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

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



Case Details (Reverse Sorted by Onset Date)

This is page 125 out of 6,867

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VAERS ID: 1582756 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO175 / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Fatigue, Headache, Neck pain, Pain in extremity, Tenderness, Tinnitus
SMQs:, Hearing impairment (narrow), 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: vyvance, Wellbutrin, rosuvastatin
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Ringing in ears, throbbing headache, sore/tender right arm, sore neck muscles, fatigued.


VAERS ID: 1582757 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hypoaesthesia, Pain in extremity, Pruritus
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: gabpentin celebrex alprazolam buspar atorvastatin Topamax solifenistin Flonase albuterol ubrelvy
Current Illness:
Preexisting Conditions: asthma adrenalin deficiency
Allergies: tree nut peanuts shell fish
Diagnostic Lab Data:
CDC Split Type:

Write-up: felt very faint, arm pain, face went numb, torso/arms and face was itchy experienced the same feeling as a allergic reaction pharmacist gave her Benadryl and made her stay for over an hour tried to call pcp but he wasnt able to see her pt is still taking Benadryl at home


VAERS ID: 1582791 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN HYPERTENSION MEDICATION
Current Illness: ANXIETY, HTN
Preexisting Conditions:
Allergies: ASPIRIN
Diagnostic Lab Data: BP 126/82 P 79 RESP RATE: 16
CDC Split Type:

Write-up: 38 y/o female passed out after receiving her 1st covid dose. 911 was called and EMS responded. It was noted she hadn''t taken any medication that day or had eaten either. Vitals listed below. She told EMS that she passes out when she receives shots. She didn''t want to go to ER. She was released to home.


VAERS ID: 1582801 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Pruritus, Rhinorrhoea, Throat irritation
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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: UA
Current Illness: UA
Preexisting Conditions: UA
Allergies: Amoxicillin
Diagnostic Lab Data: None
CDC Split Type: NA

Write-up: General Itchiness, runny nose, and throat scratchy. She did mention symptoms prior to vaccine but after receipt of vaccine feels exacerbated. Evaluated in ER and d/c home.


VAERS ID: 1582809 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Feeling hot, Headache
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? No
Previous Vaccinations:
Other Medications: Metoprolol, Pravastatin, hydrochlorothiazide, aspirin, Omeprazole, Gabapentin, Tart Cherry Extract, Green Tea, Vitamin B complex, Vitamin E, Vitamin C
Current Illness: None
Preexisting Conditions: High Blood Pressure, High Cholesterol, Acid Reflux, Neuropathy, Gout
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Feeling extremely tired to the point of having to lay down then dropped into a sleep, feeling very hot inside all over head to toe, slight headache . Lasted for 2 days, started the evening of first shot. Only treatment was Aleve


VAERS ID: 1582810 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-06
Onset:2021-08-16
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

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

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

Write-up: Broke out in hives all over my body on the 10th day? progressed quickly and the bottom of my left foot became pins and needles? feeling. No other allergies or eating anything different or changing detergents or perfumes/lotions


VAERS ID: 1582818 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-13
Onset:2021-08-16
   Days after vaccination:156
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Cough, Dyspnoea, Dyspnoea exertional
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad)

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

Write-up: This is a 81-year-old male with no significant past medical history. Does not take any medications at home. Patient is extremely hard to hear and poor historian as well. He reported that he came to the hospital with a chief complaint of progressive worsening generalized weakness for about 7-10 days. He reports that he is also having some worsening shortness of breath especially on exertion during this time. Vaccine date: 03/13/2021 Hospitalization date: 08/16/2021


VAERS ID: 1582823 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Injection site pain
SMQs:, Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Influenza, hepatitis A&B,
Other Medications: Keppra, fluoxetine, armodafinil
Current Illness:
Preexisting Conditions: Epilepsy, narcolepsy,
Allergies: Wasp, deer flies, sulfa, codeine, iodine, benadryl and many others
Diagnostic Lab Data:
CDC Split Type:

Write-up: Was dizzy that evening after injection. Very fatigued next morning and still fatigued and sore at injection site. These side effects are not bad, just thought I should report. I was very nervous about getting this shot due to my sensitivity to medicines and other allergies, so these side effects are better than I was expecting.


VAERS ID: 1582845 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient described severe myalgia all over - especially in feet and legs. She said she has been stuck in bed since the afternoon of the day of vaccination. She is just now feeling up to ambulating.


VAERS ID: 1582846 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product preparation error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: norvasc, promethazine, prilosec, prozac, zofran, imdur, metformin, gabapentin, lisinopril, crestor, and lantus
Current Illness: NA
Preexisting Conditions: NA
Allergies: no allergies
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Staff member gave patient pfizer vaccine without diluting it. Patient waited 30 minutes and had no adverse reaction.


VAERS ID: 1582853 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-02-19
Onset:2021-08-16
   Days after vaccination:178
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Unevaluable event
SMQs:

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: unknown, did not reside here then
Current Illness: unknown, did not reside here then
Preexisting Conditions: unspecified dementia, anxiety disorder, gastro-esophageal reflux disease
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Resident had vaccine prior to arrival at assisted living.


VAERS ID: 1582866 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-01-15
Onset:2021-08-16
   Days after vaccination:213
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Respiratory distress, Respiratory symptom, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was fully vaccinated. Patient has now been hospitalized on 8/16 with C19+ diagnosis. Presented with upper respiratory symptoms of distress.


VAERS ID: 1582869 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-10
Onset:2021-08-16
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Cough, Dyspnoea, Pneumonia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol 2.5 mg/3 mL (0.083%) inhalation solution, 2.5 mg= 3
Current Illness:
Preexisting Conditions: Asthma exacerbation BPH without urinary obstruction Chronic hypoxemic respiratory failure COPD with asthma Hyperte
Allergies: OMEPRAZOLE, SYMBICORT
Diagnostic Lab Data:
CDC Split Type:

Write-up: 86-year-old male with COPD, chronic hypoxic respiratory failure dependent on 3 L supplemental oxygen at home, hypertension, hypothyroidism, asthma, BPH, glaucoma. Presented to the ED via EMS with a 5 day history of shortness of breath with cough and positive COVID-19 testing outpatient. Patient reports being fully vaccinated against COVID-19. On arrival to the ED, oxygen saturation was 97% on 3 L supplemental oxygen via nasal cannula. Heart rate 97, respiratory rate 20. Patient is COVID-19 positive. Chest x-ray reveals bilateral pneumonia. VACCINE DATE: 3/10/2021 HOSPITALIZATION DATE: 8/16/2021


VAERS ID: 1582887 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-02-02
Onset:2021-08-16
   Days after vaccination:195
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Cough, Pain, Pyrexia, SARS-CoV-2 RNA
SMQs:, Anaphylactic reaction (broad), 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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: FISH OIL, ASPIRIN, METOPROLOL, LOSARTAN, ATORVASTATIN, METFORMIN, LORATIDINE
Current Illness: ABRASION OF RIGHT EAR CANAL, VASCULITIS OF THE SKIN
Preexisting Conditions: TYPE 2 DM, IMPOTENCE, HTN, SLEEP APNEA, MICROALBUMINURIA, PERIPHERAL NEUROPATHY, HX OF CABG, ARTERIOSCLEROSIS, MALIGNANT MELANOMA OF CHEST WALL, NUCLEAR SCLEROSIS
Allergies: KNA
Diagnostic Lab Data: 08/16/21: POSITIVE SARS-COV-2 RNA
CDC Split Type:

Write-up: DRY COUGH, FEVER, BODY ACHES.


VAERS ID: 1582893 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-04
Onset:2021-08-16
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain in extremity, Peripheral swelling, Pruritus, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (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: Gabapentin, Seroquel, Vyvanse, Cetirizine
Current Illness: none
Preexisting Conditions: asthma
Allergies: bee venom
Diagnostic Lab Data:
CDC Split Type:

Write-up: Itching and swelling in left upper arm as well as warm to the touch - also some discomfort


VAERS ID: 1582913 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-28
Onset:2021-08-16
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9263 / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Condition aggravated, Cough, Fatigue, Gait disturbance, Peripheral swelling, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes mellitus (HCC) ? Eczema ? Extended spectrum beta lactamase (ESBL) resistance 04/21/2017, 11/12/18 Urine E-coli HealthPartners ? Gout ? HTN (hypertension) ? OSA on CPAP ? Subdural hematoma
Allergies: NO KNOWN ALLERGIES
Diagnostic Lab Data: Positive for SARS-CoV-2 RNA by PCR Abnormal E Gene Ct cycles 26.3 Comment: Cycle threshold (Ct) values are not comparable between tests and may not be comparable between different lots of the same test. Currently there is no consensus as to whether or not particular Ct values correlate with a person being or not being infectious or risk level for disease severity. So, appropriate care should be taken with interpretation of Ct values. N2 Gene Ct cycles 28.3 Comment: Cycle threshold (Ct) values are not comparable between tests and may not be comparable between different lots of the same test. Currently there is no consensus as to whether or not particular Ct values correlate with a person being or not being infectious or risk level for disease severity. So, appropriate care should be taken with interpretation of Ct values. Resulting Agency NMRL Specimen Collected: 08/16/21 23:24 Last Resulted: 08/17/21 00:50
CDC Split Type:

Write-up: The patient presents to the ED today with concern for viral symptoms (fever, congestion, cough, fatigue) and worsening weakness. Over the last few weeks he has been weak, he now says that he has a hard time walking with his walker. Over the last 3 days he has experienced fever with a max of 102 degrees at home, cough, and congestion. He was worried about COVID infection, although he has been vaccinated with both doses of Pfizer. He saw his primary physician assistant today at the urgent care in maple grove, where he was swabbed for COVID and discharged with return precautions. He presents today with concerns for worsening of his weakness and continuation of his cough and congestion. He denies chest pain, shortness of breath, abdominal pain, or changes in bowel or urinary habits. He has some swelling in both of his legs, which is always present in his left leg, but it may be worse in his right leg today.


VAERS ID: 1582917 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: 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: When injecting the Janssen vaccine into pt arm, the vaccine spilled out of arm. Pt received more than 1/2 of vaccine. Per protocol if at least 1/2 of dose is administered, we do not repeat vaccination.


VAERS ID: 1582935 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-30
Onset:2021-08-16
   Days after vaccination:139
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

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

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

Write-up: Case developed symptoms and tested positive for COVID19.


VAERS ID: 1582957 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Paraesthesia, Paraesthesia oral
SMQs:, Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: obesity
Allergies: cinnamon, codeine, erythromycin
Diagnostic Lab Data: she went to a local emergency department and had a workup for chest pain. I do not have those results but the patient tells me they were all normal and she was discharged home.
CDC Split Type:

Write-up: within minutes after receiving the Moderna vaccine in her right deltoid she began to develop tingling and type sensations on the left side of her mouth, left side of her face, left side of her neck, left shoulder and left upper anterior chest. She was given first one Benadryl 25 mg tablet and then a short time later a second one at the pharmacy. She rested there for 30-60 minutes and had no further adverse reactions. The nurse practitioner there is thought she was safe to go home but should seek additional care if she worsened or failed to improve. 2 hours later having not improved she sought care at an urgent care center which decided that she would be better taking care of at an emergency department. She followed through on this suggestion and was seen and evaluated for chest pain. At no time did she have significant swelling of her tongue, lips or oral mucosa. At no time did she have significant chest tightness or difficulty breathing. No time did she develop hives or other rash. She comes to our office here today 2 days later with persistent soreness and some mild to moderate tenderness in the left pectoral region and the left side of her neck and trapezius region. Her neurologic exam is normal her oral exam is normal her respiratory and cardiovascular exams are normal.


VAERS ID: 1582959 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-01
Onset:2021-08-16
   Days after vaccination:196
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, Nausea, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Quetiapine, Atorvastatin, Allopurinol, Lisinopril Plavix,
Current Illness: Pneumoccal (PVC 02/14/2021)
Preexisting Conditions: CAD, HTN, Hyperlipidemia, Cobalamin deficiency, mixed hyperlipidemia, Gout, Insomnia, Osbstructive sleep apnea, Neurop
Allergies: No known allergies
Diagnostic Lab Data: Pt states he was tested positive for COVID 6 days ago.--unknown source, per history.
CDC Split Type:

Write-up: The patient presents with SOB x one week. Pt states he was tested positive for COVID 6 days ago. Pt states he had regeneron done today and his symptoms got worse. Pt c/o nausea, fever, SOB, and cough, congestion but denies V/D, chest pain, HA, myalgia, fatigue, chills. The onset was 1 days ago. The course/duration of symptoms is worsening. Patient still admitted at time for was submitted


VAERS ID: 1582963 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-11
Onset:2021-08-16
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Chest pain, Chromaturia, Dizziness, Headache, Nausea, Palpitations, SARS-CoV-2 test
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril
Current Illness: Unknown
Preexisting Conditions: HTN
Allergies: No known allergies
Diagnostic Lab Data: SARS COV2 COVID 19 PCR 08/16/2021
CDC Split Type:

Write-up: he patient presents with 1 week hx of chest pain with palpitations, mid and upper back pain, lightheadedness, headache, nausea, and dark urine. Pt reports to have experienced similar symptoms in the past, was informed he required further liver and cardiac evaluation. Pt denies shortness of breath, vomiting, numbness, tingling, fevers, chills, bowel or bladder dysfunction, abdominal pain, and all other symptoms. The onset was 1 weeks ago. Patient is still admitted at time of form submission.


VAERS ID: 1582969 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-16
Onset:2021-08-16
   Days after vaccination:181
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Condition aggravated, Neurological symptom, SARS-CoV-2 test positive, Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Hydralazine, Carvedilol, Divalproex, ASA, Jevity, Multivit
Current Illness: Unknown
Preexisting Conditions: Anxiety, back pain, Brain injury with open intracranial wound, CABG, Carotid stenosis, Claudication, Dyslipidemia
Allergies: Lisinopril, Statins, PCN
Diagnostic Lab Data: SARS COV2 COVID 19 PCR 08/16/2021 (INCIDENTAL FINDING)
CDC Split Type:

Write-up: Presents with Seizure this morning. Per EMS, Pt was increased on Depakote, and hadn''t gotten a refill on his prescription which caused back-to-back seizures, each lasting approx 30 seconds and entire episode lasting 3-5 minutes. Pt who has a hx of seizures currently is back to normal and has no complaints or pain at this time. Patient was recently hospitalized at our MC for concerns of possible CVA. He and his wife report that he had a full inpatient workup, including MRI and ultrasounds which were negative for acute stroke. Patient was determined to have had seizure activity leading to his neurological symptoms, and he was increased on his Depakote to 500 mg b.i.d.. Patient''s wife states that they have not


VAERS ID: 1582976 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-15
Onset:2021-08-16
   Days after vaccination:213
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Colace, Omega 3, Gabapentin, Lisinopril, Zinc, Loratadine,
Current Illness: Unknown
Preexisting Conditions: HTN, DM, Age, Hypercholestoremia, Thyroid disease,arthritis
Allergies: Statins
Diagnostic Lab Data: was tested for COVID on 8/9/2021 Repeated at this facility SARS COV2 COVID 19 PCR 08/16/2021
CDC Split Type:

Write-up: The patient presents with COVID positive. ED Nurse states pt is was tested for COVID on 8/9/2021 and had an X-ray that showed COVID pneumonia but it wasn''t confirmed. Nurse states pt was sent so COVID pneumonia can be r/o and pt can get medically cleared back to facility. She states the pt is 93% on room air, and pt has no complaints at this time. HPI limited to pt''s history of dementia. The course/duration of symptoms is constant. The degree at present is none. Risk factors consist of hypertension, diabetes mellitus and age. Patient was still admitted at time the form was submitted.


VAERS ID: 1582983 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Axillary mass, Pain
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pt takes multi-vitamin; Hair, Skin and Nails Supplement; Vitamin D3 and Vitamin B12
Current Illness: No illnesses noted at time of vaccination or up to one month prior.
Preexisting Conditions: Pott''s Syndrome
Allergies: No known allergies.
Diagnostic Lab Data: None at this time.
CDC Split Type:

Write-up: Spoke with pt''s mother. Pt''s mother reported that pt complained of severe pain on 8/16/21 after vaccination in PM. Pt reported to MOP-she noted a lump in armpit near breast in arm where vaccine was administered. Mother of patient could not identify arm where lump was or describe what the lump looked like. Mother of patient reported that pt continued to complain of pain (unk severity). Mother of patient reported patient did not want to go to MD today due to today being first day of school. Encouraged mother of patient to contact patient''s PCP and follow-up with provider to be assessed. Mother of patient verbalized understanding.


VAERS ID: 1582996 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-04
Onset:2021-08-16
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / UNK - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, COVID-19, SARS-CoV-2 test positive
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: SIMVASTATIN & LEVOTHYROXINE
Current Illness:
Preexisting Conditions: HYPERCHOLESTEROLEMIA & HYPOTHYROIDISM
Allergies: NKA
Diagnostic Lab Data: POSITIVE COVID-19 RESULT 08/17/2021 @ 1352.
CDC Split Type:

Write-up: COVID-19 admission complaints of severe abdominal pain 2hrs ago


VAERS ID: 1583000 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-08-02
Onset:2021-08-16
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Post-acute COVID-19 syndrome
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none at time of vaccination
Current Illness: none
Preexisting Conditions: none
Allergies: shellfish, cholesterole meds.
Diagnostic Lab Data:
CDC Split Type:

Write-up: My Left arm has redness going down my arm the pharmacists said it was covid arm


VAERS ID: 1583054 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-08-13
Onset:2021-08-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothorixin, Fish Oil, Vit B, Selenium, Legendairy, Probiotic
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Very dizzy lasting several days


VAERS ID: 1583128 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-13
Onset:2021-08-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Rash, Rash vesicular
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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 8/16/21 around 12pm rash appeared on face 8/17/21 8am rash began to blister and continued to spread 8/18/21 went to doctor to have evaluated. Doctor unable to provide any other medical diagnosis other than reaction to vaccine. Prescribe skin antibiotics to treat blisters as they pop. Follow in week if not heeling or improved


VAERS ID: 1583134 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Setraline Lo Estrin Fe Multivitamin
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Rash began on the left arm and spread to the right arm hours later. The next day the rash spread to my legs and neck.


VAERS ID: 1583143 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Diarrhoea, Myalgia, Nausea, Pain in extremity, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (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: Calcium, D3, zinc, multivitamin, Lexapro, Omeprazole
Current Illness: None
Preexisting Conditions: OCD, obesity, high cholesterol , GERD
Allergies: Maybe latex
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Nausea, vomiting, muscle and joint aches/pain, chills, fever, diarrhea, headache, arm soreness Started approximately 4:00PM ON 8-16-2021 and ended by midnight 8-17-2021. Treated with ibuprofen and Tylenol.


VAERS ID: 1583146 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A1 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Topiramate; Gabapentin, Prazosin, Sertraline, Bupropion
Current Illness:
Preexisting Conditions: Depression, anxiety, CKD stage II
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Moderna COVID-19 vaccine# 1 in series administered. A 56-year-old female completed a 30-minute observation period with the following signs and symptoms of an adverse reaction: Pseudo seizure. Action(s) taken: Epinephrine administered. Allergy to COVID-19 vaccine documented in allergies activity. Patient advised to discuss second dose considerations with a clinician.


VAERS ID: 1583148 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-15
Onset:2021-08-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: IBUPROFEN, ZYRTEC-D, MULTIVITAMIN
Current Illness: SEASONAL ALLERGY, FUNGAL INFECTION
Preexisting Conditions: THYROID, ASTHMA, SEASONAL ALLERGYS,
Allergies: SULFA ALLERGY ONLY
Diagnostic Lab Data: none yet
CDC Split Type:

Write-up: rash next day with itching. still getting bigger. took Zyrtec and recommended to take tylenol. pt has a call into pcp.


VAERS ID: 1583169 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-15
Onset:2021-08-16
   Days after vaccination:213
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Colace, Omega 3, Gabapentin, Lisinopril, Zinc, Loratadine, Metformin, Levothyroxine, Labetalol, Losrtan, Amlodipine, Tylenol ASA
Current Illness: Unknown
Preexisting Conditions: HTN, DM, Age, Hypercholestoremia, Thyroid disease,arthritis
Allergies: Statins
Diagnostic Lab Data: was tested for COVID on 8/9/2021 at Care Center Repeated at this facility SARS COV2 COVID 19 PCR 08/16/2021
CDC Split Type:

Write-up: The patient presents with COVID positive. ED Nurse states pt is from Care Center and was tested for COVID on 8/9/2021 and had an X-ray that showed COVID pneumonia but it wasn''t confirmed. Nurse states pt was sent so COVID pneumonia can be r/o and pt can get medically cleared back to facility. She states the pt is 93% on room air, and pt has no complaints at this time. HPI limited to pt''s history of dementia. The course/duration of symptoms is constant. The degree at present is none. Risk factors consist of hypertension, diabetes mellitus and age. Patient was still admitted at time the form was submitted.


VAERS ID: 1583194 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Pain in extremity, Peripheral swelling, Pyrexia, Sleep disorder
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: hydrocodone, protunic
Current Illness: esophagus got stretched from having meat stuck in it and they had to surgery remove it
Preexisting Conditions: asthma, acid reflux, bad back
Allergies: codeine
Diagnostic Lab Data: no
CDC Split Type:

Write-up: got a fever and was hot all night, dizziness and lightheaded. in the middle of the night and leg was swollen and hurting, also hand and arm became swollen which all was located on the left side the same side as the shot.


VAERS ID: 1583360 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SC

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

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

Write-up: The injection was given with a 5/8 needle which is not IM as I am a 165 lb adult.


VAERS ID: 1583389 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: NOT KNOWN
Current Illness: NOT KNOWN
Preexisting Conditions: NOT KNOWN
Allergies: HE STATED HIS TONGUE HAS SWELLED AFTER EATING LOBSTER
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: APPROXIMATELY 20 MINUTES AFTER RECEIVING THE VACCINE HE SAID HIS TONGUE WAS SWELLING. HE THEN TOOK A BENADRYL WHILE STILL AT THE PHARMACY. HE SAT AND WAITED SO WE COULD MONITOR HIM. HE NOTICED IMPROVEMENT IN THE SWELLING OF HIS TONGUE AND IT WAS RETURNING BACK TO NORMAL. WE HAD RECOMMENDED THAT HE COULD VISIT THE EMERGENCY ROOM, BUT HE OPTED TO WAIT HERE SINCE HE WAS IMPROVING AND NOT HAVING ANY DIFFICULTY BREATHING.


VAERS ID: 1583588 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose normal, Feeling cold, Hyperhidrosis, Hyperventilation, Nausea, Pallor, Visual impairment
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: No Known Health Conditions
Preexisting Conditions: No
Allergies: No known Allergies
Diagnostic Lab Data: Nothing except what was done by the EMS as reported above
CDC Split Type:

Write-up: About 10 minutes after receiving the vaccine , while seated in the pharmacy waiting area, the patient started experiencing visual disturbance. His Father was him and he alerted the pharmacist. The patient described feeling like vomiting and the pharmacist handed him a bucket. He started hyperventilating and his face turned pale. He was sweating but in a few minutes he said he he felt cold. No hives were observed. 911 was called and the EMS examined the patient. His heartrate, blood pressure and blood sugar were all reported normal. The patient was calm and said he felt better after the EMS assured him that his vitals were normal. They told him he is ok to go home but to call if anything unusual happens.


VAERS ID: 1583593 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-15
Onset:2021-08-16
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: SARS-CoV-2 test, Vaccine breakthrough infection
SMQs:, COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Xanax, Lipitor, Lexapro, Plavix, Metoprolol
Current Illness:
Preexisting Conditions: HTN, Depression
Allergies: NKDA
Diagnostic Lab Data: Sofia SARS-Cov2 Antigen
CDC Split Type:

Write-up: Breakthrough COVID19 infection


VAERS ID: 1583627 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Fatigue, Night sweats, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (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: Latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Arm soreness, extreme fatigue, fever of 100.5 for 12 hours, chills, weakness, night sweats


VAERS ID: 1583822 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 1 LA / IM

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

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

Write-up: Patient received a dose of Moderna COVID vaccine that was past the 12 hour expiration date.


VAERS ID: 1583826 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 1 RA / IM

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

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

Write-up: Patient received a dose of Moderna Covid vaccine that was past the 12 hour expiration time.


VAERS ID: 1583827 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 1 LA / IM

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

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

Write-up: Patient received a dose of Moderna COVID vaccine that was past the 12 hours expiration time


VAERS ID: 1584011 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluvoxamine, Adderall XR , Xanax, Naltrexone, Lamotrigine
Current Illness: None
Preexisting Conditions: Mental Health (multiple) including Severe Dermatillomania
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: TINGLING-NUMB(ish) FEELING Where: Entire face and tongue When: Began - Roughly 5min Following Injection (08/16/2021 - 8:30pm) Ended - Prior to Morning Rise (08/17/2021 - 8:00am)


VAERS ID: 1584201 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Adnexa uteri pain, Asthenia, Chest pain, Chills, Dizziness, Dyspnoea, Fatigue, Headache, Hyperhidrosis, Lymphadenopathy, Myalgia, Nausea, Neck pain, Pain in extremity, Pyrexia, Spinal pain
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Severe fever, intense headaches for 24 hours straight, chills and sweating, nausea, incredibly terrible muscle aches over entire body (most painful on legs). Extremely sore neck and arms, swollen lymph nodes, dizziness, icepick headaches even 48 hours after the injection. Sharp chest pain and burning, shortness of breath, fatigue and low stamina 55 hours after injection. Spine pain, stomach pain, ovary pain.


VAERS ID: 1584875 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Feeling cold, Headache, Injection site erythema, Injection site induration, Injection site mass, Injection site swelling, Pain, Pain in extremity
SMQs:, 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? 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: My arm became red and swollen and the injection site. The next day I got the chills and was very cold. The swelling and redness on the injection site is growing. It feels like there is a hard mass underneath the skin. The mass feels like it is growing too. My arm is very sore and hurts to raise it. I also have had a headache since 08/17/2021. My entire body aches, as though I have the flu, but without the nasal congestion or sore throat.


VAERS ID: 1585385 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-15
Onset:2021-08-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Lethargy, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Muscle aches, fever, tightness in chest, lethargic


VAERS ID: 1586329 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect route of product administration
SMQs:, Drug abuse and dependence (broad), Medication errors (narrow)

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

Write-up: Error: Wrong Route (SC, IM, etc.)-


VAERS ID: 1586358 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-08-11
Onset:2021-08-16
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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
Current Illness: No
Preexisting Conditions: No
Allergies: Clam
Diagnostic Lab Data:
CDC Split Type:

Write-up: Body rash- itchy, all over back and chest


VAERS ID: 1586551 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-22
Onset:2021-08-16
   Days after vaccination:175
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ? amLODIPine (NORVASC) 10 MG tablet TAKE 1 TABLET DAILY ? Aspirin (ASPIR-81 PO) take 81 mg by mouth Daily. ? atorvastatin (LIPITOR) 40 MG tablet Take 1 tablet by mouth daily. ? BD PEN NEEDLE NANO U/F 32G X 4 MM MISC USE ONE PEN NEEDLE DAILY
Current Illness: CAD (coronary artery disease) ? Carotid bruit bilateral ? DM type 2 (diabetes mellitus, type 2) (HCC) ? Family hx of colon cancer ? HTN (hypertension) ? Hyperlipidemia ? mild non proliferative retinapothy bilateral
Preexisting Conditions: CAD (coronary artery disease) ? Carotid bruit bilateral ? DM type 2 (diabetes mellitus, type 2) (HCC) ? Family hx of colon cancer ? HTN (hypertension) ? Hyperlipidemia ? mild non proliferative retinapothy bilateral
Allergies: Lisinopril
Diagnostic Lab Data: COVID19 PCR- Positive
CDC Split Type:

Write-up: Patient was hospitalized with COVID19 Pneumonia. He is currently still admitted in our ICU.


VAERS ID: 1586560 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 LA / IM

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

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

Write-up: Patient reports redness, swelling, and tenderness at the injection site (L) arm deltoid area., treated with cold compress, will continue to monitor, does not interfere with ADLS.


VAERS ID: 1586582 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-03
Onset:2021-08-16
   Days after vaccination:166
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Dizziness, Malaise, Nocturia, Pollakiuria, Productive cough, Pyrexia, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol HFA (PROAIR HFA) 108 (90 Base) MCG/ACT inhaler, inhale 2 puffs by mouth every 4 hours if needed ? allopurinol (ZYLOPRIM) 300 MG tablet, Take 1 tablet by mouth daily. ? amLODIPine (NORVASC) 5 MG tablet, Take 1 tablet by mouth dai
Current Illness: 2nd degree AV block ? Aortic stenosis, severe ? ASCVD (arteriosclerotic cardiovascular disease) ? Asthma ? Atrial fibrillation and flutter (HCC) 7/28/2015 ? Atrial flutter (HCC) ? Bilateral carotid artery disease (HCC) ? BPH (benign prostatic hypertrophy) 2/9/2009 ? Cancer (HCC) ? Cardiac pacemaker in situ ? CVA (cerebral vascular accident) (HCC) 2015 ? ED (erectile dysfunction) 2/21/2017 ? Essential hypertension 2/9/2009 ? Exogenous obesity 2/9/2009 ? GERD (gastroesophageal reflux disease) ? Glaucoma ? Gout 2/21/2017 ? Hyperlipidemia ? Moderate persistent asthma without complication [J45.40] 11/13/2015 ? Nonrheumatic aortic (valve) stenosis ? OSA (obstructive sleep apnea) ? Osteoarthritis ? Rosacea ? S/P TAVR (transcatheter aortic valve replacement)
Preexisting Conditions: 2nd degree AV block ? Aortic stenosis, severe ? ASCVD (arteriosclerotic cardiovascular disease) ? Asthma ? Atrial fibrillation and flutter (HCC) 7/28/2015 ? Atrial flutter (HCC) ? Bilateral carotid artery disease (HCC) ? BPH (benign prostatic hypertrophy) 2/9/2009 ? Cancer (HCC) ? Cardiac pacemaker in situ ? CVA (cerebral vascular accident) (HCC) 2015 ? ED (erectile dysfunction) 2/21/2017 ? Essential hypertension 2/9/2009 ? Exogenous obesity 2/9/2009 ? GERD (gastroesophageal reflux disease) ? Glaucoma ? Gout 2/21/2017 ? Hyperlipidemia ? Moderate persistent asthma without complication [J45.40] 11/13/2015 ? Nonrheumatic aortic (valve) stenosis ? OSA (obstructive sleep apnea) ? Osteoarthritis ? Rosacea ? S/P TAVR (transcatheter aortic valve replacement)
Allergies: N/A
Diagnostic Lab Data: COVID19 PCR- Positive 8/16/2021
CDC Split Type:

Write-up: Patient is a 87 y.o. male who presents to the urgent care with DIZZINESS (87 y/o male that presents w/ c/o not feeling well overall and a feeling of dizzines x''s 1 week.) History is obtained from Patient HPI Started in the past week with intermittent dizziness, especially with movements such as putting on a shirt. Cough productive of lots of small pieces of sputum. Fevers. SPO2 usually around 94-95%. Does have some nocturina and urinary frequency at baseline, somewhat worse last night but otherwise stable, no other urinary symptoms. Significant cardiac and CVA history.


VAERS ID: 1586599 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Feeling abnormal, Headache, Musculoskeletal chest pain, Rash, Sensory disturbance, Tremor
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies: NKDA
Diagnostic Lab Data: I have taken Ibuprofen and Tylenol I am setting up a apt with my primary care doctor I did reach out to occupational health at my hospital and they instructed me to reach out to my primary doctor regarding the reaction
CDC Split Type:

Write-up: Tremors- started Monday evening, Tuesday tremors became course, Wednesday and today the tremors are fine it is throughout my body. Rash on left hand: started Wednesday Chest: have a half dollar size pain in/around the fifth intercostal space. Started Monday night/Tuesday morning. Still have the discomfort today Rt arm: still feels large and fingers on rt arm feels different compared to left arm. Started within minutes after the shot. Head: starting Tuesday morning I feel foggy different Headache: started with headache Wednesday, still have it


VAERS ID: 1586674 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039821A / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Ear pain, Fatigue, Injection site swelling, Pyrexia, Swelling, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: 6 hours after receiving vaccine person become extremely tired. That evening beginning at the injection site all the way up into her neck area and side of face she noticed slight swelling along with ear pain. She developed a fever. Waking up the next morning the swelling had increased. Taking Tylenol for the fever. When she woke up Wednesday morning the fever had broke and all the swelling had went away. Everything back to normal.


VAERS ID: 1586680 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Feeling abnormal, Feeling hot, Malaise
SMQs:, Peripheral neuropathy (broad), Dementia (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: Synthroid 1.15
Current Illness: None
Preexisting Conditions: Hypothyroidism
Allergies: Codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: I took the vaccine at about 12 noon on 8/16/2021 and about 3:00 p.m. I felt a burning sensation at the very top of my head, it lasted about 5 sections then stopped, it happened again about 15 minutes later and at least three times that day. It also felt like my blood pressure was up, I checked it and it was high the first time and took it again and it was normal. The second day it happened again but not with the same burning sensation, on the second day but it just didn''t feel right, I took 500 milligrams of tylenol which made me feel a little better but that evening my head felt very hot, not like fever, I placed an ice pack on my head which helped it feel better. My ears felt hot and I generally didn''t feel good. The third day I continued to feel sensations in the top of my head for a second and then it was on the side of my head for a second or two. Today is day four and I am now recording every event and realized that unusual sensation in my head is occurring more than I realized, lasting for only a second but travels from my head to my nose area. It is very concerning to think that my brain may be affected by this vaccine. I generally feel better but the unusual sensations continue. I called my doctor on day three and they said they had not head of this reaction, the doctor said she could check my scalp but I told her nurse it is on the inside of my head/scalp, it is not external.


VAERS ID: 1586703 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-14
Onset:2021-08-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: oral birth control
Current Illness: none
Preexisting Conditions: anxiety/depression
Allergies: lexapro
Diagnostic Lab Data: none at this time
CDC Split Type:

Write-up: Supraclavicular lymph node swelling


VAERS ID: 1586740 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

Write-up: Received First dose 8/2/21 then Received second dose 8/16/21 Less than 2 8 days


VAERS ID: 1586752 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Burning sensation, Headache, Hypertension, Nausea, Paraesthesia, Throat irritation, Throat tightness, Urticaria
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Tetanus toxoid
Other Medications:
Current Illness: Was taking Keflex for skin infection at the time of vaccination.
Preexisting Conditions: HTN, HLD, and Depression w/ Anxiety
Allergies: Morphine, Vicodin, Soma, Tetanus toxoid, Azithro, Bee stings
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within 7 minutes: "Hives, burning in my arms, tingling in my arms, headache, high blood pressure, nausea, throat clogging and irritation type"


VAERS ID: 1586761 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-14
Onset:2021-08-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Eye movement disorder, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Ocular motility disorders (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:
Other Medications: No
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Woke up sweating over whole body; dizziness, eyes started rolling in the back of head.


VAERS ID: 1586771 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-08-02
Onset:2021-08-16
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Breast enlargement, Menstruation irregular
SMQs:, Lipodystrophy (broad), Fertility disorders (broad)

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

Write-up: Breast enlargement, irregular menstrual bleeding


VAERS ID: 1586807 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angina pectoris, Chest pain, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Dehydration (broad)

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

Write-up: I began noticing a sharp pain in my left side of my chest about 2 hours after I received the shot. The following morning I had the worst pain in my heart. I felt my heart beating so fast and harder than ever in my life. It has hurt equally as bad since then during these past 3 days.


VAERS ID: 1586813 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-06
Onset:2021-08-16
   Days after vaccination:132
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: positive COVID case contact with family member mild symptoms and they are already improving


VAERS ID: 1586823 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-12
Onset:2021-08-16
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: atorvaSTATin (LIPITOR) 20 mg tablet Take 1 tablet (20 mg) by mouth every night at bedtime levothyroxine 112 mcg tablet Take 1 tablet (112 mcg) by mouth 1 time per day escitalopram (LEXAPRO) 10 mg tablet Take 1 tablet (10 mg) by mouth 1 time
Current Illness: none
Preexisting Conditions: Hypothyroidism Obesity (BMI 30-39.9) Controlled type 2 diabetes mellitus without complication, without long-term current use of insulin (HCC)
Allergies: NKA
Diagnostic Lab Data: covid positive PCR test on 8/17/21
CDC Split Type:

Write-up: Developed covid-19 infection on 8/16/21


VAERS ID: 1586835 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-08
Onset:2021-08-16
   Days after vaccination:100
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, Influenza like illness, Malaise, Pain, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID-19 PCR test done on 8/16/21, reported positive.
CDC Split Type:

Write-up: Patient admitted to facility for shortness of breath and cough for several days. Patient stated that they have had flu-like symptoms for 2 weeks. Patient also stated to have malaise, congestion, and body aches.


VAERS ID: 1586846 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Lymphadenopathy, Night sweats, Paraesthesia, Skin warm
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: light headed, stomach hot, feet tingling, sweating throughout the night, lymph nodes swelling


VAERS ID: 1586902 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-02-22
Onset:2021-08-16
   Days after vaccination:175
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Influenza A virus test negative, Influenza virus test negative, Respiratory syncytial virus test negative, Rhinorrhoea, SARS-CoV-2 test positive, Sinus congestion
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin, glyburide/metfomin, Lisinopril, Ibuprofen, magnesium oxide, Naproxen, Phenylephrine, pioglitazone, Sildenafin, Tramadol
Current Illness: none
Preexisting Conditions: HTN, Strabismus lt. eye, renal disorder associated with type ii DM, Hyperlipidemia, Type ii DM, Dysthymia, Alcohol Dependence, Arthritis, glaucoma of rt. eye Cataract of lt. eye. obesity
Allergies: Penicillin Codiene
Diagnostic Lab Data: Aug 16, 2021@15:51:21 FLU A NEGATIVE, FLU B NEGATIVE, RSV NEGATIVE _COVID-19 POSITIVEA*
CDC Split Type:

Write-up: 8/16/2021 c/o runny nose and sinus congestion that started


VAERS ID: 1586921 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-15
Onset:2021-08-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Skin exfoliation
SMQs:, Severe cutaneous adverse reactions (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan 25 mg 1x daily 600 mg calcium every other day Hydrochlorothiazide 25 mg 1x daily 50 mg vitamin D3 1x daily Omeprazole 20 mg 1x daily Lo Dose Aspirin 81 mg 1x daily
Current Illness: none
Preexisting Conditions: none
Allergies: sulfa
Diagnostic Lab Data: none
CDC Split Type:

Write-up: The day after skin started to peal on both upper arms. The following day started on both upper legs and 3rd day both legs were pealing a lot.


VAERS ID: 1586930 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-03-04
Onset:2021-08-16
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Diarrhoea, Influenza A virus test negative, Influenza B virus test, Respiratory syncytial virus test negative, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Loratadine, Oxymetazoline HCL Nasal spray
Current Illness: None
Preexisting Conditions: ADHD Anxiety
Allergies: Augmentin, Penicillin, Amoxicillin, Ceftriaxone
Diagnostic Lab Data: Aug 16, 2021@08:32:20 FLU A (CEPHEID) NEGATIVE , FLU B (CEPHEID) NEGATIVE, RSV (CEPHEID) NEGATIVE _COVID-19 (CEPHEID) POSITIVEA*
CDC Split Type:

Write-up: 8.15.2021 runny nose, occassional dry cough, and diarrhea.


VAERS ID: 1586962 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-14
Onset:2021-08-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Diarrhoea, Fatigue, Insomnia, Lymph node pain, Lymphadenopathy, Myalgia, Oropharyngeal pain, Pain, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Penicillin allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Had first dose of Pfizer covid vaccine administered on Saturday the 14th, on Sunday felt run down, stating Monday and c tinging through today I have not been able to sleep, throat hurts badly, lymph nodes in neck swollen and painful, feeling tired and run down, and diarrhea. Monday and Tuesday had body aches and muscle and joint soreness.


VAERS ID: 1586966 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-08-14
Onset:2021-08-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: SARS-CoV-2 test negative, Sneezing, Swelling face
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

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

Write-up: facial swelling, sneezing


VAERS ID: 1586981 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Unknown  
Vaccinated:2020-12-21
Onset:2021-08-16
   Days after vaccination:238
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 2 LA / IM

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

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

Write-up: Patient became positive after having the COVID vaccine.


VAERS ID: 1586989 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-12
Onset:2021-08-16
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Ear pain, Headache, Hypoacusis, Pyrexia, Respiratory symptom
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hearing impairment (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: Aspirin; Cialias; Fluticasone; Vitamin D; Simvastatin
Current Illness: none
Preexisting Conditions: BPH; hyperlipidemia, restless legs, seasonal allergies, elevated PSA
Allergies: seasonal
Diagnostic Lab Data:
CDC Split Type:

Write-up: URI symptoms for 1-2 days. Symptoms include headache, fever 100.7 this am,, ear pain-can''t hear well he says, cough yesterday.


VAERS ID: 1587031 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-03-23
Onset:2021-08-16
   Days after vaccination:146
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Influenza A virus test negative, Influenza B virus test, Influenza virus test negative, Respiratory syncytial virus test negative, Rhinorrhoea, SARS-CoV-2 test positive, Sinus congestion
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: None
Preexisting Conditions: None
Allergies: no Allergies
Diagnostic Lab Data: Aug 16, 2021@15:50:32 FLU A (CEPHEID) NEGATIVE , FLU B (CEPHEID) NEGATIVE, RSV (CEPHEID) NEGATIVE _COVID-19 (CEPHEID) POSITIVEA*
CDC Split Type:

Write-up: 8.16.2021 runny nose and sinus congestion since 8/14/21


VAERS ID: 1587070 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-15
Onset:2021-08-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram ST segment depression, Intensive care, Magnetic resonance imaging heart, Myocarditis, Sinus arrhythmia, Troponin increased
SMQs:, Myocardial infarction (narrow), Disorders of sinus node function (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Other ischaemic heart disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Troponins elevated to peak 9.7 ng/mL Cardiac MR performed, read pending EKG with sinus arrhythmia, ST depression in lateral leads
CDC Split Type:

Write-up: Severe chest pain 24 hour later admitted to ICU with myocarditis Given aspirin, monitored closely for 72 hours Cardiac MRI performed No other treatment


VAERS ID: 1587114 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Fatigue, Pain
SMQs:

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

Write-up: Fatigue, Chills, Body Aches


VAERS ID: 1587189 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-15
Onset:2021-08-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Injection site pain, Lymphadenopathy, Neck pain, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), 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: None
Current Illness:
Preexisting Conditions: M?ni?re''s disease
Allergies: High sensitivity to all medications, caffeine and salt
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Day one after the shot, my left arm was sore all the way up my neck. Lots of pain and swollen under the armpits in the lymph nodes. Both sides but worse on the left-side where the shot was. Painful to use. Shot was on Sunday afternoon and the pain seems to be getting worse. It is now Thursday.


VAERS ID: 1587195 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-08-13
Onset:2021-08-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Decreased appetite, Insomnia
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: allergies
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: no appetite, no sleeping


VAERS ID: 1587197 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-26
Onset:2021-08-16
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril-hydrochlorothiazide (ZESTORETIC) 10-12.5 mg tablet; Sertraline (ZOLOFT) 100 mg tablet;Vitamin D; Cholecalciferol.
Current Illness: None
Preexisting Conditions: Essential hypertension; PCOS (polycystic ovarian syndrome); Metabolic syndrome; Obesity, morbid, BMI 50 or higher (HCC); Hyperlipidemia; Pre-diabetes; Chronic fatigue syndrome; Infertility female; Alopecia; History of gestational diabetes.
Allergies: NKA
Diagnostic Lab Data: positive COVID PCR 8/19/21.
CDC Split Type:

Write-up: patient developed COVID infection on 8/16/21.


VAERS ID: 1587220 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-03-16
Onset:2021-08-16
   Days after vaccination:153
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 LA / IM

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

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

Write-up: Fully vaccinated, tested positive for COVID-19.


VAERS ID: 1587224 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Injection site pain, Lethargy, Movement disorder, Paraesthesia, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (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: Valcyclovir 500 mg 1x daily
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: High fever for 3 days Extreme Chills Lethargic Tingling in feet Extreme pain at injection site( unable to move arm/ equivalent to getting hit with a baseball bat)


VAERS ID: 1587242 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Diarrhoea, Dysgeusia, Eye pruritus, Feeling abnormal, Feeling hot, Lymphadenopathy, Ocular hyperaemia, Pain of skin, Paraesthesia, Pyrexia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Arthritis (broad), Noninfectious diarrhoea (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: metal taste in throat, tingling/itching on right eye with redness, warmth on anus then radiated to entire vulva, weirdness mid sternum. Swollen lymph nodes, fever, diahrrea, joint and skin pain


VAERS ID: 1587267 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aurovela 24 FE 1/20 Tablets
Current Illness: None
Preexisting Conditions: Lower back issues
Allergies: Some prescriptions NSAIDS, morphine, some antibiotics
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Chills (just a couple of times), fatigue for several days, bodyaches on and off for several days ,pain in arm at injection site for 2-3 days, some joint pain Ibuprofen every 4-8 hours, 400mg


VAERS ID: 1587275 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Headache, Lip swelling, Paraesthesia, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Started with facial tingling, throat tightness, headache and abdominal pain. The symptoms decreased with single dose diphenhydramine and prednisone administration. Symptoms have waxed and waned for 3 days since. Now with lip swelling


VAERS ID: 1587302 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-25
Onset:2021-08-16
   Days after vaccination:144
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / IM

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

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

Write-up: Tested positive for Covid-19 after being fully vaccinated.


VAERS ID: 1587312 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-04-29
Onset:2021-08-16
   Days after vaccination:109
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin 845mg; Florajen; Losartan; Bactroban 2% topical ointment; Nitroglycerin; Rosuvastatin; Ambien.
Current Illness: None documented
Preexisting Conditions: Diverticulosis Irritable bowel syndrome smoker leukocytosis Diabetes mellitus thyroid nodule history of squamous cell carcinoma of the skin
Allergies: Azithromycin - Upset stomach doxycycline - Upset stomach and nausea prednisone - Elevated BP Simvastatin - Tired/Achy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient contracted COVID after being fully vaccinated


VAERS ID: 1587344 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: DOES NOT TAKE MEDICATIONS
Current Illness: NKDA
Preexisting Conditions: NKDA
Allergies: REPORTS HAVING NO ALLERGIES
Diagnostic Lab Data: NO LABORATORY TEST ARE PERFORMED YET.
CDC Split Type:

Write-up: ADMINISTRATION ERROR: NURSE ADMINISTERED FIRST DOSE OF MODERNA LOT #091D21A ON LEFT ARM TO A 13 YRS OLD. INSTEAD OF ADMINISTERING DOSE OF PFIZER WHICH IS INDICATED FOR THE AGE OF THE PATIENT TO THE AUTHORIZATION FOR EMERGENCY USE.


VAERS ID: 1587346 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Amnesia, Cerebellar ataxia, Dysarthria
SMQs:, Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypoglycaemia (broad)

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: Hydroxyzine
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient had ataxia, dysarthria and amnesia of events shortly after receiving vaccine. Went home and slept it off, upon waking in the morning was back to normal. Had acute care clinic appointment 2 days later diagnosed with acute cerebellar ataxia.


VAERS ID: 1587370 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-10
Onset:2021-08-16
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain
SMQs:, Retroperitoneal fibrosis (broad)

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

Write-up: Patient stated that starting 6 days after the vaccination she started feeling pain in her left backside and the pain continues to persist.


VAERS ID: 1587447 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-05
Onset:2021-08-16
   Days after vaccination:164
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / UNK - / -

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

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

Write-up: Positive COVID no known contacts, moderate symptoms got infusion treatment today 08/19/2021.


VAERS ID: 1587467 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Seizure, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Parkinson-like events (broad), 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:
Other Medications: No
Current Illness: No
Preexisting Conditions: No
Allergies: Yes have had many reactions to medications & vaccinations prior.
Diagnostic Lab Data: Seen by Dr. 8/17/21 next day . Doing blood work up.
CDC Split Type:

Write-up: Had convulsion tremor chills for 3 hours body shook uncontrollably


VAERS ID: 1588563 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-03-12
Onset:2021-08-16
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 1 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021A21A / 2 AR / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cough, Fatigue, Nasal congestion, Nasopharyngitis, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Alprazolam, Aspirin, Calcium, Duloxetine, Famotidine, Flecainide, Folic Acid, Metoprolol, Vitamin C, Vitamin D3, Tylenol, Spironolactone
Current Illness: A-Fib, Hypertension, Hyperkeratosis, lenticularis perstans, Sleep Disorder, Polyneuropathy, Anemia, sub arachnoid hemorrhage
Preexisting Conditions: A-Fib, Hypertension, Hyperkeratosis, lenticularis perstans, Sleep Disorder, Polyneuropathy, Anemia, sub arachnoid hemorrhage
Allergies: Gabapentin, Morphine, NSAIDS
Diagnostic Lab Data: Rapid Test 8-19-2021 4:00 pm MST Vikor nasal swab, respira ID testing. sample taken 4:30pm 8-19-2021, shipped over night no results as of today
CDC Split Type:

Write-up: showed cold like symptoms after returning from visit to family home, symptoms started 8-16-2021 in the evening Cough, stuffy nose, fatigue


VAERS ID: 1588724 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Auditory disorder, Chills, Fatigue, Injection site pain, Injection site swelling, Insomnia, Migraine, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hearing impairment (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Chill, fever, insomnia, body aches, migraine, pain at site of injection, tiredness, auditory anomalies, swollen injection site


VAERS ID: 1588757 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-13
Onset:2021-08-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood immunoglobulin G, Blood lactate dehydrogenase increased, C-reactive protein increased, Cardiac imaging procedure abnormal, Chest pain, Echocardiogram, Electrocardiogram ST segment elevation, Electrocardiogram repolarisation abnormality, Myocardial fibrosis, Pericardial effusion, Troponin increased
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (narrow), Conduction defects (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: No medications
Current Illness:
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data: MIS-C labs significant for CRP 35.5 and troponin 9,900, positive IgG antibodies to COVID-19 ($g20) on day of presenting to PCP. EKG obtained in clinic showed elevated J point and early take off vs early repolarization. In our ED, MIS-C labs were repeated; significant for CRP 16, LDH 273, and troponin 3,852. EKG and TTE normal (TTE showed trivial pericardial effusion). Last troponin on 8/19 AM was 379. Repeat EKG normal. Cardiac MRI significant for scarring of myocardium.
CDC Split Type:

Write-up: chest pain 3 days after receiving 2nd dose of COVID vaccine with no associated symptoms (no shortness of breath, fever, nausea, vomiting), presented to PCP and found to have troponin $g 9,000. EKG borderline. Chest pain resolved after ibuprofen same day.


VAERS ID: 1588915 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Nervousness, Paraesthesia, Presyncope
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: patient had a vaso-vagal response. patient was sweaty and out of it. we called 911. EMT monitored patients vitals. patient recovered and refused to go to the ER. he reported feeling shaky and hands tingling. he walked out of the store on his own with his friend who accompanied him. I unsuccessfully attempted to reach patient the following 2 days with no contact.


VAERS ID: 1588921 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-04-02
Onset:2021-08-16
   Days after vaccination:136
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Deafness unilateral, Ear pain
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: n/a
Current Illness: n/a
Preexisting Conditions: on blood thinner, High blood pressure and high cholesterol
Allergies: doxycycline, penicillin
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: After recieving 2nd dose on 4/2/2021, patient stated on monday 4/5/2021, he started having sharp ear pain in the right ear. he want to doctors and they told him it was not covid vaccation related. Patient insist that after receiving his 2nd dose of moderna, he started to lose his hearing in the right ear.


VAERS ID: 1589712 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-03
Onset:2021-08-16
   Days after vaccination:166
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein increased, COVID-19, Coronavirus test positive
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: OSA, HTN, BMI 35.
Allergies:
Diagnostic Lab Data: 8/19/2021 16:00 CRP, SER QL: 5.4 (H) 8/19/2021 16:10 CORONAVIR PAN 2019-NCOV, NAA, QL: COVID DETECTED (A)
CDC Split Type:

Write-up: COVID-19 positive, requiring admission and oxygen support.


VAERS ID: 1589715 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-11
Onset:2021-08-16
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Muscle spasms, Polymenorrhoea, Sleep disorder, Thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dystonia (broad), Thrombophlebitis (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: Heaviest period I?ve ever had, early in cycle. Large clots. Extreme cramping. On day 5 and still large clots and cramping that has kept me up all night long almost unbearable. Bleeding through tampons in less than an hour.


VAERS ID: 1591176 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-07
Onset:2021-08-16
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Dizziness, Dizziness postural, Herpes zoster, Nausea, Pain, Rash
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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: Quercetin, Calcium with Vitamin D, Zinc, Venlafaxine, Calcitrol, Verapamil, Clonodine
Current Illness: None
Preexisting Conditions: Hypoparathryoidism by birth , hypertension
Allergies: None
Diagnostic Lab Data: No labs. Virtual visit. My doctor could see the rash.
CDC Split Type:

Write-up: Shingles diagnosed by Primary Care doctor on August 17. Right side of my body hurts (right arm & upper part of the right side of my back). Rash started on my breast and upper back. Rash keeps expanding. This is the first time in my life I have ever had Shingles. Prescribed Valacyclovir and Gabapentin. This happened after my first shot of Moderna. I also had body aches, temperature of 100.6, nauseous, dizzy and couldn''t get out of bed the day after my first Moderna shot.


VAERS ID: 1591252 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 RA / IM

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

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

Write-up: Pfizer vaccine administered to a child that was 11 y/o 6 months old. Current manufacture recommends for 12 y/o and older.


VAERS ID: 1591273 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-06
Onset:2021-08-16
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Headache, Pyrexia, Upper respiratory tract congestion
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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine
Current Illness: none
Preexisting Conditions: hypothyroid, degenerative arthritis, GERD
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: fever, upper respiratory congestion and headache starting on 8/16/21


VAERS ID: 1591278 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-08-16
Onset:2021-08-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Gait disturbance, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Estradiol, lisinopril, unknown cholesterol medication
Current Illness: none
Preexisting Conditions: Scoliosis
Allergies: Codiene and PCN
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient reports she cannot walk without holding on to something, and that she is "all over the place". Reports vomiting and a fever.


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