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

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



Case Details (Reverse Sorted by Onset Date)

This is page 126 out of 3,524

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VAERS ID: 1381744 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-05
Onset:2021-05-20
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Herpes zoster
SMQs:, 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: Rashes after having vaccines to travel to Brazil
Other Medications:
Current Illness: Psoriatic Arthritis
Preexisting Conditions: Psoriatic Arthritis
Allergies: Meats (except saltwater fish) Peanuts Pistachios Medical grade adhesive
Diagnostic Lab Data: I was seen by my medical provider who confirmed shingles as the diagnosis.
CDC Split Type:

Write-up: I developed a case of shingles on my right torso


VAERS ID: 1381757 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 RA / SYR

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

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

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


VAERS ID: 1381832 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-14
Onset:2021-05-20
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bell's palsy, Dizziness, Facial paralysis, Pain in jaw
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad), Vestibular disorders (broad), Osteonecrosis (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: unknown
Current Illness: None listed with vaccine checklist
Preexisting Conditions: None listed with vaccine checklist
Allergies: No Known allergies
Diagnostic Lab Data: The pt was instructed to go to an urgent care or emergency department. The mother reported that he was taken to the ERD and was told that he had Bells Palsy. He was told to follow up with the PCP . We were able to speak with the mother today and were told that the PCP was unable to see pt. An appointment was offered in our office and unsure if accepted at this time.
CDC Split Type:

Write-up: On 05-20-21 We received a text message from the pts mother stating that the pt was experiencing drooping of the face , pain in jaw all on left side and dizziness.


VAERS ID: 1381835 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Balance disorder, Ear discomfort, Headache, Lymphadenopathy, Middle ear effusion
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Hearing impairment (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril 20mg B complex 100mg, K2 100mcg, D3 5000 IU, Ester C 1000mg
Current Illness: No illnesses
Preexisting Conditions: Chiropractor visits monthly for adjustments to lower back
Allergies: (Biaxin), (Augmentin), Dilaudid, Nitrofurantoin, Lyrica Dairy and Gluten Contrast dye
Diagnostic Lab Data:
CDC Split Type:

Write-up: PAIN BASE OF HEAD BACK OF LEFT EAR. LEFT EAR FELT LIKE IT WAS FULL OF WATER. TOOK TYLENOL 500 MG 2-3Xs DAILY FOR PAIN. ON FOURTH DAY WENT TO DR.''s OFFICE. NURSE PRACTITIONER SAID THAT MY LYMPH NODES WERE SWOLLEN IN NECK, THERE WAS ALSO YELLOW , PUSS LIKE SUBSTANCE IN LEFT EAR. SHE PRESCRIBED: AMOXICILLIN 875 MG 2X DAILY FOR 5 DAYS and PREDNISONE 60MG 1X DAILY FOR 3 DAYS PAIN HAS SUBSIDED, FULLNESS IN EAR IS STILL THERE, MY BALANCE IS SOMETIMES OFF


VAERS ID: 1381893 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-13
Onset:2021-05-20
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash over body


VAERS ID: 1382045 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bacterial test negative, Blood test normal, Chest pain, Dizziness, Electrocardiogram normal, Fatigue, Fibrin D dimer normal, Headache, Oral discomfort, Pain, Pain in extremity, Pyrexia, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Bronchitis and pleurisy one month prior to vaccination
Preexisting Conditions: TMJ
Allergies:
Diagnostic Lab Data: The patient went to the ED on May 24 with chest pain. They did 2 EKG''s and some ''bloodwork'', and she reports that everything came back normal. She was sent home. She was told that the vaccine might have caused the pleurisy to flare up again, causing the chest pain. Her doctor''s office later ordered more lab work. The patient states that they did a d-dimer and checked for a bacterial infection. Those results also came back within normal range.
CDC Split Type:

Write-up: On 5/20, patient experienced a sore arm. Then on the same day she developed dizziness, tightness in the throat, body aches, a low grade fever, headache, fatigue and it felt like the roof of her mouth was on fire. Now nearly 3 weeks later she still has a low grade fever (99.7.) She has been taking Tylenol and Ibuprofen and is staying very well hydrated. She does not know if her temperature is actually higher than what is registering because she is medicating herself. She also still feels very tired and has an occasional headache. The sore arm barely lasted a day. Her biggest complaint is that the fever has not subsided and she still feels tired.


VAERS ID: 1382080 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Immediate post-injection reaction, Nausea, Tremor
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown to the vaccine administer
Current Illness: unknown
Preexisting Conditions: history of blood clot during pregnancy few years ago.
Allergies: unknown
Diagnostic Lab Data: Unknown to the pharmacy was done at the hospital.
CDC Split Type:

Write-up: Patient experienced immediate side effects right after her first dose of Pfizer Covid vaccine. The symptoms including shortness of breath, chest tightness, tremor and nausea. The pharmacist on duty had to call for 911 due to her conditions.


VAERS ID: 1382097 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pharyngeal paraesthesia, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Influenza vaccine, mild allergic reaction of throat tingling and mild throat closure. Patient last refused the influenza vaccine
Other Medications: Calcium with Vitamin D, Depo-Provera, Fluoxetine, Ibuprofen, Omeprazole, Polyethylene glycol
Current Illness:
Preexisting Conditions: Depression, environmental allergies, Dyspepsia
Allergies: egg, eggshell membrane, latex, shellfish derived
Diagnostic Lab Data:
CDC Split Type:

Write-up: After 14 minutes of vaccine administration, patient began feeling a mild allergic reaction of tingling in the throat with a mild feeling of throat closing, per patient. Patient was given Benadryl IM immediately, symptoms resolved and observed for 50 minutes total.


VAERS ID: 1382155 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Immediate post-injection reaction
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt began to faint while receiving vaccine. Via w/c to Observation area. Alert, diaphoretic & taking liquids. Ice pak to neck & improving rapidly. Dismissed w/o assistance.


VAERS ID: 1382174 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-18
Onset:2021-05-20
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 2 LA / SYR

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

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

Write-up: That night or the next day my left thigh was almost as sore as my arm. All discomfort subsided within a day or two. A month later, around May 20, I experienced severe shooting pain in my thigh. Then the same thing two weeks after that, on June 4. It would come and go for a few hours, and it was a 10 on a scale of 1 to 10. Since then just a little pain in my thigh, a 1 on a scale of 1 to 10. I reported it to my doctor and he recommended I report it to VAERS.


VAERS ID: 1382258 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-17
Onset:2021-05-20
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Grip strength decreased, Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: Patient experienced persisting pain and swelling of her bilateral hands as well as weakend grip strength.


VAERS ID: 1382293 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-18
Onset:2021-05-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Fatigue, Lethargy
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: Zyrtec, Vyvanse, MethylPro with Cofactors
Current Illness: Upper respiratory allergies were bad
Preexisting Conditions: Allergies, MTHFR mutation, ADHD
Allergies: Upper respiratory allergies to trees, grasses, ragweed, etc; allergy to hazelnut; sensitivities to egg, wheat, dairy, turkey, corn, soy, sulphites
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tired, lethargic and weak for 10 days


VAERS ID: 1382516 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-18
Onset:2021-05-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthma, Cough
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

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

Write-up: Patient had asthma flare approximately 48 hours after 1st dose Pfizer. Was put on 2 courses of high dose prednisone. Patient was still on prednisone and coughing when she came back to vaccination site for 2nd dose. Patient was told to withhold on second vaccine for another week until patient has been off prednisone and not coughing.


VAERS ID: 1382688 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Activated partial thromboplastin time, Acute myocardial infarction, Amblyopia, Astigmatism, Blood calcium normal, Blood chloride normal, Blood cholesterol normal, Blood creatinine normal, Blood potassium normal, Blood sodium normal, Blood triglycerides normal, Blood urea decreased, Carbon dioxide increased, Cardiac telemetry normal, Chest discomfort, Chest pain, Chills, Dysphagia, Echocardiogram normal, Ejection fraction normal, Electrocardiogram PR segment elevation, Electrocardiogram ST segment elevation, Electrocardiogram abnormal, Glomerular filtration rate, High density lipoprotein decreased, Influenza like illness, International normalised ratio, Low density lipoprotein normal, Musculoskeletal discomfort, Myocarditis, Non-high-density lipoprotein cholesterol, Pain, Pyrexia, Skin lesion, Troponin, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Dyslipidaemia (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Corneal disorders (narrow), Lipodystrophy (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: none
Allergies: None
Diagnostic Lab Data: EKG, echocardiogram, bloodwork
CDC Split Type:

Write-up: Cardiology Consult: Patient ID: (Name) Date of birth: (Date) Primary Care Provider: (Name), MD Admitting Provider: (Name), MD Admitted: 5/22/2021 Reason for Admission: Chest pain SUMMARIZED H&P: Patient is a 36 year old male with no significant past medical history, healthy gentleman, that presents post covid vaccine with chest pain. He got his second dose of Moderna vaccine on Wednesday and then later that evening developed fevers, chills, body aches and flu likely symptoms. They continued through Thursday evening. He was taking ibuprofen but was having a hard time swallowing it. He started developing neck and chest discomfort and initially thought it was due to difficulty with pills. Symptoms continued through Friday despite the flu like symptoms improving. They talked to a family member that recommended they present for presentation. On presentation EKG showed diffuse ST elevation with PR depression. PR elevation in V4. Troponin peaked at 16.57 and is now 6.59. Echo with normal EF and no effusion. He was started on colchicine yesterday. Tele without any arrhythmias. He reports that symptoms were worse when laying down or taking deep breaths. Has not had any symptoms today. No history of heart disease, exertional symptoms or family history of early CAD Patient Active Problem List: Skin lesion of left leg Anisometropic amblyopia of right eye Myopia of both eyes with astigmatism NSTEMI (non-ST elevated myocardial infarction) PMH: has no past medical history on file. PSH: has a past surgical history that includes pr create eardrum opening,gen anesth (11/06). FH: family history is not on file. SH: reports that he has never smoked. He has never used smokeless tobacco. Social History Occupational History ? Not on file Tobacco Use ? Smoking status: Never Smoker ? Smokeless tobacco: Never Used Substance and Sexual Activity ? Alcohol use: Not on file ? Drug use: Not on file ? Sexual activity: Not on file Allergies: has No Known Allergies. Medications: Prior to Admission medications Medication Sig Start Date End Date Taking? Authorizing Provider fexofenadine (ALLEGRA) 180 MG tablet Take 180 mg by mouth once daily as needed Yes Provider, Historical, MD FIBER PO Take 1 tablet by mouth once daily Yes Provider, Historical, MD ibuprofen (MOTRIN) 200 MG tablet Take 200-600 mg by mouth every 6 hours as needed for Pain Yes Provider, Historical, MD Review of Systems: A 10 point ROS was obtained and was otherwise negative except for chest pressure Physical Exam: GENERAL: thin, well-appearing individual in no apparent distress. Vital Signs:*BP 98/70 Pulse 79 Temp 96.3 ?F (35.7 ?C) (Oral) Resp 18 Ht 5'' 11" (1.803 m) Wt 156 lb 6.4 oz (70.9 kg) SpO2 98% BMI 21.81 kg/m2Body mass index is 21.81 kg/m?. EYES: EOM intact bilaterally. EARS: hearing is grossly intact. NOSE: patent and moist. OROPHARYNX: moist and pink. NECK: supple, no masses, no adenopathy, no thyromegaly, no JVD, no carotid bruits. LUNGS: Clear to auscultation bilaterally. No rhonchi, rales or wheezes. HEART: Regular rate and rhythm, normal S1 and S2, no murmur(s). No rubs or gallops. ABDOMEN: Soft, nondistended. Nontender to deep palpation. No palpable masses, or organomegaly. Positive bowel sounds. EXTREMITIES: No clubbing,cyanosis. no pedal edema. CIRCULATION: 2+ pedal pulses bilaterally. SKIN: No rashes or open lesions. NEURO/PYSCH: No gross focal deficits. Alert and oriented x 3. Appropriate affect and mood. Most recent diagnostics and Labs: Recent Labs Component Name 05/23/21 0808 CHOLESTEROL 142 TRIGLYCERIDE 60 HDL 44 LDL 86 NONHDL 98 Recent Labs Component Name 05/23/21 0808 05/22/21 1415 WBC 6.0 9.1 Recent Labs Component Name 05/23/21 0808 05/22/21 1415 SODIUM 141 140 POTASSIUM 3.8 4.0 CHLORIDE 104 102 CO2 32* 27* BUN 11 8 CREATININE 0.90 0.9 CALCIUM 9.4 9.2 GFR $g90 $g90 No results for input(s): APT, INR in the last 87600 hours. Echo: ? Ejection fraction is 5560%. Question extremely mild area of inferoapical hypokinesis. ? There is no clinically significant regurgitation or stenosis. ? Pulmonary arterial systolic pressure is within the normal range. ? No significant pericardial effusion. IMPRESSION: Myopericarditis 2/2 covid vaccine - EKG changes and positive troponin - No evidence of effusion - troponin trending down and symptoms are improving PLAN: I reviewed findings with patient and his fianc?. We discussed pathophysiology and treatment. Since he had a difficult time with ibuprofen, we will treat with colchicine for 6 weeks at 0.6mg BID. Discussed side effect of diarrhea. I reviewed recommendations for avoiding strenuous activity and contact sports for 1 month due to cardiac inflammation. I reviewed risk of cardiac arrhythmias with myopericarditis and do recommend continuing with metoprolol on discharge. Recommend follow up with general cardiology in 4-6 weeks for follow up Thank you, (Name), DO Cardiac Electrophysiology


VAERS ID: 1383800 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-01
Onset:2021-05-20
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood urine present, Diarrhoea, Fatigue, Headache, Pain, Pyrexia, Urine analysis abnormal, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Urinalysis June 8, 2021
CDC Split Type:

Write-up: Fever started within 6 hours of receiving the second dose of the vaccination. Within the first 4 days post vaccination I had body aches, headache, fatigue, 1 day of vomiting and diarrhea. All other symptoms besides the fever and fatigue where gone by day 5 but fever persisted for 2 weeks and 5 days. On day 19 I had bloody urine that showed high white count, blood and traces of protein on the urinalysis.


VAERS ID: 1383808 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Myocarditis
SMQs:, Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Myocarditis per patient''s mother


VAERS ID: 1384134 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-05-13
Onset:2021-05-20
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Appendicitis, SARS-CoV-2 test
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? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data: Test Date: 20210520; Test Name: Nasal Swab; Test Result: Negative
CDC Split Type: PRPFIZER INC2021592302

Write-up: Abdominal pain and vomits, appendicitis diagnosed and surgery needed.; This is a spontaneous report from a contactable consumer (patient). A 15-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 via an unspecified route of administration, administered in Arm Left on 13May2021 13:00 (Batch/Lot Number: EW0179), at the age of 15 years old as 1st dose, single for COVID-19 immunization. The patient had no medical history and no known allergies. The patient''s concomitant medications were not reported. The patient had no other vaccines in four weeks and no other medications in two weeks. The patient had abdominal pain and vomits, appendicitis was diagnosed and surgery (removal of appendix) was needed. The event occurred on 20May2021 04:00 and was hospitalized for 1 day. The patient underwent lab tests and procedures which included COVID test post vaccination nasal swab: negative on 20May2021. The outcome of the events was recovering.


VAERS ID: 1384286 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-05-20
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HUMIRA
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210609117

Write-up: UNEVALUABLE EVENT (SIDE EFFECT OR COVID VACCINE WAS LITTLE ROUGH); This spontaneous report received from a patient concerned a 62 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number was not reported) dose was not reported, administered on 19-MAY-2021 for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. Concomitant medications included adalimumab. On 20-MAY-2021, the subject experienced unevaluable event (side effect or covid vaccine was little rough). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of unevaluable event (side effect or covid vaccine was little rough) was not reported. This report was non-serious.


VAERS ID: 1384324 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:2021-05-20
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Poor quality product administered, Product temperature excursion issue
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210612503

Write-up: VACCINE ADMINISTERED FROM VIALS AFTER BEING BROUGHT BACK TO REFRIGERATION TEMPERATURE (MEDICATION ERROR); TEMPERATURE EXCURSION FOR VACCINE PRODUCT; This spontaneous report received from a pharmacist concerned a 44 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1821286 expiry: UNKNOWN) dose was not reported, administered on 20-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 20-MAY-2021, the subject experienced vaccine administered from vials after being brought back to refrigeration temperature (medication error). On 20-MAY-2021, the subject experienced temperature excursion for vaccine product. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the temperature excursion for vaccine product and vaccine administered from vials after being brought back to refrigeration temperature (medication error) was not reported. This report was non-serious. This case, from the same reporter is linked to 20210612294, 20210611759, 20210612311 and 20210612749.


VAERS ID: 1384592 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH W01768721 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Disorientation, Dizziness, Electrocardiogram, Heart rate, Heart rate decreased, Hyperhidrosis, Loss of consciousness, Ventricular extrasystoles
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), Ventricular tachyarrhythmias (narrow), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Allergic reaction to antibiotics
Allergies:
Diagnostic Lab Data: Test Date: 20210520; Test Name: EKG; Result Unstructured Data: Test Result:PVC of heart; Test Date: 20210520; Test Name: heart rate; Result Unstructured Data: Test Result:Low bpm(30-40)
CDC Split Type: USPFIZER INC2021593172

Write-up: Passed out roughly 4 minutes after injection; Low bpm afterwards when paramedic showed up (30-40); sweating; EKG showed PVC of heart; dizziness; disorientation; low energyand weakness; This is a spontaneous report from a contactable consumer (patient). A 24-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 via an unspecified route of administration, administered in Arm Left on 20May2021 10:30 at age of 24 years old, (Lot Number: W01768721) as 1st dose, single for covid-19 immunisation. Medical history included known allergies: Augmentin. Any other medications the patient received within 2 weeks of vaccination was none. Clinical course reported that: Passed out roughly 4 minutes after injection. Woke up after 2 minutes sweating. Low bpm afterwards when paramedic showed up (30-40). 2 IV bags administered. EKG showed PVC of heart. Still have dizziness and disorientation as well as low energy and weakness 4 days later. Adverse events onset date reported as 20May2021 10:30 AM. Events resulted in Doctor or other healthcare professional office/clinic visit, Emergency room/department or urgent care. Outcome for events was not recovered. The patient was not diagnosed with COVID-19 prior to vaccination, and since the vaccination, the patient has not been tested for COVID-19. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. Information on Lot/Batch number was available. Additional information has been requested.


VAERS ID: 1384604 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FSA RX 0884468 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Inflammation, Pain in extremity, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ADVIL 12 HOUR
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021593718

Write-up: Very inflamed under neck; Severe rash/rash started up around my neck and spreading/rash took over neck and chest; front and back; severe pain in left hand; This is a spontaneous report from a contactable consumer (patient). A 52-year-old female patient received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Lot Number: FSA RX 0884468; Expiration date was not reported) on the left arm on 19May2021 (16:30) as a 1st dose, single dose, with route of administration unspecified, for COVID-19 immunization at the pharmacy/drug store. The patient had no relevant medical history. Concomitant medication included ibuprofen (ADVIL 12 HOUR). The patient was not pregnant at the time of vaccination. On 20May2021, the patient had severe pain in the left hand. On 21May2021, the patient had severe rash; the rash started up around the neck and spreading. On 22May2021, the patient''s rash took over the neck and chest, front and back; and the patient was very inflamed under the neck. The patient had received diphenhydramine (BENADRYL) and ibuprofen (ADVIL) as treatment for the events. The outcome of the events was not recovered. Prior to vaccination, the patient was not diagnosed with COVID-19. The patient had not been tested for COVID-19 since the vaccination. Information on the lot/batch number has been requested.


VAERS ID: 1384607 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Blood test, Cough, Diarrhoea, Electrocardiogram, Heart rate, Heart rate increased, Nasopharyngitis, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Dehydration (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19 (Prior to vaccination, the patient was diagnosed with COVID-19.)
Allergies:
Diagnostic Lab Data: Test Date: 20210520; Test Name: blood work; Result Unstructured Data: Test Result:unknown; Test Date: 20210520; Test Name: ekg; Result Unstructured Data: Test Result:unknown; Test Date: 20210520; Test Name: heart rate; Result Unstructured Data: Test Result:204; Test Date: 20210520; Test Name: heart rate; Result Unstructured Data: Test Result:106; Test Date: 20210520; Test Name: heart rate; Result Unstructured Data: Test Result:97-116; Comments: still higher than normal, when usually is around 80; Test Date: 20210522; Test Name: Covid-19 test; Test Result: Negative ; Comments: Nasal Swab; Test: Pcr
CDC Split Type: USPFIZER INC2021594556

Write-up: Heart rate on 5/20 of 204 until now still higher than normal between 97-116, when usually is around 80; diarrhea; cough; cold symptoms; This is a spontaneous report from a contactable consumer (patient) reported for herself. A 14-years-old female patient received bnt162b2 (BNT162B2), dose 1 via an unspecified route of administration, administered in Arm Left on 19May2021 12:45 (Batch/Lot Number: EW0186) as 1ST DOSE, SINGLE for covid-19 immunization at the age at vaccination of 14 years old. Patient was not pregnant. Medical history included prior to vaccination, the patient was diagnosed with COVID-19. Past drug reported as none. There were no concomitant medications. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The patient experienced heart rate on 5/20 of 204 until now still higher than normal between 97-116, when usually is around 80 (medically significant) on 20May2021 09:45 with outcome of not recovered; diarrhea, cough and cold symptoms (non-serious) on 20May2021 09:45 with outcome of not recovered. Reported as: Heart rate on 5/20 of 204 then we took her to the urgent care was given fluid and ekg and blood work, after that HR when down to 106, and until now still higher than normal between 97-116, when usually is around 80, also she had diarrhea on 5/20, and also cough from 5/20 until now like cold symptoms. The patient underwent lab tests which included blood test: unknown on 20May2021, electrocardiogram: unknown on 20May2021, heart rate: 204 on 20May2021, heart rate: 106 on 20May2021, heart rate: 97-116 on 20May2021 (still higher than normal, when usually is around 80), sars-cov-2 test: negative on 22May2021 (Nasal Swab; Test: Pcr). The events induced Emergency room/department or urgent care. The treatment received for the adverse event included: Fluids thru IV. Information on Lot/Batch number was available. Additional information has been requested.


VAERS ID: 1384641 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW00185 / 1 RA / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021602958

Write-up: fell out of his chair; confused; did not feel well; This is a spontaneous report from a contactable other health professional (patient). A 23-year-old male patient received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE; Lot Number: EW00185) intramuscularly administered into right arm on 20May2021 (at the age of 23-year-old) as 1st dose, single for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. On 20May2021, patient was in observation for 20 minutes then he fell out of his chair, he was confused and did not feel well. The events resulted in emergency room visit. Outcome of events was unknown. Information on Lot/Batch number was available. Additional information has been requested.; Sender''s Comments: The contributory role of the suspect product to reported fall cannot be excluded.


VAERS ID: 1384790 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Asthma (patient takes an inhaler only for sports where she''s exerting herself. she was diagnosed maybe 3 years ago, 2018 or maybe it was 2016); Horseshoe kidney (the patient was diagnosed with a horseshoe kidney a year or two ago.)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021658961

Write-up: sore arm; little fatigue; This is a spontaneous report from a contactable consumer via a Pfizer sponsored program. A contactable consumer reported for a 13-year-old female patient who received first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Solution for injection), via an unspecified route of administration on 20May2021 (Batch/Lot Number: EW0177) as a single dose for covid-19 immunization. Medical history included athletic induced asthma (she was diagnosed maybe 3 years ago, 2018 or maybe it was 2016) and horseshoe kidney (the patient was diagnosed with a horseshoe kidney a year or two ago, meaning when the patient was in the her mother''s womb, her kidneys while they were developing never separated so she has to be careful not to get kidney infections and not to get hit in the stomach when she''s playing sports). On 20May2021, the patient experienced sore arm, little fatigue. Caller (reporter) stated that there was a report that came out. Caller states her daughter got her first dose, she was 13, and had no reaction other than a sore arm and a little fatigue the first day. Caller states the reports says it''s causing enlarged heart in a lot of teens; she asked her doctor about it and the doctor said the benefits of getting the vaccine outweigh the risks and advised the caller to still get it for her daughter. The outcome of the events was unknown. Pfizer Covid Vaccine: Caller confirms the patient received the Pfizer Covid Vaccine. NDC: Unknown; Expiry Date: Unknown; Unknown Dosage; Indication: Caller states they are pretty good about not going anywhere, but they certainly venture out more than she does. Caller states she wants to make sure she was protected. Caller states she learned a day or two before she scheduled the shot that her daughter''s school is not offering school from home next year. Caller states it''s called E classroom, they are also doing hybrid but her daughter opted to stay home. Caller states she learned they weren''t doing any of that next year. Caller confirms her daughter is scheduled for her second dose on 10Jun2021. PSCC Communication: Report 2 of 7. Caller does not provide any further information on patient; therefore, no further information obtained or verified. Additional information has been requested.


VAERS ID: 1385093 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-02
Onset:2021-05-20
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN NOT AVAILABLE / 1 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Aortic aneurysm repair, Aortic dissection, Arteriogram coronary abnormal, Asymptomatic COVID-19, Capillary nail refill test abnormal, Echocardiogram, Endotracheal intubation, Hypoaesthesia, Pain in extremity, Peripheral coldness, Pulse absent, SARS-CoV-2 test positive, Sensory loss, Sternotomy
SMQs:, Angioedema (broad), Peripheral neuropathy (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Guillain-Barre syndrome (broad), Other ischaemic heart disease (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen, albuterol inh, docusate, ibuprofen
Current Illness: Type A dissecting thoracic aortic aneurysm measuring up to 6.1
Preexisting Conditions: Hypertension, obesity, asthma, ex-smoker, heart failure
Allergies: none
Diagnostic Lab Data: 5/20 COVID-19 positive
CDC Split Type:

Write-up: On 5/20/21 patient arrives to hospital via EMS for leg pain and numbness. Left lower extremity cooler to the touch. Unable to palpate pulses. Unable to Doppler pulses. Cap refill is slow, around 3 to 4 seconds. Patient reports he is unable to feel a sensation. Able to wiggle toes. 5/20 CT angiogram reveals dissecting aneurysm. 5/20 COVID-19 positive 5/20 cardiothoracic surgery : MEDIAN STERNOTOMY for REPLACEMENT, AORTA, ASCENDING (HEMASHIELD PLATINUM 34MM), AND TEE Intubated or the surgery and of typical uration post-operatively On high flow NC oxygen Critical care MD notes: Not symptomatic due to COVID No COVID treatment(s) were ever needed. Discharged to home


VAERS ID: 1385234 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-04-06
Onset:2021-05-20
   Days after vaccination:44
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Echocardiogram, Electrocardiogram, Magnetic resonance imaging, Thrombosis, Transient ischaemic attack
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Synthroid, Cartia, Ativan, Crestor, Zoloft, Plaquenil, Omeprazole, Lisinopril, Daily Vitamin
Current Illness:
Preexisting Conditions: Lupus, Afib
Allergies: MSG, Clindamycin, Erythromycin, Cipro, Seroquel, Oxycodone
Diagnostic Lab Data: MRI, EKG, Echocardiogram, Blood tests, Chest X-ray
CDC Split Type:

Write-up: Blood Clot from heart to brain. Caused a TIA


VAERS ID: 1385280 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-04-30
Onset:2021-05-20
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 2 LA / IM

Administered by: Private       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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: body rash/ spots


VAERS ID: 1385389 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Wyoming  
Vaccinated:2021-05-04
Onset:2021-05-20
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Condition aggravated, Dysphonia, Pain in extremity, Respiratory tract congestion
SMQs:, Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Tetanus
Other Medications:
Current Illness: Common cold at the time of second vaccination on 06.04.2021
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Approximately ten years ago, I had an adverse reaction to a tetanus vaccine that resulted in a transverse myelitis diagnosis. At that time, my neurologist said, "no more vaccines for you EVER!" When COVID hit, and a vaccine became available, I asked my new neurologist if it was ok for me to get the vaccine, she said yes since it was new technology, but my primary care physician said no. Due to the nature of my work in the energy industry and travel, I needed to get the COVID vaccine. Now, after receiving both rounds of the vaccine, I am seeing similar symptoms I had after my tetanus vaccine. I''ve reached out to my neurologist several times without a return call and I''ve scheduled an appointment with my primary care physician.
CDC Split Type:

Write-up: approximately two weeks after my first injection I came down with a terrible cold and then swelling and pain in my right foot. I also started noticing less sensitivity in my hands, cold feet and weakness in my hands. After I received my second shot, the pain in my feet worsened, I had extreme pain in my lower back. My chest congestion continues and my voice is raspy.


VAERS ID: 1385414 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-04-28
Onset:2021-05-20
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Computerised tomogram thorax abnormal, Deep vein thrombosis, Dyspnoea, Dyspnoea exertional, Fibrin D dimer increased, Pulmonary embolism
SMQs:, Anaphylactic reaction (broad), Haemorrhage laboratory terms (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

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

Write-up: Patient presented to urgent care with shortness of breath. Patient had positive D-dimer and referred to the ER for CT. At ER visit, he reports progressive worsening shortness of breath over the past 3 to 4 weeks. Dyspnea on exertion 5/20/2021. Patient was admitted to the hospital with diagnoses of bilateral PE with small saddle embolus and left DVT (left popliteal vein occlusion). Treatment included heparin drip in the hospital with a conversion to Eliquis.


VAERS ID: 1385858 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-07
Onset:2021-05-20
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Thrombocytopenia
SMQs:, Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Thrombocytopenia, unspecified


VAERS ID: 1385877 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest X-ray, Dyspnoea, Electrocardiogram
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Chest x-ray and EKG done at ER - negative
CDC Split Type:

Write-up: shortness of breath the following day


VAERS ID: 1385944 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Body temperature increased, Fatigue, Inflammation, Inflammatory marker increased, Joint range of motion decreased, Magnetic resonance imaging head, Magnetic resonance imaging spinal, Mobility decreased, Movement disorder, Muscle spasms, Muscle tightness, Nausea, Neuralgia, Pain, Tremor
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Bupropion 150 mg Diclifenac 75 mg Escitalopram 20 mg Omeprazole 20 mg
Current Illness: None
Preexisting Conditions: COVID DEC 2020
Allergies: Silver
Diagnostic Lab Data: Inflammation markers were extremely high in the 80?s for over 10days Repeated MRIs of spine and Brain Injection in SI joint did nothing Steroids reduced inflammation. For a few days but I?m back to where I was after the vaccine but worse
CDC Split Type:

Write-up: First 8 hrs tired weak temperature 102.7, back tight like it was fused and unable to move Nauseated like I had COVID all over again I was in bed Thursday through the weekend. I ended up with excruciating pain that landed me in the hospital for two weeks for extreme nerve pain to the point I can?t walk, sit or stand for long periods of time. I was given heavy doses of steroids, pain meds, IV fluids and met with a neurologist did multiple MRI?s and I?m left with severe muscle spasms and tremors the Drs can?t seem to understand why They said this is not related to back issues however they did a steroid back injection hoping it would help with inflammation and I was sent home after two weeks in the hospital. I?m at home and dear if my life doesn?t turn around I will lose everything. I was a athlete with no prior previous existing health issues and now I can?t even leave my house without serious tremors and muscle spasms I?m on medication for seizures, muscle spasms pain meds and have a jacuzz I can?t even raise my leg to get into This ALL HAPPENED RIGHT AFTER I GOT THE VACCINE!!!! 1st dose I did have a bad case of COVID in December for the record.


VAERS ID: 1386022 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-05-18
Onset:2021-05-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Appetite disorder, Computerised tomogram, Fatigue, Injection site erythema, Injection site pain, Injection site swelling, Lymph node pain, Lymphadenopathy, Pain in jaw, Tenderness
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Osteonecrosis (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allesse BCP Celebrex 200mg PO QD Biotin Vitamin C Elderberry Ibuprofen 800mg
Current Illness: left eye sclera redness, irritation - seen HCP
Preexisting Conditions: history of Idiopathic Thrombocytopenic Purpura - 2 episodes, one at 18yo, second in late 30s
Allergies: watermelon Quaternium 15 Formaldehyde Thimerasol Diazolidinyl urea
Diagnostic Lab Data: saw and discussed w HCP multiple times; CT scan 5/27/21 afternoon
CDC Split Type:

Write-up: RECEIVED vaccine 5/18/21; 5/20/21 evening, large red, swollen area with moderate tenderness to injection site - arm was one inch bigger in diameter than non vaccinated arm - lasted close to a week; 5/23/21 afternoon, noted moderate swelling on lymph node under ear lobe behind jaw, tenderness to palpation, fatigue, any chewing on that side of mouth was unbearable as sharp shooting pains in the swollen area resulted; was unable to close jaw fully due to pain during this time; remained on soft food and liquids only through 5/27/21. Lymph swelling subsided this day, while tenderness continued through 5/30/21.


VAERS ID: 1386047 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-13
Onset:2021-05-20
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Mammogram normal, Thrombophlebitis superficial, Ultrasound scan
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (narrow)

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

Write-up: This was reported after the fact by the patients doctor. The patient began to have rippling lines in her breast, one week after receiving the vaccine. She began seeking treatment at her PCP and was sent to Doctor at the center. According to Dr. she presented with creases and dents in her left breast. A mammogram was negative. A left breast ultrasound was then preformed, and found branches of superficial thrombosed veins in her left breast. Dr. believes it is related to the covid vaccine. Patient was then sent to the ER for fear of DVT. Patient was found to have no DVTs and was diagnosed with superficial thrombophlebitis and sent home.


VAERS ID: 1386163 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-13
Onset:2021-05-20
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Fatigue, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

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

Write-up: PATIENT STATED THAT 1 WEEK AFTER THE VACCINE HE IS EXPERIENCING SEVERE FATIGUE AND SPENDS MOST OF THE DAY SLEEPING. HE ALSO HAS EXPERIENCED CONFUSION


VAERS ID: 1386216 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Pain in extremity
SMQs:, Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 55, Dec 2020, shingles shot, Shingrix, arm was sore for 2 days where I got the shot
Other Medications: Yes - too lazy to list.
Current Illness: Borderline diabetic, asmatic
Preexisting Conditions: asthma
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: At night same day as shot. Both knees sore and arms and legs were sore as well. Too OTC pills for the pain. Generic brands. Took a pill every 4 hours as recommended until it no longer hurt.


VAERS ID: 1386394 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN EWO182 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: International normalised ratio normal, Pain in extremity, Skin discolouration, Ultrasound scan normal
SMQs:, Hypotonic-hyporesponsive episode (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin 81 mg, 1 tablet(s) by oral route, 1 time per day Clopidogrel 75 mg, 1 tablet(s) by oral route, 1 time per day, for 30 days Warfarin 5 mg, 1-2 tablet(s), 1 time per day, 1.5 tabs 5 days a week; 2 tabs 2 days a week Atorvastatin 80 mg
Current Illness: None
Preexisting Conditions: Cardiovascular disease, high blood pressure, blood clotting - I had a portal vein clot in 2003 (approx).
Allergies: None
Diagnostic Lab Data: They ran an ultrasound on areas of my arm that were unaffected (why? I don''t know). They checked my INR since I''m on blood thinners, which was normal.
CDC Split Type:

Write-up: I had no symptoms until the next morning when I woke up with very extreme pain in my left arm with the epicenter of the pain on the back of my left hand between the bones leading to the ring finger and the pinky. Whenever my hand was below my heart, the entire hand was dark purple in color. I had read that severe reactions from the shot generally dissipated in a day so I took some Hydrocodone which I had for migraines, kept my hand elevated, and decided to wait it out. The next day the pain was still extreme so I went to urgent care. Urgent care eventually said I needed to go to the emergency room to have an ultra-sound. I did so. After many hours of waiting, they got me into the ultrasound room where they told me they cannot ultrasound the back of the hand because the vessels are too small and don?t show up. So they ran an ultrasound on the shoulder and front of the arm and found nothing. I?m not surprised as that is not where the pain was coming from. I went home and alternately put my left hand in ice water and hot water periodically, which eventually reduced the pain to a tolerable amount. As of today, all the pain is gone except for the region mentioned in the back of the hand. That still hurts, so I''m answering item 20 with a No.


VAERS ID: 1386599 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site movement impairment, 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 reported "COVID Arm" for 3 days after the vaccine. She reported this to the pharmacy on 6/9/21. She said that she experienced redness, swelling, and had trouble moving her arm.


VAERS ID: 1386606 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Hot flush, Insomnia, Nervousness, Palpitations, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: After sitting calmly for a few minutes post vaccine, there was a sudden hot flush that rose up through my chest and into my face. My heart then started pounding very hard a quickly and my body started trembling. I became short of breath and lightheaded, but never felt I was wheezing. The pharmacist did not seem to know what was going on and told me to just stay seated and let him know if there were any changes. I took my mask off to get enough air and after a few minutes my heart rate slowed down and then the issue seemed to come in waves for about 10 minutes. After 15-20 minutes I felt shaky and lightheaded, but my heart rate seemed normal. At that point I asked the pharmacist to take my BP, which was normal. Over the next week I had an increase in heart palpitations and difficulty sleeping. It felt like I had increased amount of adrenaline in my system. 3 weeks out I still have increased palpitations, but they are less frequent than they were initially.


VAERS ID: 1386623 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-07
Onset:2021-05-20
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Electrocardiogram, Ventilation/perfusion scan
SMQs:, Anaphylactic reaction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Obesity
Allergies: None
Diagnostic Lab Data: 5/24/2021 Emergency Room 2 EKG 1 lung scan Several other tests I?m not aware of
CDC Split Type:

Write-up: Chest tighness


VAERS ID: 1387722 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-11
Onset:2021-05-20
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Gait inability, Hypoaesthesia, Muscle strain, Pain in extremity, SARS-CoV-2 test, Thrombosis
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dystonia (broad), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Tendinopathies and ligament disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210524; Test Name: COVID Test; Test Result: Negative ; Comments: Nasal swab
CDC Split Type: USPFIZER INC2021599419

Write-up: massive blood clot from her thigh to her ankle; incapable of walking; serious pain in my left thigh/muscle strain; serious pain in my left thigh/muscle strain; leg fell asleep; This is a spontaneous report from a contactable consumer (patient). A 24-year-old female patient received the second dose of BNT162B2 (Pfizer-BioNTech COVID-19 vaccine, lot number and expiry date unknown), via an unspecified route of administration, administered in the left arm on 11May2021 at 14:45 as a single dose for COVID-19 immunization. The patient''s medical history was not reported. Prior to vaccination, the patient was not diagnosed with COVID-19. The patient was taking unspecified birth control medication. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The patient was on her second week of completing the vaccine. The patient reported that on Thursday night, 20May2021, she was just laying down on her couch watching Netflix with her laptop on her lap, her leg fell asleep but she didn''t think anything of it because once she started walking around it went back fine. However, on 21May2021, Friday morning, she was having serious pain in her left thigh. She believed it was a muscle strain. The patient did a cold compress, warm bath and took Tylenol from Friday to Saturday. She thought it got better but by 23May2021, Sunday night, she was incapable of walking on her own and needed assistance just to go to the bathroom. On 24May2021, she went to Urgent Care and they stated that she may have a blood clot so she went to the ER (Emergency Room). While at the ER they said she had a massive blood clot from her thigh to her ankle. She would need a procedure done to remove it and was later admitted into the hospital and scheduled for the procedure. Blood thinners and suctioning out the blood clot was done as treatment. The patient been tested for COVID-19 (nasal swab) on 24May2021 with a result of negative. The outcome of the events was unknown.


VAERS ID: 1387798 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Blood pressure measurement, Dark circles under eyes, Diarrhoea, Fatigue, Feeling abnormal, Headache, Heart rate, Heart rate increased, Hypoaesthesia, Limb discomfort, Nausea, Pain in extremity
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Faint (when she faints, she stops breathing); Fear; Feeling unwell; Illness; Sensation of heat; Vasovagal attack (Verbatim: vasovagal syncope)
Allergies:
Diagnostic Lab Data: Test Date: 20210520; Test Name: blood pressure; Result Unstructured Data: Test Result:122/80; Comments: 122/80 something; Test Date: 20210520; Test Name: Heart rate; Result Unstructured Data: Test Result:90s
CDC Split Type: USPFIZER INC2021641331

Write-up: sore arm; both arms go numb all the way to pinky, heavy feeling that she can''t describe in any other way; headache; nausea; stomach pain; dark circles under her eyes; heart rate was elevated; so foggy the first day; diarrhea; extreme fatugue; both arms go numb all the way to pinky, heavy feeling that she can''t describe in any other way; This is a spontaneous report from a contactable consumer (patient) or other non hcp from an Agent Team. A 42-year-old female patient received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VAC-CINE, Solution for Injection, Batch/Lot Number: EW0177) via an unspecified route of administration, administered in arm left on 20May2021 08:57 (at the age of 42-year-old) as 1st dose, single dose for covid-19 immunisation. Medical history included vasovagal syncope (Verbatim: vasovagal syncope), overheated, fearful, or not feeling well, she faints. Caller states if she has an illness, she will throw up and pass out. Reporter states when she faints, she stops breathing. The patient''s concomitant medications were not reported. Patient previously took vaccine included Titanus (she got was 11 years ago and that was the tetanus DDAP or TDAP). On an unspecified date the patient experienced sore arm, on 20May2021 the patient experienced extreme fatigue, both arms go numb all the way to pinky, heavy feeling that she can''t describe in any other way, diarrhea, heart rate was elevated, so foggy the first day, on 21May2021 the patient experienced headache, nausea, stomach pain, dark circles under her eyes, on an unspecified date in Jun2021 the patient experienced both arms go numb all the way to pinky, heavy feeling that she can''t describe in any other way. patient having symptoms from the Covid vaccine that she got about 14 days ago and she''s due for her second dose Thursday. Transferring agent states the caller doesn''t want to, s patient having concerns that patient going to experience the same thing patient having if she gets the second dose and if she is, patient doesn''t want to go through with the second dose. Patient states basically 14 days after having the first dose, which patient had on 20May2021 at 0850. patient states she still having some side effects 14 days later and from asking around and reading up, most people aren''t still having side effects 14 days later. Patient states she was concerned about whether she should get the second dose or not. she can''t take SSRIs, NSAIDS, can''t have caffeine. Patient states she been having headaches every single day since the first dose. she was extremely fatigued. Patient states starting a few days ago, her arms go numb. Patient states yesterday they were numb all afternoon into the evening, there was nothing she could do, she tried to stretch and move each arm. Patient states her pinky''s are numb on each hand, which is new, that''s never happened before. Patient states just based on all that, she did have some pretty strong symptoms for the first 48 hours after vaccine. Patient states within first 15 minutes, her heart rate was elevated her normal resting heart rate is in the 50s and 60s and even some-times at night while she''s sleeping, it goes into the 40s and after the vaccine it went up to the 90s. Patient states her blood pressure last time at the doctor was 97/60. Caller states her blood pressure is usually really low. Patient took her blood pressure 15 minutes after the first dose, she thinks it was 122/80 something, which is normal for most people, but for her its really high. Patient states her cardiologist said she had a little bit of inflammation and said to check with her primary care provider so she messaged her all that information but her primary care doctor is supposed to be leaving for her vacation, so she might not have a chance to look at it. the first 48 hours, she felt incredibly heavy, she could get up and walk around, she just didn''t feel right. Patient states anytime her significant other went over a bump in the car on the way home, she just doesn''t know how to describe it, it wasn''t motion sickness, she thought oh my gosh don''t go over anymore bumps, it intensified the heavy feeling. Patient states had nausea and stomach pain but that''s mostly gone away now. she also had diarrhea for the first 24 hours. Patient states other family members who had Moderna were very sick after their second dose. Patient states there was a report that came out. Patient states her daughter and significant other also got their first dose and her daughter is 13, they had no reaction other than a sore arm and a little fatigue the first day. Headache: Patient states she had a headache within 24 hours, it''s more of an after effect, definitely a lingering one. Caller states it''s not constant, they come and go but for someone who never usually gets headaches unless severely ill is weird. Fatigue: Patient states fatigue started that day, 20May2021, it was definitely worse the first several days after, and hasn''t completely gotten better, its still lingering. Patient states she thinks its improved, she''s trying to exercise more. Caller states the days she does exercise, she feels less fatigued. Patient states she has been exercising more since 01Jun2021. Arms go numb; pinkies are numb on each hand: the numbness started within the last few days. Patient states it''s from her scapula down to her pinky, its weird. Heaving feeling: Patient states she got a heavy feeling within 5 or 10 minutes of getting the shot then it kind of worsened through out the day, it was weird. Patient states she would get to the point where she needs to lay down but if she laid down for a long time she would feel worse and then she would start moving around but then if she kept doing stuff she would get to the point where she had to lay down again. Diarrhea began right after shot when she got home within an hour and it was just the next 24 hours. Nausea; stomach pain, the nausea and stomach pain lingered. she does have to follow a GERD diet to prevent stomach ulcers so when she sticks to that she doesn''t have any stomach pain but if she has a tomato or onion here or there it will start to come back. she was so foggy the first day. dark circles, she had been sleeping up to 8 hours a night and before she was only sleeping 6 hours a night so she would think it wouldn''t be that way. Went with Pfizer because a family member had zero reaction to either dose whereas those who took Moderna were very sick after the second. The immediate members of Patient household were completely fine after their first Pfizer dose. patient underwent lab tests and procedures which included blood pressure measurement: 122/80 (122/80 something), heart rate: 90 on 20May2021.The outcome of the event headache was not resolved, outcome of the event extreme fatigue, both arms go numb all the way to pinky, heavy feeling that she can''t describe in any other way, heart rate was elevated, so foggy the first day, sore arm was unknown, outcome of the event nausea, stomach pain, dark circles under her eyes was resolving, outcome of the event both arms go numb all the way to pinky, heavy feeling that she can''t describe in any other way was resolved on an unspecified date in 2021, outcome of the event diarrhea was resolved on 22May2021.


VAERS ID: 1388070 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Blood test, Eating disorder, Gastrointestinal disorder, Ultrasound Doppler, X-ray
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: None
Current Illness: No
Preexisting Conditions: No
Allergies: Soy
Diagnostic Lab Data: I had blood work done, X-rays and an ultrasound 2 days ago while I was in the ER. I am going to see a specialist soon.
CDC Split Type:

Write-up: I have had gastrointestinal issues since the day after relieving the shot, I spent the night in the ER because of it 2 days ago. For 3 weeks I have not been able to eat without being in excruciating pain.


VAERS ID: 1388076 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-14
Onset:2021-05-20
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Exercise tolerance decreased, Impaired work ability, Pain, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Arthritis (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: Only mild achy/drowsy symptoms for about 24 hours after intramuscular influenza vaccines in the past, including this COVID19 vac
Other Medications: None at time of vaccination. But I have occasionally taken aspirin and ibuprofen since the vaccine.
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I work as a security officer for a multi-story office building. About a week after receiving the vaccine I began having a pain in my hip. Normally, my job requires me to walk between 2-4 miles per shift, and I?ve never had problems doing so. But since the vaccine I?ve only been able to walk for about 30 minutes before needing to sit and rest; the pain becomes unbearable. It doesn?t feel like a backache. It feels like a sharp stabbing sensation in my hip/thigh joint when I''m standing or walking. OTC aspirin and IB have had no effect and the problem hasn?t subdued. A dull pain is always there, even at home and when I''m sleeping, but it becomes a major issue at work because of the constant walking. I?m unsure if it?s vaccine related.


VAERS ID: 1388173 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-09
Onset:2021-05-20
   Days after vaccination:100
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Menstrual disorder, Oligomenorrhoea
SMQs:, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Menstrual cycle changes; increased cycle length


VAERS ID: 1388194 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Buspar, Lexapro
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Went to emergency room and urgent care multiple times.
CDC Split Type:

Write-up: Broke out in a really bad hives and rash. Has lasted over 3 weeks.


VAERS ID: 1388397 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-13
Onset:2021-05-20
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus, Injection site rash, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient came in for second dose today 6-10-21. She stated that about 7-10 days after the first shot she had a terrible itching near the injection site. The left arm had fever, redness, and rash. It lasted for 3 or 4 days and is fully resolved with no other complications.


VAERS ID: 1388895 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

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

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

Write-up: Patient reported feeling dizzy 10 minutes post-administration of first Pfizer dose. Had patient sit down and take off mask to make sure patient is breathing adequately. Took patient''s blood pressure twice; both WNL 5 minutes apart. Provided patient with some water and snacks while he was waiting in our facility for 30 minutes. Then patient and his sisters decided to leave afterwards.


VAERS ID: 1388919 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040BZ1A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043BZ1A / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Injection site hypoaesthesia, Injection site pruritus, Injection site scab, Injection site scar, Injection site swelling, Musculoskeletal stiffness
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)

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

Write-up: Numbing of left arm around injection site, stiffness for 2-3 days. Itchy but did not scratch area. After 3 days or so swelling and stiffness gone. A week later very mild scarring/scabby near injection sight. Still visible as of 6/10/21 3:10pm.


VAERS ID: 1389101 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-13
Onset:2021-05-20
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

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

Write-up: carpal tunnel like tingling in both wrists


VAERS ID: 1389108 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 RA / IM

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

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

Write-up: patient was 11 years old at the time of the vaccination. We discovered this on 6/10/2021. The patient''s father told us on 5/20/2021 that she was born in 2008 and was 12 years old. We were unable to bill the insurance and we told him that he needed to fix the date of birth with the insurance company. At the second dose of the vaccine on 6/10/2021 we attempted to bill the insurance for the second dose of the vaccine and the date of birth was still flagged. We asked him about why that was not fixed and he said that it''s because she is actually born in 2009, making her 11 years old. He later admitted that he just wanted his daughter to receive the vaccine. At this time we are not aware of a side effect or treatment being performed.


VAERS ID: 1389183 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-18
Onset:2021-05-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Hypoaesthesia oral, Tongue pruritus
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)

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

Write-up: Intermittent numbness and itching of the tongue. Resolves without intervention. Still ongoing intermittently for 3 weeks.


VAERS ID: 1389246 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-06
Onset:2021-05-20
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Inflammation, Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: Swollen right hand and inflamed and painful index tendon sheath. Swollen right foot and painful large toe


VAERS ID: 1389293 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Swelling face
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: pt called in about getting second dose saying he had shortness of breath for a week, facial swelling and was concerned about second dose. we had not had this reported to us at an earlier date and pt did not report


VAERS ID: 1389539 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-13
Onset:2021-05-20
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / UNK - / IM

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

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

Write-up: LARGE RED, ITCHY SKIN ERUPTIONS ON ARMS AND LEGS. STARTED APPROX. 7 DAYS AFTER 1ST DOSE AND STILL SAME SIZE AND ITCHINESS AS OF 6/10/2021


VAERS ID: 1390037 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pharyngeal swelling, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (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: High blood pressure meds and birth control vitamins d b and zinc and potassium
Current Illness: None
Preexisting Conditions:
Allergies: Latex and penicillin per my allergist years ago i reacted to all items he tested
Diagnostic Lab Data:
CDC Split Type:

Write-up: swelling of throat and tightness of airway . Took 100 mg of benadryl around 4pm swelling of throat improved immediately. Air was tight most of the night the next morning took inhaler and losen up my airway


VAERS ID: 1390050 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-17
Onset:2021-05-20
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Heart rate increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Dehydration (broad)

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

Write-up: Heart beating fast Shortness of breath Can hear my heart beat in my neck or other areas.


VAERS ID: 1390200 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Vertigo
SMQs:, Vestibular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Patient did describe one episode of brief vertigo about one week prior to vaccination, about 5/13/2021, so not entirely clear that these were new symptoms after vaccination.
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Brief 1-2 second episodes of vertigo once or twice daily since day of vaccination, reported on 6/10/2021. Of note, patient had one such episode of vertigo one week prior to first vaccination on or about 5/13/2021, so not entirely clear that this was new symptom after vaccine, but frequency did increase. No other associated cardiac or neurologic symptoms.


VAERS ID: 1390324 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: California  
Vaccinated:2009-12-20
Onset:2021-05-20
   Days after vaccination:4169
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / IM

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

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

Write-up: Parent was not honest about patient age. Patient is actually 11 year old


VAERS ID: 1390325 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 - / -

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

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

Write-up: client received 1st dose pfizer covid vaccine at age 10. Client did not report any adverse reactions.


VAERS ID: 1390693 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: North Carolina  
Vaccinated:0000-00-00
Onset:2021-05-20
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Confusional state, Dizziness, Dysphonia, Dyspnoea, Fatigue, Feeling jittery, Gait disturbance, Headache, Heart rate increased, Hypersensitivity, Insomnia, Lip swelling, Oedema peripheral, Paraesthesia oral, Throat tightness, Tremor
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Toxic effect of isopropyl alcohol
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210612515

Write-up: CONFUSED; HARD TO WALK; MAYBE HARD TO BREATH OXYGEN HELPED; LIGHT HEADED; SWELLING LEGS/ANKLES; JITTERY; SLIGHT HAND TREMORS; WEAK; TIRED; HEADACHE; MOUTH WAS TINGLING; LIP SWELLING; THROAT TIGHTENING; WHISPER VOICE; HEART RATE INCREASED; DIFFICULTY SLEEPING; ACUTE ALLERGIC REACTION; This spontaneous report received from a patient concerned a 73 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included isopropyl alcohol. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 203a21a, and batch number: 203A21A expiry: 23-JUN-2021) dose was not reported, administered on 20-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 20-MAY-2021, the subject experienced mouth was tingling. On 20-MAY-2021, the subject experienced lip swelling. On 20-MAY-2021, the subject experienced throat tightening. On 20-MAY-2021, the subject experienced whisper voice. On 20-MAY-2021, the subject experienced heart rate increased. On 20-MAY-2021, the subject experienced difficulty sleeping. On 20-MAY-2021, the subject experienced acute allergic reaction. On 21-MAY-2021, the subject experienced headache. On 22-MAY-2021, the subject experienced confused. On 22-MAY-2021, the subject experienced hard to walk. On 22-MAY-2021, the subject experienced maybe hard to breath oxygen helped. On 22-MAY-2021, the subject experienced light headed. On 22-MAY-2021, the subject experienced swelling legs/ankles. On 22-MAY-2021, the subject experienced jittery. On 22-MAY-2021, the subject experienced slight hand tremors. On 22-MAY-2021, the subject experienced weak. On 22-MAY-2021, the subject experienced tired. Treatment medications (dates unspecified) included: diphenhydramine hydrochloride, and methylprednisolone acetate. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from mouth was tingling, throat tightening, whisper voice, and heart rate increased on 20-MAY-2021, lip swelling, acute allergic reaction, and headache on 21-MAY-2021, difficulty sleeping, and confused on 22-MAY-2021, hard to walk on 28-MAY-2021, light headed, and tired on 29-MAY-2021, and swelling legs/ankles, jittery, and slight hand tremors on 23-MAY-2021, and the outcome of maybe hard to breath oxygen helped and weak was not reported. This report was non-serious.


VAERS ID: 1391068 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BABY ASPIRIN
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Stroke (Verbatim: stroke)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021659063

Write-up: sore arm; little tired; This is a spontaneous report from a contactable consumer or other non hcp. A 33-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for injection, Lot number: EW0177 and Expiration date: unknown), dose 1 via an unknown route of administration on 20May2021 as single dose for covid-19 immunisation. Medical history included stroke from 2019 that was caused because the heart valve, PFO, never closed when he was born so he had an occluder put in. Concomitant medication included acetylsalicylic acid (BABY ASPIRIN) taken once a day for an unspecified indication and ongoing. On 20May2021, the patient experienced sore arm and a little fatigue. He has scheduled to get the second dose on 10Jun2021. Outcome of events was unknown. Information on Lot/Batch number was available. Additional information has been requested.


VAERS ID: 1391126 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-19
Onset:2021-05-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021664909

Write-up: bumping on the day after; flared up and was red, bumpy and itchy; flared up and was red, bumpy and itchy; as hives that are covering her entire belly, under her breasts, on her arms and some spots on her legs and it is going to the sides of her abdomen under the armpits was mostly her upper body.; This is a spontaneous report from a contactable other HCP (patient). A 60-year-old female patient received BNT162b2 (PFIZER BIONTECH COVID-19 mRNA VACCINE, Solution for injection, Lot number- unknown) via an unspecified route of administration on 19May2021 as 2nd dose, single dose for COVID-19 immunization. Medical history and concomitant medications were not reported. Historical vaccine included BNT162b2 (PFIZER BIONTECH COVID-19 mRNA VACCINE, Solution for injection, Lot number- unknown) via an unspecified route of administration as 1st dose, single dose for COVID-19 immunization. Patient stated that she had the second dose of the Pfizer covid 19 vaccine on 19May2021. Patient stated that she started bumping on the day after (20May2021) then it flared up and was red, bumpy and itchy. Caller described it as hives that are covering her entire belly, under her breasts, on her arms and some spots on her legs. Caller stated it is going to the sides of her abdomen under the armpits Patient stated it was mostly her upper body. Patient sated it did not cover her face. Patient stated she called out of work on 27May2021, 28May2021 and 30May2021 because the benadryl made her sleep Caller stated she had been taking benadryl and using eucerin since 20May2021. Caller stated this is helping some. Patient stated yesterday it flared up again. Patient stated she took two benadryl last night so she could sleep. Patient wanted to know when it should clear up. Patient wanted to report AE. The outcome of the events was unknown. Information about the Lot/batch number has been requested.


VAERS ID: 1391621 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-05-11
Onset:2021-05-20
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Periarthritis
SMQs:, Arthritis (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: Antihypertensive medications ADD medications
Current Illness: None
Preexisting Conditions: Hypertension ADD
Allergies: Penicillin, Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Left frozen shoulder


VAERS ID: 1391976 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

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

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


VAERS ID: 1313632 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-14
Onset:2021-05-19
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047BZIA / 1 RA / -

Administered by: Public       Purchased by: ?
Symptoms: Injection site pruritus, Injection site rash, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (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: none
CDC Split Type:

Write-up: Injection site itching and mild swelling and rash in near perfect triangle. 3" x 3" in size.


VAERS ID: 1328994 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Injection site pain, Insomnia, Pyrexia, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic 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)

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: Insomnia, swelling, pain at vaccine site, fever


VAERS ID: 1328999 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Blood pressure increased, Dizziness, Headache, Injection site pain, Myalgia, Nausea, Neck pain
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Progesterone, testosterone, calcium, immunosupport, DIM with SGS, calcium d-glucarate, magnesium citrate, biotin, digestive enzymes, candida forte, gastromend, floramyces
Current Illness: Leaky gut
Preexisting Conditions: None
Allergies: Gluten, penicillin, cephalosporins, sulfates
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe headache, nausea, dizziness, light headedness, increased blood pressure, pain at injection site, neck pain, abdominal cramps, muscle aches


VAERS ID: 1329619 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Arthralgia, Hypoaesthesia, Neck pain, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec 10 mg 1 tablet Q AM HCTZ 25 MH 1 tablet Q AM Lisinopril 20 mg 1 tablet Q AM Pravastatin 40 mg 1 tablet Q HS Prednisone dose pack Methocaramol 500 mg 2 tabs BID Gabapentin 300 mg 1 tab Q HS
Current Illness: None
Preexisting Conditions: HTN and Hyperlipidemia
Allergies: NKDA
Diagnostic Lab Data: Chiropractor, steriod shots, oral steroids, muscle relaxers, scheduled for a EMG
CDC Split Type:

Write-up: Numbness and pain to left arm from shoulder/neck to tips of fingers


VAERS ID: 1329683 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK RA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site pain, Musculoskeletal stiffness, Nausea
SMQs:, Acute pancreatitis (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: Buproprion, healthy trim, escitalopram
Current Illness: Moderate to severe headache a day prior
Preexisting Conditions: Na
Allergies: Na
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, fatigue, nausea, pain at injection, stiff neck and shoulder.


VAERS ID: 1329854 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ear pain, Injection site pain, Pain in jaw
SMQs:, Extravasation events (injections, infusions and implants) (broad), Osteonecrosis (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 pain in jaw and ear on left side, identified 10 hours post injection and continuous Pain at injection site, continuous and not subsided since injection


VAERS ID: 1329881 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA I DON?T KNOW / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Dysstasia, Fall, Loss of consciousness, Syncope
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), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (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: Amphetamine Salts 10mg 2x daily
Current Illness: Ear infection, underweight
Preexisting Conditions: Ear infection and underweight BMI: 17.9
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Waking up at 4:30 AM I went to urinate. Feeling weak I started to slouch and have trouble standing while urinating. Upon returning to my room I fainted. I suddenly lost consciousness and fell on my clothes/bed. I drank about 1.5 liters of water and felt better after about 15 minutes.


VAERS ID: 1329903 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-15
Onset:2021-05-19
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Irritable bowel syndrome
SMQs:, Noninfectious diarrhoea (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: 1:00 am - Ate entire bag of Ricola Lemon Cough Drops - Intense IBS 4AM - 8AM
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: 1:00am - Ate Entire Bag of Lemon Cough drops 4:00am - 8:00am = Intense IBS


VAERS ID: 1329924 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Chills, Exposure during pregnancy, Fatigue, Immediate post-injection reaction, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Hypersensitivity (narrow)

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

Write-up: 5 and half weeks pregnant. Severe nausea, chills, stomach pain, extremely tired


VAERS ID: 1329932 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Aphasia, Chills, Dyspnoea, Fall, Hyperhidrosis, Hypokinesia, Loss of consciousness, Mental impairment, Nausea
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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: None
Current Illness: A cold 2 weeks before
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA Unable to speak, move, or think clearly for 10 minutes, sudden onset Lost consciousness and fell Combined with expected symptoms (nausea, chills, shortness of breath, sweating)


VAERS ID: 1329985 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Anxiety, Bradycardia, Feeling cold, Hyperhidrosis, Loss of consciousness, Pain in extremity, Pallor
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: clondine, adderal, duloxetine
Current Illness: none
Preexisting Conditions: PTSD
Allergies: none
Diagnostic Lab Data: Patient taken to ED via stretcher with code team to be monitored
CDC Split Type:

Write-up: Patient anxious complained of arm pain with injection and approximately 3 minutes later patient had loss of consciousness for approximately 2 minutes. BP low normal 108/60. Patient pale, diaphoretic and cool to touch, Patient assisted to stretcher and on monitor and found to be bradycardic HR as low as 38 . CODE team arrived and within 5 minutes patient back to baseline


VAERS ID: 1330017 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Other       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? 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 has not eaten today. She felt light headed with vaccine . Offered juice, crackers, water. Kept for observation, till 9:00 AM Pulse 48 SPO2 99% BP 98/50 Discharge home as she get normal.


VAERS ID: 1330026 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

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

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

Write-up: A few minutes after receiving the vaccine, the patient fainted. The mother caught her son in her arms and we were both able to lay him on the floor safely without hitting his head. He came to within a few seconds. He remained in the pharmacy area for approximately 20 more minutes for observation. He was feeling back to normal before leaving.


VAERS ID: 1330118 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Blood pressure increased, Feeling abnormal, Headache, Nausea, Vertigo
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Vestibular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Active miscarriage 2 days ago not complete
Preexisting Conditions: Migraine
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The Chief Complaint is: 27 y/o F at the COVID vaccine line to get her first COVID-19 vaccine. Within 5 minutes of vaccination she complained of "head expanding", worsening headache, blood rushing to her head and feeling off balance like the room was moving. Did not feel like she was going to pass out. Vital obtained initially showed slight hypertension with BP 139/85, HR 75, RR 20 and SPO2 98% on room air. She denied any dyspnea/itching/pain (other than HA), GI symptoms. She noted she had a miscarriage on Monday but had been feeling well and staying hydrated over the last 2 days. She was observed, moved to a gurney, given water, and vitals monitored. Within 20 minutes after getting her injection she noted her head was feeling worse, hurting more and that she was starting to get nauseated. No abdominal pain. Vitals improved to BP 126/89, HR 78 and 97% on room air. EMS was called for evaluation due to worsening symptoms, recent miscarriage, ddx includes migraine/thrombosis/vagal reaction/anxiety/do not suspect allergic reaction. EMS evaluated the patient and took her for further evaluation. Will file VAERS report. Once medical issues addressed, can discuss with PCM whether she can get the 2nd dose. At this time no evidence of allergic reaction. No hives/angioedema/wheezing/abnormal vital signs.


VAERS ID: 1330157 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, Lisinopril, Vitamin D2
Current Illness: None
Preexisting Conditions: High blood pressure, Diabetes
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient began feeling lightheaded and collapsed out of his chair. The patient did not recall falling from the chair but was conscious when attended to by the pharmacist. He had just started new medications (Lisinopril and Metformin) and had taken them in the morning prior to arriving for his vaccination. The patient did not eat anything in the morning prior to arriving for his vaccination. He was given water, a cold pack, and then orange juice. His symptoms improved and he was able to get up and walk under his own power.


VAERS ID: 1330167 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-05-01
Onset:2021-05-19
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Dizziness, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

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

Write-up: Patient complained of feeling dizzy , c/o difficulty breathing. Nurse then intervened with ammonia. Patient immediately said he was feeling better.


VAERS ID: 1330297 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808996 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Nausea, Presyncope
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: near syncopal ,nausea


VAERS ID: 1330314 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Seizure, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Pt had syncope x 1 postvaccination followed by seizure x 2. Pt recovered spontaneously after 3-5 seconds. No labored breathing. Alert and oriented x 3. Pt brought to ER.


VAERS ID: 1330323 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-04-17
Onset:2021-05-19
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 LA / IM

Administered by: Other       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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin (daily), Collagen (daily), Baby aspirin (daily)
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Unexplained dizziness, started when woke up. Not resolved 3 hours later. Ongoing.


VAERS ID: 1330351 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Syncope following every vaccination received
Other Medications: None given at this time
Current Illness: asthma
Preexisting Conditions: asthma
Allergies: penicillin
Diagnostic Lab Data: 5/19/21 10:05am - BP 90/49, HR 49, O2 90% 5/19/21 10:15am - BP not obtained, HR 60, O2 99%
CDC Split Type:

Write-up: Patient reported before the vaccine was administered that she had a history of fainting upon receiving vaccines in the past. As predicted, she fainted within seconds of administering the Janssen vaccine. While unconscious, patient had a few mild head/neck twitches which then progressed to 2-3 full body twitches/spasms before regaining consciousness. Total time unconscious with less than 1 minute. Once fully awake and alert, patient informed me that she had a history of a seizure once before. We gently laid her on the floor and I took her vitals. Vitals were low with BP 90/49, HR 49, and O2 90%. She continued to lay on the floor for approximately 10 minutes before checking her vitals again. At that time, vitals were better with HR 60 and O2 99; I was unable to retake her BP at that time, but patient claimed that it usually was on the low side. She called her mother who agreed to come stay with her to keep watch for more events at her home. A family friend was also called to come pick her up and drive her home. Before leaving, I strongly advised patient to see a doctor to check everything out. Patient just moved here and claims to not have a primary at either location.


VAERS ID: 1330355 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Disorientation, Hypertension, Syncope, Visual impairment
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Hypertension (narrow), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: PT had vasovagal syncopal episode, couldn?t see, disoriented,. Checked out by ALS, administered fluids, hypertensive. Transported ALS to Hospital. Run # 58372


VAERS ID: 1330365 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Dyspnoea, Electrocardiogram, Hypoaesthesia oral, Paraesthesia oral
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: alprazolam, ambien, gabapentin, lisinopril, methocarbomol, and sertraline
Current Illness: none
Preexisting Conditions: hypertension
Allergies: cipro, klonopin
Diagnostic Lab Data: EKG
CDC Split Type:

Write-up: increased blood pressure, lips numb/tingling, and short of breath


VAERS ID: 1330369 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood pressure increased, Contusion, Erythema, Induration
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Hypertension (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 5/19/21 patient is noted to have a red circular area approx 3 inches in diameter. The center of this circle is dark bruised. This red circular area is not hardened or raised. Vital signs within normal limits. No other signs or symptoms noted or reported. Consumer appears in no distress and denies chest pain, shortness of breath or trouble breathing.


VAERS ID: 1330387 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Cooling therapy, Hepatic enzyme increased, Loss of consciousness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Liver related investigations, signs and symptoms (narrow), 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), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Vasovagal syncope a few minutes after receiving shot. Waiting to check in to observation area and fainted. LOC but immediately awake, A&O. LEs elevated, cool compress to neck. HR, BP checked, stable. Rested and resolved. Home with dad.


VAERS ID: 1330404 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, 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), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: The patient felt some lightheadedness and dizziness post vaccination. While talking with the patient he began to collapse in his chair. The pharmacist held the patient up in the chair while the event occurred. The patient came back to within about 30 seconds of the event starting and was unaware that he had lost consciousness for a short period of time. At this time he was given some water and a cool pack to rest on his neck. He was then given some orange juice. He began to feel better and moved himself from the vaccination room to a post-vaccination waiting chair in view of the pharmacy. He was able to walk under his own power to the chair and remained seated for the duration of his post-vaccination wait time. Upon completion of his wait time the patient left on his own and said that he was feeling well and able to go.


VAERS ID: 1330418 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Seizure, Vomiting
SMQs:, Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Patient reported history of syncope episode with another vaccine in the past. Patient has history of seizure disorder. At 10:10am, patient was sitting with her mother when she started to convulse sitting up right in a chair. She also vomited while convulsing for about 15seconds. Full consciousness regained.


VAERS ID: 1330439 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anxiety, Asthenia, Hyperhidrosis, 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), Guillain-Barre syndrome (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
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient warned of previous vaso-vagal syncope. Patient was placed in supine position for vaccine administration and about 1 min afterward became anxious and passed out. He was unconscious for 10 sec and awoke, sweaty, weak. He was not confused, did not seize or lose bowel/bladder continince.


VAERS ID: 1330448 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-05-17
Onset:2021-05-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of personal independence in daily activities
SMQs:, Dementia (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: Tylenol 500 mg x2 and Ibuprophen 200 mg x2, taken at one time on 5/18/2021 pm.
Current Illness: None
Preexisting Conditions: None
Allergies: Wellbutrin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Absent minded; Doing things that are not my normal routine. Reading messages incorrectly, taking wrong turns when I know the streets so well. I am a school bus driver, I know my route and made a few odd mistakes today. I am not distracted, I am not forgetful, I am just doing things that make no sense.


VAERS ID: 1330478 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN EW0185 / 1 RA / IM

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

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

Write-up: First pt of the day was given an expired vaccine that was ?found? in a cooler. RN assumed that the doses were from the first draw of the day, even though she did not visualize the Clinical Lead bring in the first draw of the day. After the pt was vaccinated did the Clinical Lead realize that there were vaccines in a cooler that were expired from an unknown date and time. Incident Command was informed and, Field Lead, was informed. Per RN Field Clinical Director via phone, Pt was informed of the incident and that the pt was vaccinated with an expired vaccine and that we are in contact with our Medical Director to figure out what the next step will be. Dr called and informed us to go ahead and revaccinate the pt after she communicated with the pt and made sure that the pt understood what was happening. Pt was revaccinated and placed in observation. Pt left observation without further incident. V/S, BP:140/78, HR: 84, SPO2: 96% 2nd set of vitals BP: 138/78, HR: 84, SPO2: 96%


VAERS ID: 1330504 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: When he received multiple vaccines at once, vomited
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Assessment on site
CDC Split Type:

Write-up: Was sitting in observation room, felt dizzy and put his hands on his head, then passed out. Hit head on carpeted surface. LOC less than 10 seconds.


VAERS ID: 1330510 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Feeling hot, Headache, Nausea, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypoglycaemia (broad)

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

Write-up: 5 minutes after administration, she started having a headache and then nausea. Afterwards she felt hot and was shaking. She reported chest pain. Vitals were stable. EMS transported her due to inability to reach parents and inability to drive herself home.


VAERS ID: 1330514 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 RA / IM

Administered by: School       Purchased by: ?
Symptoms: Condition aggravated, Seizure, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Seizure medications. Unknown, not in database and not able to obtain information from patient. Stated she took her morning doses.
Current Illness: Stated last major seizure was in April but appeared to have had several smaller seizures leading up to today.
Preexisting Conditions: Long standing history of seizures
Allergies: No allergies stated
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was non-communicative but sitting still in the chair. Appeared to be in a mild type of seizer temporarily. After a few minutes was able to communicate and was feeling better.


VAERS ID: 1330517 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient began to feel faint within 2 minutes after receiving vaccine. Became pale and diaphoretic. Patient was brought to floor and began to show improvement immediately. Patient remained in observation until 9:05 AM (25 minutes after vaccine administration) and was cleared to discharge home with father at that time.


VAERS ID: 1330526 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

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

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

Write-up: patient took vaccine went over to post vaccination area and fainted. Patient immediately woke up in cold sweats. Sat for 30 minutes and felt better.


VAERS ID: 1330528 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 1 LA / IM

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

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

Write-up: 5 minutes after receiving the vaccine, she reported headache, nausea, shaking, and some chest pain. Vitals were stable. Transported by EMS due to inability to reach parents or drive herself home.


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