sleep comfortably without the spasms and my head rolling. He recommended Benadryl and Tylenol which I began taking which helped the numbness but not the shakiness and nerve spasms. He also offered a muscle relaxer, but I was concerned about waking up and driving to work in the early mornings so I declined since having trouble waking up with all the fatigue. It didn''t matter anyway because since then I have missed work due to the sudden weakness, head fog, indigestion, and nerve tremors. Wednesday, I needed assistance going up and down stairs because my limbs felt limp like rubber bands. My joints are unusually cracking while my breathing is more labored. My resting heart rate was elevated and I could feel it beating harder than normal. Thursday, I drove myself to the E.R. because I feel as if I have aged 30 years in under a week. Their blood tests, EKG, and x-rays found nothing abnormal and I received fluids through an IV. However my nervous system feels absolutely shot. THIS IS NOT NORMAL. I WAS INCREDIBLY HEALTHY BEFORE THE SHOT. I WAS NOT INFORMED OF THESE RISKS. I LIVE A CLEAN, ACTIVE LIFESTYLE WITH REGULAR DIET AND EXERCISE. I HAVE NEVER NOT BEEN ABLE TO ARTICULATE MY BODY MOVEMENTS FLUIDLY AND PRECISELY. my doctor suspected I previously had an asymptomatic case of Covid, and that I had an allergic reaction directly related to the vaccine that attacked my nervous system. I FEEL SO MISERABLE AND WRONG. I worry about my quality of life from here on out even though I''m told these symptoms will pass. Today, over a week post my first shot, I have loss of sensation in my arms, tingling in my extremities and base of skull, neck, and lower back (worse at night and when resting). My nerves are still randomly firing and I feel shaky. My body feels as if it has slowed down its automatic functions.


VAERS ID: 1358282 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-18
Onset:2021-05-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood creatine phosphokinase, Blood creatinine, Blood electrolytes normal, Fatigue, Laboratory test abnormal, Myalgia, Renal function test normal, Rhabdomyolysis, Urine analysis
SMQs:, Rhabdomyolysis/myopathy (narrow), Neuroleptic malignant syndrome (broad), Eosinophilic pneumonia (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: Ibuprofen, Ondansetron, Citalopram
Current Illness: None
Preexisting Conditions: Panic disorder, insomnia
Allergies: No known allergies
Diagnostic Lab Data: Electrolytes, Creatinine, urinalysis, CK.
CDC Split Type:

Write-up: Seen for persistent myalgia and fatigue. Labs showing mild rhabdomyolysis. No evidence or symptoms of decreased urine output. Electrolytes and renal function within normal limits. Started on IV fluids and with follow up the next day.


VAERS ID: 1358350 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Interchange of vaccine products, No adverse event
SMQs:, Medication errors (broad)

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

Write-up: No adverse event; patient received Pfizer vaccine on 4/29/21 and received Moderna vaccine on 5/20/21.


VAERS ID: 1358371 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Vaccination 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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: No known allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Adverse event: patient inadvertently received Moderna vaccine instead of Pfizer. No adverse reaction/response reported by mother of child.


VAERS ID: 1358403 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-13
Onset:2021-05-20
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / SYR

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

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

Write-up: The client tested positive for COVID19 shortly after her second dose in the two dose series of the Moderna vaccine.


VAERS ID: 1358425 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-03-30
Onset:2021-05-20
   Days after vaccination:51
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Injection site pain, 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: Vitamins:D 3, Omega 3, Calcium RX: Estradiol 1mg
Current Illness: none
Preexisting Conditions: none
Allergies: latex
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pain in right arm at injection site, sometimes radiating down to elbow and or hand. There is no swelling or redness. I hd the same pain for a few days after receiving the vaccine, but was not expecting it to reoccur almost 3 months later. Right arm was where I received my first injection on March 1, 2021. My second injection was received in my left arm on 3/30/2021. My left arm is not causing me any discomfort.


VAERS ID: 1358516 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-18
Onset:2021-05-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site swelling, Injection site warmth, Nausea, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol Succinate Extended Release, Terazosin, Hydrochlorothiazide, fish oil capsules, vitamin D3, COQ10, holy basil, hawthorn berry drops
Current Illness: none
Preexisting Conditions: Hypertension
Allergies: Shellfish, chicken and mushrooms, Lisinopril, Benicar, trees, grasses, some animal fur
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Severe headache, similar to a sinus headache but much worse, severe nausea, extreme fatigue, red rash on clavicle bone, red rash on and around upper right arm vaccination site, heat and swelling around site. No treatment of any kind. All symptoms began clearing on Wednesday, May 26, 2021. All symptoms cleared on Friday, May 28, 2021.


VAERS ID: 1358693 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-10
Onset:2021-05-20
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Dysgeusia
SMQs:, Taste and smell disorders (narrow)

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

Write-up: Metallic taste in mouth


VAERS ID: 1358707 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-05
Onset:2021-05-20
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Echocardiogram, Laboratory test, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine, flexeril, iron, Flovent, folic acid, meloxicam, MVI, pantoprazole
Current Illness: N/A
Preexisting Conditions: HTN, GERD, arthritis, seasonal allergies
Allergies: NKDA
Diagnostic Lab Data: Echo, labs, hospitalization
CDC Split Type:

Write-up: Pericarditis


VAERS ID: 1358708 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-17
Onset:2021-05-20
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / UNK RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Cardiac monitoring, Chest X-ray, Echocardiogram, Electrocardiogram, Heart rate increased, Infectious mononucleosis, Laboratory test, Pericarditis
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol
Current Illness: NONE
Preexisting Conditions: ASTHMA
Allergies: NKDA
Diagnostic Lab Data: LAB WORK ECHO CARDIOGRAM CHEST XRAY CARDIAC MONITORING EKG
CDC Split Type:

Write-up: RAPID HEART RATE PERICARDITIS + MONO WEAKNESS


VAERS ID: 1358712 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-13
Onset:2021-05-20
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Angiogram cerebral normal, Bacterial test negative, Blood culture negative, Blood lactate dehydrogenase increased, C-reactive protein increased, CSF culture negative, CSF pressure increased, Cytomegalovirus test negative, Diarrhoea, Epstein-Barr virus test negative, HIV test negative, Haemophagocytic lymphohistiocytosis, Hepatitis viral test negative, Herpes simplex test negative, Hypotension, Intensive care, Magnetic resonance imaging head normal, Mental status changes, Papilloedema, Pyrexia, Retching, SARS-CoV-2 antibody test, SARS-CoV-2 antibody test positive, SARS-CoV-2 test negative, Serum ferritin increased, Systemic inflammatory response syndrome, Toxicity to various agents, Venogram normal
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Drug abuse and dependence (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Optic nerve disorders (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Sepsis (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow), 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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: YAZ, Lamictal, Invega, Atarax, Benadryl, and melatonin.
Current Illness: None
Preexisting Conditions: Bipolar disorder, anxiety disorder, polycystic ovary disease
Allergies: None. Celiac disease but not proven by biopsy.
Diagnostic Lab Data: (Labs are from 5/24/2021 to present) This individual developed high grade inflammatory syndrome that most resembled HLH. She had high ferritin levels to 11,600 mcg/L, CRP to 64 mg/L, LDH to 1,200 u/L. COVIC PCR was negative. COVID IgG was positive for spike protein antibody and negative for nucleocapsid antibody. Viral studies for CMV, HSV, EBV, viral hepatitis panel and HIV were all negative. Head MRI/MRA/MRV negative except for nonspecific toxic reaction in corpus callosum. CSF opening pressure was elevated and patient has papilledema. CSF bacterial culture, blood cultures negative. Started to improve after psychiatric medications were discontinued so also entertaining diagnosis of Lamictal induced HLH.
CDC Split Type:

Write-up: This 15 year and 11 month old female developed fevers, abdominal pain, diarrhea and constant wrenching. She was seen in the ED and noted to be hypotensive and meeting SIRS criteria so was admitted to the PICU and started on norepinephrine pressor support. She had fevers to 39 degrees C and about a day into hospitalization developed acute mental status changes.


VAERS ID: 1358719 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWD179 / 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: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: NKDA
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Patient came to receive her follow-up COVID vaccine indicating that she had previously received the Pfizer vaccine. Accordingly we gave her the Pfizer vaccine and she went on her way after waiting 15 minutes and having no ill effects. Upon entering her information later in the day we discovered she had actually previously received the Moderna vaccine. We notified the patient, our clinical team and district manager. Upon further research we found that because they are both mRNA vaccines the patient does not require further vaccination for COVID. We informed the patient who seemed pleased with this outcome.


VAERS ID: 1359032 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

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

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

Write-up: Patient accidentally given Pfizer dose 2 in covid vaccine series instead of Moderna which is what he should have gotten. MD has provided guidance on potential sx to look for and when to report to PCP or ED.


VAERS ID: 1359282 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 2 RA / IM

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

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

Write-up: Patient is not having any adverse reaction. but first dose given 04/29/21, so the second dose was given a week early on 05/20/21


VAERS ID: 1359948 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:2021-05-20
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Antibody test, Therapy non-responder
SMQs:, Lack of efficacy/effect (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210520; Test Name: Antibody test; Result Unstructured Data: NEGATIVE, less than 1
CDC Split Type: USJNJFOC20210551575

Write-up: CONFIRMED IMMUNOLOGICAL VACCINE FAILURE; This spontaneous report received from a consumer concerned a male of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 206A21A, expiry: UNKNOWN) 1 total, dose was not reported, administered on 12-APR-2021 for prophylactic vaccination. No concomitant medications were reported. The patient''s wife reported that, on 20-MAY-2021, the patient''s antibody test was negative with score less than 1 (confirmed immunological vaccine failure). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of confirmed immunological vaccine failure was not reported. This report was serious (Other Medically Important Condition). This case, from the same reporter is linked to 20210551477 and 20210550960.; Sender''s Comments: V0:20210551575-covid-19 vaccine ad26.cov2.s -confirmed immunological vaccine failure . This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS


VAERS ID: 1360603 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Iron deficiency anemia; Migraine (migraines); Pulmonary embolism (PE''s)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021575984

Write-up: Fever; Chills; Body aches; No energy; Vomiting; Nauseous; Just don''t feel like sitting up; This is a spontaneous report from a contactable consumer (the patient). A 45-years-old non-pregnant female patient received first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for injection, Batch/Lot number was not reported) via an unspecified route of administration, in left arm on 19May2021 17:00 (at the age of 45-years-old) as a single dose for COVID-19 immunization. Medical history included iron deficiency anemia, migraines and pulmonary embolism (reported as PE''s) from an unknown date and unknown if ongoing. The patient''s concomitant medications were not reported. The patient did not receive any other vaccines within 4 weeks prior to COVID vaccine. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient has not been tested for COVID-19. On 20May2021 03:00, the patient experienced fever, chills, body aches, no energy, vomiting, nauseous, just don''t feel like sitting up. The consumer considered events as non-serious. The patient did not receive treatment for adverse events. Information on the lot/batch number has been requested.


VAERS ID: 1360604 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210520; Test Name: body temperature; Result Unstructured Data: Test Result:100 Fahrenheit; Test Date: 20210520; Test Name: body temperature; Result Unstructured Data: Test Result:100.9 Fahrenheit
CDC Split Type: USPFIZER INC2021576005

Write-up: Caller reports that she is running a fever today in which the fever was 100 degrees Fahrenheit; This is a spontaneous report from a contactable consumer. A 67-year-old female patient received bnt162b2 (BNT162B2), dose 1 via an unspecified route of administration on 19May2021 (Batch/Lot number was not reported) as 1ST DOSE, SINGLE for covid-19 immunization. The patient medical history and concomitant medications were not reported. The patient reported, she received the first dose of the Pfizer Covid-19 vaccine yesterday and she is running a fever today in which the fever was 100 degrees Fahrenheit earlier today and is now 100.9 degrees Fahrenheit. Outcome of event was unknown. Information about lot/batch number has been requested.


VAERS ID: 1360613 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-04-30
Onset:2021-05-20
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Flank pain, Pulmonary embolism, SARS-CoV-2 test
SMQs:, Retroperitoneal fibrosis (broad), Embolic and thrombotic events, venous (narrow), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Gout; Hypertension; Osteochondritis dissecans
Allergies:
Diagnostic Lab Data: Test Date: 20210521; Test Name: Nasal Swab; Test Result: Negative
CDC Split Type: USPFIZER INC2021584939

Write-up: bilateral subsegmental PTEs; right flank pain under ribs; This is a spontaneous report received from a contactable HCP. A 64-year-old male patient received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, Lot number EW0153), via an unknown route, on 30Apr2021 (at the age of 64-year-old) at single dose for COVID-19 immunisation, administered at Pharmacy/drug store. The patient was not diagnosed with COVID-19 before vaccination. Relevant medical history included hypertension (HTN), gout and osteochondritis dissecans (OCD). No relevant concomitant medications were provided. The patient did not have allergies. No other vaccine was received in four weeks. The patient presented to the emergency room (ER) with right flank pain under ribs. Found to have bilateral subsegmental pulmonary thromboembolisms (PTEs). The onset date of the events was provided as 20May2021. Both events were reported serious because requiring hospitalization for 3 days (admission date not provided) and as life-threatening conditions. The patient was treated with enoxaparin then apixaban. Nasal swab was done on 21May2021 and resulted negative. The patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, Lot number EW0172) on 21May2021 for COVID-19 immunisation. The patient was treated with enoxaparin then apixaban. The patient was recovering from the events.; Sender''s Comments: Based on the current available information and the plausible drug-event temporal association, a possible contributory role of the suspect product BNT162B2 to the development of all reported events cannot be totally excluded. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.


VAERS ID: 1360616 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Decreased appetite, Hallucination, Illness, Movement disorder, Pain, Swelling, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021586922

Write-up: hallucinations; very sick; unable to move/unable to get out of bed; pain throughout my entire body; Vomiting; swelling; lost of appetite for 2 days; This is a spontaneous report from a non-contactable consumer (patient). A 36-year-old male patient received the second dose of BNT162B2 (PFIZER COVID-19 VACCINE, lot number: EW0182), at the age of 36 years old, in left arm on 20May2021 10:15 at single dose for covid-19 immunisation. The patient medical history was none. The patient had no known allergies. The patient was not diagnosed with covid-19 prior to vaccination. The patient did not receive any other medications within 2 weeks of vaccination. The patient previously received the first dose of BNT162B2 (lot number: EW0170), at the age of 36 years old, in left arm on 29Apr2021 10:15 at single dose for covid-19 immunization. The patient did not receive any other vaccines within 4 weeks prior to vaccination. The patient became very sick, unable to move, unable to get out of bed, incredible pain throughout his entire body, vomiting, swelling, hallucinations and lost of appetite for 2 days on 20May2021 23:00. The patient had not been tested for covid-19 since the vaccination. The treatment for events was unknown. The outcome of events was recovering. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1360619 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-18
Onset:2021-05-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 2 RA / -

Administered by: Other       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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021592135

Write-up: Leg swollen; Foot swelling; This is a spontaneous report from a contactable consumer. An 84-year-old male patient received bnt162b2, dose 2 via an unspecified route of administration, administered in Arm Right on 18May2021 (Batch/Lot Number: ER8736, Expiry Date: 31Aug2021) as 2ND DOSE, SINGLE for covid-19 immunization. The patient medical history was not reported. The patient''s concomitant medications were not reported. NDC and UPC number of vaccines is unknown. On 20May2021 patient experienced leg swollen- peripheral swelling, foot swelling 2 days after taking shot. The outcome of the events was unknown. The outcome of events unknown.


VAERS ID: 1360620 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021592410

Write-up: Asked if he could take medicine for his headache; This is a spontaneous report from a Pfizer- sponsored program Covax US Support. A non-contactable male consumer (patient) of an unspecified age received BNT162b2 (PFIZER BIONTECH COVID-19 mRNA VACCINE, Solution for injection, Lot number: unknown), via an unspecified route of administration on 20May2021 as 1st dose, single for COVID-19 immunization. The patient medical history and concomitant medications were not reported. Medical questions addressed by this program were not forwarded/referred to medical information. The patient was asked if he could take medicine for his headache. The patient was received the 1st dose of Pfizer COVID-19 vaccine a few hours ago (20May2021). Customer and/or medical inquiry was not forwarded or referred to MI. Outcome of the event was unknown. No follow-up attempts are possible; information about lot/batch number cannot be obtained.


VAERS ID: 1360749 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 2 LA / SC

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

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

Write-up: fever,chills,muscules pain.


VAERS ID: 1360838 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-17
Onset:2021-05-20
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Chest pain, Cough, Deep vein thrombosis, Dyspnoea, Echocardiogram abnormal, Full blood count, Haemoptysis, Leukocytosis, Murphy's sign test, Pneumonia, Pulmonary embolism, SARS-CoV-2 test negative, Sepsis, Supraventricular tachycardia, Tachypnoea, Ultrasound abdomen normal
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Supraventricular tachyarrhythmias (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (broad)

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

Write-up: Presented to ED with complaint of chest pain onset 0800 this morning. He endorse shortness of breath and a cough that has been ongoing for three weeks.Patient even at rest has significant tachypnea usually in the 40s and sometimes even into the 50s breaths per minute. Sepsis present on admission. COVID-19 infection was diagnosed on the eighth of this month, now is negative. Has been on a ceftriaxone and azithromycin. Could be due to multifocal pneumonia and PE. Changed to cefuroxime,7-day course. Leukocytosis could be due to steroids, recommend to repeat CBC in about a week. Multifocal pneumonia: With underlying COVID-19 diagnosed on the eighth, now is negative. Completed azithromycin for 3 days and was on a ceftriaxone, changed to p.o. cefuroxime on antibiotic for suspicion for secondary bacterial infection, will complete the course. Acute bilateral pulmonary emboli: on Xarelto. Echo reviewed. Mild hemoptysis: Could be due to pulmonary emboli, infarcts, remains on anticoagulation. No recurrence. Left lower extremity DVT/SVT: Anticoagulation as above. Transaminitis: Denies use of alcohol, he has some nonspecific complaint on the right sided abdomen but negative Murphy and ultrasound shows normal gallbladder, normal liver, stable.


VAERS ID: 1360909 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-18
Onset:2021-05-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 2 RA / IM

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

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

Write-up: Patient states severe pain that is underarm between his shoulder and elbow.


VAERS ID: 1361172 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-15
Onset:2021-05-20
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Fatigue, Heart rate increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (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: Robitussin , Tylenol Severe Cold On 5/18/21 I was prescribed MethyIPREDNISolone, 6 day package. I was on day 2 when the accelerated heart rate started.
Current Illness: nasal congestion from Covid starting on March 21st.
Preexisting Conditions: Asthmatic cough triggered by seasonal allergies
Allergies: none; seasonal allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 5/15/21 I experienced a high fever (100) from 10:30pm until 8:00am. I was very tired and experienced lots of coughing through most of 5/16. On 5/20/21 around 12:15pm I experienced an accelerated heart rate between 125 and 152 over the course of 6 hours.


VAERS ID: 1361176 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW018N / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Amnesia, Confusional state, Dizziness, Fatigue, Feeling abnormal, Hypoaesthesia, Lip disorder, Malaise, Paraesthesia, Pulse abnormal
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D, Reveratrol, Fish Oil
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Standard physical exam and standard neurological exam.
CDC Split Type:

Write-up: Walking to the observation room approximately 2 minutes post shot I felt extreme dizziness. Felt like I could potentially pass out so I waited 30 minutes in the observation room before leaving. After I was fairly confident I would not pass out I left the facility. When I made it outside it felt like the right side of my brain was "not there," like a portion of my brain was dead. While driving home approximately 45 minutes post shot I felt numbness and tingling on the right side of my face. Mental confusion also started. I don''t recall the numbness and tingling in my face continuing at this time. Proceeded home, laid down on the couch to relax and about 3 hours post shot felt my heart racing. Checked heart rate with pulse oximeter and heart rate was 120 w/98 oxygen. 5 minutes later the heart rate went down to around 90 but blood oxygen went to 90. I sat up, drank water and pulse/oxygen returned to normal. The next day the mental confusion continued. Approx. 24 hours post shot tingling and numbness felt on right side of face. Couldn''t move lips properly, communicate to my facial muscles. This lasted around an hour or two. 30 hrs post shot short term memory loss caused confusion when typing texts, following conversation, etc. Symptoms improved greatly over the next couple of days. Tiredness/general unwell feeling approximately 48hrs post shot but unremarkable. By the time I went to a GP 84hours post shot I felt 95%. Went to a neurologist 108hrs post shot who performed standard tests and all was well. 1 week post shot got into an argument and felt tingling and numbness on right side which lasted approximately 10 seconds.


VAERS ID: 1361287 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-12
Onset:2021-05-20
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site rash, Injection site reaction, Rash, 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: metformin, Levothyroxine
Current Illness:
Preexisting Conditions: type 2 diabetes
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Rash on left arm for days after the injection. It was itchy and red and increased in size but weakened in color over the last few days. Then she noticed that her skin around her neck had small bumps. It seems maybe the problem has spread.


VAERS ID: 1361313 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Gingival bleeding
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gingival disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adult vitamins
Current Illness: None
Preexisting Conditions: None
Allergies: Allergic to saccharine, Indocin, and sulfa drugs
Diagnostic Lab Data: As stated before, I have no health care or providers.
CDC Split Type:

Write-up: Moderately severe gum bleeding around each tooth. I drooled blood at night onto a towel. "Signs and symptoms" gradually ended.


VAERS ID: 1361353 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-13
Onset:2021-05-20
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Condition aggravated, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (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: None
Current Illness: High cholesterol
Preexisting Conditions: High cholesterol
Allergies: None
Diagnostic Lab Data: Na
CDC Split Type:

Write-up: Heart palpitations started last week and are getting worse today.. every few minutes


VAERS ID: 1361400 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-05-16
Onset:2021-05-20
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Ear discomfort, Gait inability, Loss of personal independence in daily activities, Neurodevelopment test, Vertigo
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Vestibular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Vertigo, dizziness, lightheadedness and pressure in ears for almost 2 weeks after second dose
Other Medications: Sumatriptan 100 mg
Current Illness: Migraine
Preexisting Conditions: No
Allergies: Not known
Diagnostic Lab Data: neurologist tests
CDC Split Type:

Write-up: After five days from the second dose of Moderna Covid Vaccine, I started to have vertigo, dizziness and lightheadedness and pressure on my ears. It is worse when I walk or turn my haead; I am at the day 13 today from the vaccine secon dose, and still have those feelings without any improvement. This has made me unfunctional and unable to walk or do my daily activities. I went to my neurologist 2 days ago and she found nothing wrong with my tests. She finally prescribed otc medication: "meclizine" that has not helped me much. I saw a lot of people are experiencing the same issue, dizziness and vertigo ;Please see thsi forum which shows I am not the only one. /


VAERS ID: 1361426 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

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

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

Write-up: Received the first shot on 05/19/21 around 7:00pm. Noticed side effects on 5/20/21 around 9:00am. Severe itching redness, welts. Started taking antihistamine on 5/21/21. The problem still persist after taking antihistamine for a week. Went to the Urgent Care on 05/29/21. The Nurse Practitioner prescribed Methylprednisolone tablets and cream. I have taken day 1 dose and still no relief. I now regret taking the shot.


VAERS ID: 1361470 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-13
Onset:2021-05-20
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Appendicectomy, Appendicitis, Back pain, Computerised tomogram abdomen abnormal, Laboratory test abnormal, Neutrophil count increased, Surgery, White blood cell count increased
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril 2.5mg Fluoxetine 20mg
Current Illness: None
Preexisting Conditions: PMDD & high blood pressure
Allergies: None
Diagnostic Lab Data: CT Scan 5/22/21 Labs 5/22/21 Surgery 5/22/21
CDC Split Type:

Write-up: Abdominal pain and lower back pain started on May 15, 2021. No fever, nausea or vomiting. Labs on 5/22/21 showed elevated white blood cells and neurophils. CT Scan confirmed acute appendicitis on 5/22/21. Appendix removed on 5/22/21.


VAERS ID: 1361649 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-19
Onset:2021-05-20
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Back pain, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Retroperitoneal fibrosis (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Joint and muscle pain everyday. I?m not sure it?s because of the vaccine obviously, but I?ve never experienced it before. My elbows and my right shoulder and back have been hurting so much recently.


VAERS ID: 1361687 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal discomfort, Decreased appetite, Diarrhoea, Fatigue, Headache, Weight decreased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Valium 5mg/night
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chronic severe headache Chronic Upset stomach Chronic Diarrhea Loss of appetite Weight loss Chronic fatigue


VAERS ID: 1361734 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

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

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

Write-up: Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Systemic: Allergic: Itch Generalized-Medium, Systemic: Allergic: Rash Generalized-Medium


VAERS ID: 1361792 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-13
Onset:2021-05-20
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Diarrhoea, Dizziness, Fatigue, Headache, Heart rate increased, Myalgia, Nausea, Postural orthostatic tachycardia syndrome
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin, Lexapro 5mg
Current Illness: None
Preexisting Conditions: None
Allergies: Allergic to penicillin
Diagnostic Lab Data: Patient has been seen multiple times since the onset of the symptoms. He has been to the ER. We were advised by his pediatrician to have him be seen by a pediatric cardiologist immediately for suspected PoTS. patient was 100% healthy with NO chronic conditions prior to the first dose of the COVID vaccine (Pfizer).
CDC Split Type:

Write-up: Six days (evening of 5/20) after the first dose of the COVID vaccine (Pfizer), Patient started to experience severe dizziness and nausea. Since that evening he has experienced the following: - Significant increase in heart rate when transitioning from laying down to sitting and/or standing. - Severe dizziness - Excessive fatigue - Headaches - Gastrointestinal issues (constant nausea. Nausea increases in severity when standing. Diarrhea.) - Muscle pain in his upper arms and upper legs The above symptoms have continued 24/7 since their onset.


VAERS ID: 1362137 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Burning sensation, Herpes zoster, Pain, Rash
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

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

Write-up: Moderna COVID-19 Vaccine EUA, on my upper left back and middle front belly, burning- throbbing pain for days, which erupted as rash in defined circles or clusters 5 days later. Diagnosed as Herpes Zoster (Shingles) on 27-May-21. Still in throes of the rash and pain, currently being treated with valacyclovir 1000 mg po tid, for 7 days.


VAERS ID: 1362217 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-07
Onset:2021-05-20
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-05-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pyrexia, SARS-CoV-2 test negative
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I take Lisinopril, metoprolol, Once a week a take Vitamin B pill, I take Pepcid AC and a generic for singulair.
Current Illness: I did not have any illnesses.
Preexisting Conditions: I have diabetes (type 2), asthma and high blood pressure.
Allergies: I am allergic to sulfa.
Diagnostic Lab Data: I had a COVID test performed and it came back negative.
CDC Split Type: vsafe

Write-up: I had a fever that ran high for 2-3 days. The highest it got was to 103 degrees. I ended up with bronchitis. I was given amoxicillin and another pill for a cough suppressant. Today I am feeling fine.


VAERS ID: 1362238 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-05-12
Onset:2021-05-20
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019B21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dry skin, Pain in extremity, Rash erythematous, Rash pruritic, Skin exfoliation
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartin
Current Illness: Pinched nerve in back
Preexisting Conditions: Back pain and hypertension
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Itchy thick and red rash. Rash turned into one large blob. Presently, the site is healing, flaky and dry a little sore.


VAERS ID: 1362524 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

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

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

Write-up: Patient stated after 2nd dose of Moderna, 1.5 hours and 14 hours after receiving the shot he was shaking convulsively.


VAERS ID: 1362602 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-17
Onset:2021-05-20
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Echocardiogram, Full blood count, Pulmonary embolism, Ultrasound Doppler
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Alendronate 70 mg, gabapentin 300mg, vitamin D 1000 units, Naproxen 550mg
Current Illness: none
Preexisting Conditions: Dystonia, essential tremors
Allergies: primidone, Clonazepam
Diagnostic Lab Data: cbc and differential, echo, us doppler vein bilateral lower extremities,
CDC Split Type:

Write-up: the diagnosis was : Acute Pulmonary Embolism


VAERS ID: 1363803 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Ohio  
Vaccinated:0000-00-00
Onset:2021-05-20
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Non-smoker
Preexisting Conditions: Comments: The patient had no known drug allergy.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210553177

Write-up: LOSS OF TASTE; COUGH; BODY ACHES; CHILLS; FEVER; FATIGUE; HEADACHE; NAUSEA; MUSCLE ACHES; This spontaneous report received from a patient concerned an 81 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included non-smoker, and non-alcohol use, and other pre-existing medical conditions included the patient had no known drug allergy. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1820095, and batch number: 1820095 expiry: UNKNOWN) dose was not reported, administered on 13-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 20-MAY-2021, the subject experienced loss of taste. On 20-MAY-2021, the subject experienced cough. On 20-MAY-2021, the subject experienced body aches. On 20-MAY-2021, the subject experienced chills. On 20-MAY-2021, the subject experienced fever. On 20-MAY-2021, the subject experienced fatigue. On 20-MAY-2021, the subject experienced headache. On 20-MAY-2021, the subject experienced nausea. On 20-MAY-2021, the subject experienced muscle aches. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from loss of taste on 25-MAY-2021, body aches, and muscle aches on 22-MAY-2021, chills on 24-MAY-2021, fever on 27-MAY-2021, and headache, and nausea on 26-MAY-2021, and was recovering from cough, and fatigue. This report was non-serious.


VAERS ID: 1363820 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Florida  
Vaccinated:0000-00-00
Onset:2021-05-20
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Joint swelling
SMQs:, Haemodynamic oedema, effusions and fluid overload (narrow), 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:
Current Illness:
Preexisting Conditions: Comments: The patient had no known allergies.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210554403

Write-up: RIGHT ANKLE SWELLING; This spontaneous report received from a patient concerned a 38 year old female. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included the patient had no known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 205A21A, and expiry: UNKNOWN) dose was not reported, administered on 17-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 20-MAY-2021, the subject experienced right ankle swelling. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from right ankle swelling. This report was non-serious.


VAERS ID: 1363923 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Ohio  
Vaccinated:0000-00-00
Onset:2021-05-20
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Feeling abnormal, Hypersensitivity, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Dementia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210556692

Write-up: FEEL BAD; RASH ALL OVER BODY; ALLERGY; This spontaneous report received from a patient concerned a female of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 20-MAY-2021 11:00 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 20-MAY-2021, the subject experienced rash all over body. On 20-MAY-2021, the subject experienced allergy. On 21-MAY-2021, the subject experienced feel bad. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from rash all over body, and feel bad, and the outcome of allergy was not reported. This report was non-serious.


VAERS ID: 1363961 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-05-20
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Laboratory test, Pruritus, Pustule, Rash, Skin exfoliation, Skin lesion
SMQs:, Severe cutaneous adverse reactions (broad), 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: VITAMIN B COMPLEX; VITAMIN D [ERGOCALCIFEROL]; METOPROLOL SUCCINATE; CARDIZEM [DILTIAZEM]; COQ10 [UBIDECARENONE]; BENADRYL [DIPHENHYDRAMINE HYDROCHLORIDE]
Current Illness: Alcohol use; Cigarette smoker (Half a pack a day usually but since on prednisone she was taking a pack per day); Drug allergy
Preexisting Conditions: Medical History/Concurrent Conditions: Clostridium difficile colitis; Colitis microscopic; Partial knee replacement; Premature atrial contraction; Psoriasis; Psoriatic arthritis; Total hysterectomy; Total knee replacement; Tumour excision; Comments: The patient had no known drug abuse or illicit drug usage and no egg allergy
Allergies:
Diagnostic Lab Data: Test Name: Laboratory test; Result Unstructured Data: slightly elevated sodium levels and high triglycerides
CDC Split Type: USJNJFOC20210557913

Write-up: LAYERS OF PUSTULES ON TOP OF PUSTULES ON HER LEFT ARM, PUSTULES STARTED LEAKING OUT; LESIONS ON HER RIGHT FOREARM AND WRIST, LESIONS CONTINUING TO SPREAD, LESION ON HER INTERIOR LOWER RIGHT LEG JUST ABOVE ANKLE; SKIN PEELED OFF ON THE LEFT FOREARM, SKIN PEELING FROM OTHER LESIONS; LESIONS ON HER RIGHT FOREARM AND WRIST, LESION ON HER INTERIOR LOWER RIGHT LEG JUST ABOVE ANKLE; RASH BOTH RIGHT AND LEFT FOREARMS, LEFT TORSO, CHEST, LEFT BREAST, RASHY SYMPTOMS" ON BOTH BUTTOCKS AND HIPS AND BOTH UPPER THIGHS, RASH ON THE BACK OF HER NECK, RASH ON FACE; This spontaneous report received from a patient concerned a 55 year old female. The patient''s height, and weight were not reported. The patient''s past medical history included psoriatic arthritis, premature atrial complexes, microscopic colitis, psoriasis, partial knee replacement, total knee replacement, three tumor removals, complete hysterectomy, and clostridium difficile colitis, and concurrent conditions included dilaudid allergy, rare alcohol use, cigarette smoker, and nsaid allergy, and other pre-existing medical conditions included the patient had no known drug abuse or illicit drug usage and no egg allergy. The patient experienced itchiness and rash when treated with influenza vaccine, and itchiness when treated with codeine. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 202A21A, and expiry: 23-JUN-2021) dose was not reported, administered on 18-MAY-2021 for prophylactic vaccination. Concomitant medications included diltiazem, diphenhydramine hydrochloride, ergocalciferol, metoprolol succinate, ubidecarenone, and vitamin b complex. On 20-MAY-2021, the subject experienced lesions on her right forearm and wrist, lesion on her interior lower right leg just above ankle. On 20-MAY-2021, the subject experienced rash both right and left forearms, left torso, chest, left breast, rashy symptoms" on both buttocks and hips and both upper thighs, rash on the back of her neck, rash on face. On 22-MAY-2021, the subject experienced layers of pustules on top of pustules on her left arm, pustules started leaking out. On 22-MAY-2021, the subject experienced lesions on her right forearm and wrist, lesions continuing to spread, lesion on her interior lower right leg just above ankle. On 22-MAY-2021, the subject experienced skin peeled off on the left forearm, skin peeling from other lesions. Laboratory data (dates unspecified) included: Laboratory test (NR: not provided) slightly elevated sodium levels and high triglycerides. Treatment medications (dates unspecified) included: calamine/glycerol/zinc oxide, methylprednisolone, and hydrocortisone. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from rash both right and left forearms, left torso, chest, left breast, rashy symptoms" on both buttocks and hips and both upper thighs, rash on the back of her neck, rash on face, layers of pustules on top of pustules on her left arm, pustules started leaking out, lesions on her right forearm and wrist, lesions continuing to spread, lesion on her interior lower right leg just above ankle, skin peeled off on the left forearm, skin peeling from other lesions, and lesions on her right forearm and wrist, lesion on her interior lower right leg just above ankle. This report was non-serious.


VAERS ID: 1364002 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-04-22
Onset:2021-05-20
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030B21A / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Chills, Dyspnoea, Loss of consciousness, Pyrexia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ABILIFY
Current Illness:
Preexisting Conditions: Comments: No medical history was provided by the reporter.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20211

Write-up: Passing out feeling when trying to stand up; Severe abdominal pain; Problem to breath in air all the way because of abdominal pain; Chills; Fever; This spontaneous case was reported by a consumer and describes the occurrence of LOSS OF CONSCIOUSNESS (Passing out feeling when trying to stand up) in a 23-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 002C21A and 030B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No medical history was provided by the reporter. Concomitant products included ARIPIPRAZOLE (ABILIFY) for an unknown indication. On 22-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 20-May-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 20-May-2021, the patient experienced LOSS OF CONSCIOUSNESS (Passing out feeling when trying to stand up) (seriousness criterion medically significant), ABDOMINAL PAIN (Severe abdominal pain), DYSPNOEA (Problem to breath in air all the way because of abdominal pain), CHILLS (Chills) and PYREXIA (Fever). The patient was treated with IBUPROFEN at a dose of 1 dosage form. At the time of the report, LOSS OF CONSCIOUSNESS (Passing out feeling when trying to stand up), DYSPNOEA (Problem to breath in air all the way because of abdominal pain), CHILLS (Chills) and PYREXIA (Fever) outcome was unknown and ABDOMINAL PAIN (Severe abdominal pain) had not resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Since 20 May 2021, roughly since 9:00pm onwards, patient started the symptoms like fever, chills and passing out feeling when trying to stand up and severe abdominal pain and having problem to breath in air all the way because of abdominal pain. Patient took Ibuprofen two tablets for the symptoms developed and the abdominal pain still not better, according to the patient. Patient did not take the regular medication Abilify, today (on day of report) which patient used to take daily, because of abdominal pain. Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. This case was linked to MOD-2021-162196 (Patient Link).; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.


VAERS ID: 1364015 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-13
Onset:2021-05-20
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Acute myocardial infarction, Atrial fibrillation, Blood cholesterol, Blood magnesium, Blood phosphorus, Blood triglycerides, Glycosylated haemoglobin, SARS-CoV-2 test
SMQs:, Myocardial infarction (narrow), Supraventricular tachyarrhythmias (narrow), Embolic and thrombotic events, arterial (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: Cholestrol; Test Result: Inconclusive ; Result Unstructured Data: 195; Test Name: Magnesium; Result Unstructured Data: normal; Test Name: Phosphorus; Result Unstructured Data: normal; Test Name: Triglycerides; Test Result: Inconclusive ; Result Unstructured Data: 169; Test Name: HA1c; Test Result: Inconclusive ; Result Unstructured Data: 5.3; Test Date: 20210501; Test Name: Covid-19 test; Test Result: Positive ; Result Unstructured Data: positive
CDC Split Type: USMODERNATX, INC.MOD20211

Write-up: NSTEMI; Rapid atrial fibrillation; This spontaneous case was reported by an other health care professional (subsequently medically confirmed) and describes the occurrence of ACUTE MYOCARDIAL INFARCTION (NSTEMI) and ATRIAL FIBRILLATION (Rapid atrial fibrillation) in a 72-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 003CZ1A) for COVID-19 vaccination. No Medical History information was reported. On 13-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 11-May-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 20-May-2021, the patient experienced ATRIAL FIBRILLATION (Rapid atrial fibrillation) (seriousness criteria hospitalization and medically significant). On an unknown date, the patient experienced ACUTE MYOCARDIAL INFARCTION (NSTEMI) (seriousness criteria hospitalization and medically significant). The patient was hospitalized on 20-May-2021 due to ACUTE MYOCARDIAL INFARCTION and ATRIAL FIBRILLATION. At the time of the report, ACUTE MYOCARDIAL INFARCTION (NSTEMI) and ATRIAL FIBRILLATION (Rapid atrial fibrillation) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 01-May-2021, SARS-CoV-2 test: positive positive (Positive) positive. On an unknown date, Blood cholesterol: 195 (Inconclusive) 195. On an unknown date, Blood magnesium: normal normal (normal) normal. On an unknown date, Blood phosphorus: normal normal (normal) normal. On an unknown date, Blood triglycerides: 169 (Inconclusive) 169. On an unknown date, Glycosylated haemoglobin: 5.3 (Inconclusive) 5.3. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant product was not provided by the reporter. Patient reported that he was healthy with no medical problems and took no medications prior to his vaccines. A pulmonary emboli was ruled out, no history or suspicion of sleep apnea. Treatment information was not provided. The patient received both scheduled doses of mRNA-1273 prior to the event; therefore, action taken with the drug in response to the event was not applicable. Company Comment: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. This case was linked to MOD-2021-163089 (Patient Link).; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.


VAERS ID: 1364316 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-15
Onset:2021-05-20
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, SARS-CoV-2 test
SMQs:, COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data: Test Date: 20210522; Test Name: COVID test; Test Result: Negative ; Comments: Nasal Swab
CDC Split Type: USPFIZER INC2021600726

Write-up: severe headache; This is a spontaneous report from a contactable consumer (patient). A 41-year-old male received the second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 VACCINE), administered in left arm, on 15May2021 12:00 PM (at the age of 41-years-old) at 2nd dose, single for COVID-19 immunization. Medical history was reported as none. The patient had not known allergies. Prior to vaccination, the patient was not diagnosed with COVID-19. Concomitant medications were not reported. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine and/or any other medications within 2 weeks of vaccination. The patient previously received the first dose of BNT162b2 on 24Apr2021 (at the age of 41-years-old) administered in left arm for COVID-19 immunisation. After four days from taking a second shot, on 20May2021 at 16:00 (as reported), the patient started feeling severe headache, it was getting worse until the reporting day (25May2021). The event was reported as serious due to life-threatening event and 2 days of hospitalization from May2021 to May2021. The event resulted in doctor or other healthcare professional office/clinic visit and emergency room/department or urgent care. The patient underwent lab tests and procedures, which included COVID test, nasal swab on 22May2021: negative. Therapeutic measures were taken as a result of the event and included treatment with blood thinner medicine injected. The patient had not recovered from the event. Information on the lot/batch number has been requested.


VAERS ID: 1364489 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Arm sourness and rash; 28 yr; 4/28/2021; COVID-19 vax--MODERNA
Other Medications: Flex oil supplementation.
Current Illness: No
Preexisting Conditions: No
Allergies: Allergic to penicillin.
Diagnostic Lab Data:
CDC Split Type:

Write-up: I had a fever up to 100 degrees for a whole day, and I recovered without treatment after 1 day.


VAERS ID: 1364681 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-13
Onset:2021-05-20
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Appendicectomy, Appendicitis
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Motrin
Current Illness: Arthritis / fibromyalgia pain
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 5-20-2021 and 5-21-2021-- all hospital records from admission to hospital
CDC Split Type:

Write-up: 5-20-21 --- appendicitis and surgery to remove appendix


VAERS ID: 1364722 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-17
Onset:2021-05-20
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017621A / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Pruritus, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Swollen, redness, red ring around swelling, hot surface, itching after 3 weeks


VAERS ID: 1364762 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Keppra, Venlafaxine, Omeprazole
Current Illness: none
Preexisting Conditions: Asthma, GERD, IBS, cysts, hernias, kidney stones, migraines, seizures, endometriosis
Allergies: NKA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Fatigue Nausea Headache Fever- approximately 9pm start, continued for 20 hours Body/Join Aches- caused difficulty sleeping Lasted approximately 24 hours- unable to work during this time


VAERS ID: 1364808 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-05
Onset:2021-05-20
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Decreased appetite, Dyskinesia, Head banging, Seizure, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Dyskinesia (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Mother noticed regression from a vaccine when she was about 4, but does not remember which one, and told her that it was autism.
Other Medications: Women''s daily vitamins (vita fusion), Cannabis infused MCT oil or coconut oil (medical marijuana).
Current Illness: None.
Preexisting Conditions: Autism, epilepsy (lympic seizure).
Allergies: Adhesive as a child.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: She got her vaccine, she went home and seemed to have slept a lot with both vaccines. She also had lack of appetite and did not want to come down to the table to eat, just wanted to sleep. If her mother could get her down to eat, she would take 2 bites of food and go back to bed, which mother feels the vaccine may have lowered her threshold for seizures. About 15 days after the vaccine she came to her door and she was banging in the hallway and was hollering help me. Her mother felt that she was having a seizure which she has not had any in about 2 1/2 years, and she was into one that her mother stopped with the cannabis oil. They have been controlled with the cannabis oil for the last 2 1/2 years but she was having multiple daily seizures prior to the cannabis oil. Her mother went downstairs and got her cannabis capsules and the MCT oil which she gave sublingually and she started to subside from the screaming and then moaned for 30 minutes. She then started to have involuntary neck movements and her head would swing back as she is walking, and she has been tapping her head on items and on her mother, which her mother thinks she is trying to tell her that something is wrong. She was not doing this prior to the 2nd vaccine. Her days and nights also seemed to be out of sorts since the vaccine as well. She is very limited in communication and does not speak much, but has so more since she started the cannabis oils.


VAERS ID: 1364856 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Military       Purchased by: ?
Symptoms: Syringe issue, Underdose
SMQs:, Medication errors (broad)

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

Write-up: Some of the vaccine leaked out at the hub during administration - more than half of the dose was given so a repeat dose was not given.


VAERS ID: 1364895 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Hypoaesthesia, Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Eczema (no recent flare-up within month prior to vaccine)
Allergies: Citrus: hives, GI intolerence
Diagnostic Lab Data:
CDC Split Type:

Write-up: Right arm numbness, swelling, pain for 4 days. Fatigue for 2-3 days.


VAERS ID: 1364929 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-13
Onset:2021-05-20
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Culture urine negative, Dysuria, Urine analysis
SMQs:

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

Write-up: Painful urination, urination urgency beginning in the evening one week after dose. Was seen by family physician next morning; urine test done; white blood cells seen; urine culture done; bacteria not found. Was given antibiotics while waiting for culture results (3 days;) some improvement, but not as expected. Discontinued antibiotics when urine culture found negative. Condition continued to improve, lasting about another 4 days.


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