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From the 5/7/2021 release of VAERS data:

Found 188,897 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 13 out of 1,889

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VAERS ID: 1272629 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-26
Onset:2021-04-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Body temperature increased, Chills, Feeling abnormal, Headache, Memory impairment
SMQs:, Neuroleptic malignant syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (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: Anthrax, large subcutaneous nodule, 35 yrs,
Other Medications: Gabapentin, Tramadol, Lotensin
Current Illness: None
Preexisting Conditions: Lower Back Injury, Neuropathy
Allergies: PCN
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever began approx 12 hrs post-injection and varied between 101 to 103.5 for 48 hours accompanied by severe headache, chills and exceptional low energy state. A ''brain fog'' remained and is still evident at time of submission (simple math and some memory details difficult to execute/recall).


VAERS ID: 1273220 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-04-10
Onset:2021-04-27
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Angiogram cerebral abnormal, Anticoagulant therapy, Arteriogram carotid normal, Computerised tomogram head abnormal, Computerised tomogram neck, Condition aggravated, Headache, Heparin-induced thrombocytopenia test, Intensive care, Magnetic resonance imaging head abnormal, Platelet count decreased, Seizure, Subarachnoid haemorrhage, Transverse sinus thrombosis, Venogram abnormal
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Haemorrhagic central nervous system vascular conditions (narrow), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: clonazepam, co-q 10, Jardiance, Insulin, lacosamide, lamotrigine, lisinopril, lorazepam, MVI, Fycompa, simvastatin,
Current Illness: seizures
Preexisting Conditions: seizure disorder, diabetes, hypertension, hyperlipidemia
Allergies: Keppra, reaction unknown to patient
Diagnostic Lab Data: CT Head 4/27/21, CTA head & neck 4/27, MRI brain 4/27/21, MRV bran 4/27/21 Labs: HIT antibody negative, drawn 4/28 Platelets 111 on 4/27/21 (baseline was 280 in November 2020)
CDC Split Type:

Write-up: Right transverse sinus thrombus with b/l subarachnoid hemorrhage. Presented with headache and seizure. Initially treated with heparin gtt 4/27, but changed to bivalirudin gtt 4/28. The patient remains on ICU 4/30 AM on bivalirudin drip and will be transitioned to oral anticoagulants if CT of head today is stable. Patient is recovering. She will require a stay at a rehab/skilled facility at discharge for continued recovery. She remains in hospital as of today (4/30/21)


VAERS ID: 1273729 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-04-12
Onset:2021-04-27
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 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:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: I started to notice what I thought was a bug bite. It was not getting bette after a couple of days so i booked a virtual appointment. I was diagnosed with shingles 4/29/21. I?ve never had this happen before. I have had chicken pox when I was a child but never had a flare up before. I am now on anti viral medication as of 4/29/21


VAERS ID: 1274081 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-27
Onset:2021-04-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Fatigue, Influenza like illness
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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Initially, a few minutes post-vaccination, dizziness and faint feeling requiring lying on the floor. Fatigue and flu-like symptoms occurred the following day. No symptoms two days later.


VAERS ID: 1274222 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-12
Onset:2021-04-27
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: DONT KNOW.
CDC Split Type:

Write-up: THE PATIENT IS IN HOSPITAL. THE WIFE CALLED AND SAID HE GOT SICK FROM THE VACCINE.


VAERS ID: 1274234 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-09
Onset:2021-04-27
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cerebral venous sinus thrombosis, Computerised tomogram head abnormal, Headache, Platelet count normal, Sinus pain
SMQs:, Embolic and thrombotic events, venous (narrow), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Confirmed venous sinus thrombosis on CT scan on 4/30/21 during emergency department visit. Platelets were with normal limits.
CDC Split Type:

Write-up: Symptoms started 4/27 in patient - presented to the ED on 4/30 for sinus pain and headache. Confirmed venous sinus thrombosis on CT scan on 4/30/21 during emergency department visit. Platelets were with normal limits.


VAERS ID: 1274709 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-27
Onset:2021-04-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dyspnoea, Headache, Nausea, Skin burning sensation
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 50 mcg Levothyroxine daily 25 mg Metoprolol - twice a week
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Concerned this was caused by shingles shot received Feb 4, 2021. Was told to wait 4-6 months before second shingle shot and suspect Covid vaccine may have prompted this reaction because it was too soon after shingles shot #1.
CDC Split Type:

Write-up: Skin burning, yet shivering while wrapped in multiple blankets and clothing, nausea, severe headache, shortness of breath; symptoms lasted for about 12 hours


VAERS ID: 1274780 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-03-10
Onset:2021-04-27
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Herpes zoster
SMQs:, Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Alendronate Sodium,Actemra, prednisone, levothyroxine, Lisinopril, Multivitimim
Current Illness: none
Preexisting Conditions: hypothyroid, rheumatoid arthritis, hypertension
Allergies: none
Diagnostic Lab Data: diagnosed by Dermatologist
CDC Split Type:

Write-up: 49 days after the single injection of the Covid Johnson & Johnson vaccine I was diagnosed with Shingles even though I had been vaccinated with the Shingles vaccine in October and December in 2019


VAERS ID: 1275244 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-29
Onset:2021-04-27
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Deep vein thrombosis, Pain in extremity, Ultrasound scan abnormal
SMQs:, Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (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: Turmeric, melatonin, magnesium, probiotic
Current Illness: None
Preexisting Conditions: None
Allergies: Pcn
Diagnostic Lab Data: Ultrasound on 4/30/21 revealed DVT in right calf.
CDC Split Type:

Write-up: Experienced severe leg pain for several days. Ultrasound in ER revealed right calf DVT. Prescribed 21 day regimen of Xarelto starting yesterday.


VAERS ID: 1275837 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-04-08
Onset:2021-04-27
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Computerised tomogram thorax, Condition aggravated, Pulmonary embolism, Respiratory distress, Small cell lung cancer
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological malignant tumours (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Gabapentin, Tamsulosin, Albuterol, Folic Acid, methylprednisolone
Current Illness: small cell lung cancer, peripheral neuropathy
Preexisting Conditions: benign prostatic hypertrophy, small cell lung cancer, peripheral neuropathy
Allergies: None
Diagnostic Lab Data: Chest CTA 4/30/21
CDC Split Type:

Write-up: Patient found to have pulmonary embolism 22 days after receiving vaccine. Onset of symptoms occurred 18-19 days after receiving vaccination, however, very likely PE related to patient hx of small cell lung cancer. He is currently hospitalized for respiratory distress as of 4/30/21


VAERS ID: 1276534 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Unknown  
Location: Maine  
Vaccinated:0000-00-00
Onset:2021-04-27
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, Feeling cold, Groin pain, Headache, Pain in extremity
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Osteonecrosis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210453909

Write-up: FEELING COLD; JOINT PAIN IN GROIN; LEG AND ARM PAIN; HEADACHE; STOMACH PAIN; This spontaneous report received from a patient concerned a 29 year old of unspecified sex. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 206A21A, and expiry: UNKNOWN) dose was not reported, administered on 27-APR-2021 13:00 for prophylactic vaccination. No concomitant medications were reported. On 27-APR-2021, the subject experienced stomach pain. On 27-APR-2021, the subject experienced feeling cold. On 27-APR-2021, the subject experienced joint pain in groin. On 27-APR-2021, the subject experienced leg and arm pain. On 27-APR-2021, the subject experienced headache. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from joint pain in groin, leg and arm pain, feeling cold, headache, and stomach pain. This report was non-serious.


VAERS ID: 1276552 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Washington  
Vaccinated:0000-00-00
Onset:2021-04-27
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Non-smoker
Preexisting Conditions: Comments: The patient had no known allergies.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210454484

Write-up: ITCHINESS AT INJECTION SITE; INJECTION SITE ARM FEELS PAIN/SORE/HURTS; This spontaneous report received from a patient concerned a 44 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included non smoker, and other pre-existing medical conditions included the patient had no known allergies. The patient was previously treated with nortriptyline for antidepressant, duloxetine for antidepressant, progesterone, and estradiol. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 02-APR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 27-APR-2021, the subject experienced itchiness at injection site. On 27-APR-2021, the subject experienced injection site arm feels pain/sore/hurts. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from injection site arm feels pain/sore/hurts, and itchiness at injection site. This report was non-serious.


VAERS ID: 1276555 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:0000-00-00
Onset:2021-04-27
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Chills, Headache, Pain, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210454643

Write-up: CAN HEAR OWN HEART BEAT IN EARS; BODY ACHES SORENESS; CHILLS; NOT STRONG WEAK; HEADACHE; .This spontaneous report received from a patient concerned a 23 year old male. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 27-APR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 27-APR-2021, the subject experienced can hear own heart beat in ears. On 27-APR-2021, the subject experienced body aches soreness. On 27-APR-2021, the subject experienced chills. On 27-APR-2021, the subject experienced not strong weak. On 27-APR-2021, the subject experienced headache. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the chills, headache, not strong weak, body aches soreness and can hear own heart beat in ears was not reported. This report was non-serious.


VAERS ID: 1276591 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:2021-04-27
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Headache, Muscular weakness, Pain assessment
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Non-smoker
Preexisting Conditions: Comments: The patient had no known allergies and no drug abuse or illicit drug. The patient was not pregnant at the time of report.
Allergies:
Diagnostic Lab Data: Test Date: 20210427; Test Name: Pain scale; Result Unstructured Data: 7/10, severe headache with a pain level; Test Date: 20210428; Test Name: Pain scale; Result Unstructured Data: 1/10, severe headache with a pain level drops
CDC Split Type: USJNJFOC20210456372

Write-up: MUSCLE WEAKNESS; SEVERE HEADACHE; EXTREME FATIGUE; This spontaneous report received from a patient concerned a 41 year old female. The patient''s weight was 120 pounds, and height was 165 centimeters. The patient''s concurrent conditions included non smoker, and non alcoholic, and other pre-existing medical conditions included the patient had no known allergies and no drug abuse or illicit drug. the patient was not pregnant at the time of report.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 204A21A expiry: UNKNOWN) dose was not reported, administered on 27-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On 27-APR-2021, the subject experienced muscle weakness. On 27-APR-2021, the subject experienced severe headache. On 27-APR-2021, the subject experienced extreme fatigue. Laboratory data included: Pain scale (NR: not provided) 7/10 severe headache with a pain level. On 28-APR-2021, Laboratory data included: Pain scale (NR: not provided) 1/10 severe headache with a pain level drops. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from severe headache, extreme fatigue, and muscle weakness. This report was non-serious.


VAERS ID: 1276635 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Vermont  
Vaccinated:0000-00-00
Onset:2021-04-27
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Military       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Myalgia, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210457603

Write-up: SHAKING; SHIVERING; LINGERING MUSCLE ACHES; TIREDNESS; HEADACHE; This spontaneous report received from a patient concerned a 45 year old female. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 27-APR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 27-APR-2021, the subject experienced shaking. On 27-APR-2021, the subject experienced shivering. On 27-APR-2021, the subject experienced lingering muscle aches. On 27-APR-2021, the subject experienced tiredness. On 27-APR-2021, the subject experienced headache. Treatment medications (dates unspecified) included: ibuprofen. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from shaking, shivering, and headache on 27-APR-2021, and was recovering from lingering muscle aches, and tiredness. This report was non-serious.


VAERS ID: 1276649 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Michigan  
Vaccinated:0000-00-00
Onset:2021-04-27
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 20210427; Test Name: Antibody test; Result Unstructured Data: nonreactive result for antibodies
CDC Split Type: USJNJFOC20210458307

Write-up: SUSPECTED IMMUNOLOGICAL VACCINE FAILURE; This spontaneous report received from a patient concerned a female of unspecified age. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 01-APR-2021 for prophylactic vaccination. Batch number was not reported and has been requested. No concomitant medications were reported. On 27-APR-2021, the subject experienced suspected immunological vaccine failure. Laboratory data included: Antibody test (NR: not provided) nonreactive result for antibodies. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of suspected immunological vaccine failure was not reported. This report was non-serious.


VAERS ID: 1276669 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-04-27
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210458963

Write-up: CAN''T SLEEP; BODY ACHE; FEVER; This spontaneous report received from a patient via a company representative concerned a female of unspecified age. The patient''s weight, height, and medical history were not reported.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) dose, start therapy date were not reported for prophylactic vaccination. Batch number was not reported. Per procedure, no follow up will be requested for this case. No concomitant medications were reported. On 27-APR-2021, the subject experienced can''t sleep. On 27-APR-2021, the subject experienced body ache. On 27-APR-2021, the subject experienced fever. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the body ache, fever and can''t sleep was not reported. This report was non-serious.


VAERS ID: 1276671 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Florida  
Vaccinated:0000-00-00
Onset:2021-04-27
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Hypokinesia, Injection site pain, Injection site swelling
SMQs:, Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Diabetes mellitus; Food allergy; Hypertension; Iodine allergy; Leg cramps; Non-smoker; Osteoarthritis; Shellfish allergy; Sulfonamide allergy; Venous reflux
Preexisting Conditions: Medical History/Concurrent Conditions: Pruritus; Vitiligo; Comments: The patient had no drug abuse or illicit drug usage.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210458980

Write-up: UNABLE TO RISE UP ARM; KNOB LEFT ARM; LEFT SHOULDER PAIN; This spontaneous report received from a patient concerned a 78 year old female. The patient''s height, and weight were not reported. The patient''s past medical history included vitiligo, and pruritus, and concurrent conditions included diabetes mellitus, hypertension, severed leg cramps, osteoarthritis, venous reflux, sulfonamide allergy, iodine allergy, shellfish / lobster allergy, shrimp/ lemon/ pepper allergy, no alcoholic user, and non smoker, and other pre-existing medical conditions included the patient had no drug abuse or illicit drug usage.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 1808980, and batch number: 1808980 expiry: UNKNOWN) dose was not reported, administered on 09-APR-2021 12:45 for prophylactic vaccination. No concomitant medications were reported. On 27-APR-2021, the subject experienced unable to rise up arm. On 27-APR-2021, the subject experienced knob left arm. On 27-APR-2021, the subject experienced left shoulder pain. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from left shoulder pain on 28-APR-2021, and had not recovered from knob left arm, and unable to rise up arm. This report was non-serious.


VAERS ID: 1276804 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-04-08
Onset:2021-04-27
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abnormal dreams
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: Lisinopril 10mg daily Daily probiotic
Current Illness: N/a
Preexisting Conditions: High blood pressure
Allergies: Penicillin Gluten and wheat
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: Very vivid and bizarre dreams every night starting 4 nights ago. Also, deeper sleep but I wake up well rested.


VAERS ID: 1277526 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-27
Onset:2021-04-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Error: Improper Storage (temperature)


VAERS ID: 1277528 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-27
Onset:2021-04-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Error: Improper Storage (temperature)


VAERS ID: 1277742 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-07
Onset:2021-04-27
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

Administered by: Private       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:
Other Medications: Hypertension meds
Current Illness: None
Preexisting Conditions: Hypertension
Allergies: None
Diagnostic Lab Data: Determined by doctor by physical exam
CDC Split Type:

Write-up: Singles outbreak.


VAERS ID: 1278309 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-04-27
Onset:2021-04-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Feeling cold, Hypoaesthesia, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Patient''s lower legs began hurting on 04/27/21, along with toes feeling cold and losing feeling off and on; this lasted most of the night into the early morning and the symptoms resolved on around 6:00 am on 4/28/21 From 10:00 am 4/28/21 to 08:00 am on 4/29/21 patient experienced fatigue


VAERS ID: 1280144 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-10
Onset:2021-04-27
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood calcium decreased, Blood creatine phosphokinase MB increased, Blood creatine phosphokinase increased, Blood glucose normal, Brain natriuretic peptide increased, COVID-19, Full blood count, Haematocrit decreased, Haemoglobin decreased, Mean cell haemoglobin concentration decreased, Platelet count normal, Protein total decreased, Red blood cell count decreased, SARS-CoV-2 test positive, Troponin normal, White blood cell count decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Pulmonary hypertension (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Protonix Trulicity Pen Tylenol with Codeine #4 Ultram Xanax allopurinol atorvastatin bisoprolol cyanocobalamin gabapentin glipiZIDE isosorbide mononitrate pramipexole zolpidem Effient Omega 3 Niacin Ranolazine
Current Illness:
Preexisting Conditions: Diabetes MI Hx of Cancer
Allergies: Azithromycin Peaches
Diagnostic Lab Data: 5/1/2021 - Abnormal Results: - SARS COVID PCR Testing - Positive - Chemistry: Glucose - 137, Calcium - 8.5, AST - 111, ALT - 59, Protein - 6.3, Total CK - $g2000, CKMB - 31.53, (negative troponin), BNP - 222 - CBC: WBC - 3.9, RBC - 3.35, HGB - 10.2, HCT 0 32.7, MCHC - 31.2 (platelets normal @ 185)
CDC Split Type:

Write-up: Pt. was diagnosed with COVID - via PCR - and required hospitalization.


VAERS ID: 1280635 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-04-27
Onset:2021-04-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Fatigue
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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None to date
CDC Split Type:

Write-up: Within within 2-3 hours was dizzy and fatigued, since that day progressive feelings of exhaustion and little balance.


VAERS ID: 1281977 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-09
Onset:2021-04-27
   Days after vaccination:49
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 LA / IM

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

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

Write-up: red lump on hip


VAERS ID: 1282130 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-27
Onset:2021-04-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye pain, Fatigue, Headache, Influenza like illness, Pain, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Glaucoma (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril 20mg (only one dose once a day)
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Day 2 following the vaccine, patient began to experience flu-like symptoms (fatigue, head ache, body ache). Followed by a syncope episode, did not follow up with any emergency care. Did not contact primary care or go to the hospital, or take any medication to treat symptoms. Mentioned having eye soreness, eyes feeling fatigued which is not usual for the patient and coincide with timing of adverse effects.


VAERS ID: 1282170 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-27
Onset:2021-04-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Chest X-ray normal, Chills, Computerised tomogram abdomen, Computerised tomogram abdomen normal, Echocardiogram, Hypotension, Mental status changes, Pyrexia, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin-acetaminophen-caffeine (Excedrin Extra Strength) 250-250-65 MG per tablet atorvastatin (LIPITOR) 20 MG tablet buPROPion (WELLBUTRIN XL) 150 MG 24 hr tablet cyclobenzaprine (FLEXERIL) 5 MG tablet 4 hydrOXYzine (ATARAX) 50 MG tabl
Current Illness: none reported -- scheduled for prostate surgery for BPH
Preexisting Conditions: Anxiety Barrett''s esophagus without dysplasia 10/11/2017 Benign non-nodular prostatic hyperplasia with lower urinary tract symptoms 6/9/2017 Depression anxiety Elevated PSA 6/30/2017 Hyperlipidemia 6/30/2017 Hypertension Morbid obesity due to excess calories
Allergies: Lactose intolerance Childhood penicillin reaction unknown, tolerates ceftriaxone and cefpodoxime
Diagnostic Lab Data: 4/28 ? chest xray, TTE and CT abdomen/pelvis all reveal no acute disease
CDC Split Type:

Write-up: Fever, chills, generalized weakness after vaccine 4/27 4/28 altered mental status, hypotensive, tachycardic and admitted to the hospital


VAERS ID: 1283058 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-08
Onset:2021-04-27
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: CSF protein, Guillain-Barre syndrome, Lumbar puncture, Magnetic resonance imaging head abnormal, White blood cell count decreased
SMQs:, Haematopoietic leukopenia (narrow), Peripheral neuropathy (narrow), Systemic lupus erythematosus (broad), Guillain-Barre syndrome (narrow), Demyelination (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Eliquis, amlodipine, carvedilol, chlorthalidone, lisinopril, rosuvastatin
Current Illness: hypertension, atrial fibrillation,
Preexisting Conditions: hypertension, nephrolithiasis, atrial fib
Allergies: none
Diagnostic Lab Data: Lumbar puncture 5/3/21 CSF protein 240, WBC 3. MRI brain Enhancement of left facial nerve 5/1/2021
CDC Split Type:

Write-up: facial diplegia/Guillain Barre Varient.


VAERS ID: 1284677 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: New Mexico  
Vaccinated:0000-00-00
Onset:2021-04-27
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Product dispensing error, Product storage error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: The patient had No known drug allergies and unknown drug abuse or illicit drug usage. It was unknown that the patient smoke and consume alcohol
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210460163

Write-up: INCORRECT STORAGE OF DRUG; VACCINE RECEIVED THAT HAD BEEN PUNCTURED 2 WEEKS PRIOR TO ADMINISTRATION; This spontaneous report received from a health care professional concerned an adult of unspecified sex. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included the patient had no known drug allergies and unknown drug abuse or illicit drug usage. It was unknown that the patient smoke and consume alcohol. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 041A21A, and expiry: 30-JUN-2021) .5 ml, administered on 15-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On 27-APR-2021, the subject experienced vaccine received that had been punctured 2 weeks prior to administration. On an unspecified date, the subject experienced incorrect storage of drug. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the vaccine received that had been punctured 2 weeks prior to administration and incorrect storage of drug was not reported. This report was non-serious.


VAERS ID: 1284678 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-04-27
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Fatigue, Product storage error
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19 (3 months ago)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210460180

Write-up: DIZZY; TIRED; PRODUCT STORED AT INAPPROPRIATE STORAGE CONDITION; This spontaneous report received from a consumer concerned a 64 year old female. The patient''s height, and weight were not reported. The patient''s past medical history included covid-19.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) dose was not reported, administered on 27-APR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 27-APR-2021, the subject experienced dizzy. On 27-APR-2021, the subject experienced tired. On 27-APR-2021, the subject experienced product stored at inappropriate storage condition. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from dizzy on 27-APR-2021, and tired on 28-APR-2021, and the outcome of product stored at inappropriate storage condition was not reported. This report was non-serious.


VAERS ID: 1284862 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-23
Onset:2021-04-27
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Myocarditis, SARS-CoV-2 test
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210427; Test Name: Nasal Swab/ COVID-19 virus test; Test Result: Negative
CDC Split Type: USPFIZER INC2021476742

Write-up: myocarditis; Chest pain; This is a spontaneous report from a contactable Physician. A 43-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE Solution for injection), dose 2 intramuscular on 23Apr2021 (43-year-old at time of vaccination) (Batch/Lot number was not reported) as single dose for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. Patient had no prior vaccination. Patient had no known allergies. Patient previously took dose 1 of BNT162B2 (lot number: not available/provided to reporter at the time of report completion) for COVID-19 immunisationThe patient presented with chest pain found to have myocarditis on 27Apr2021. The patient was hospitalized for myocarditis and chest pain for 2 days. Patient resulted visiting emergency room and physician office due to myocarditis. Patient had test post vaccination test which is nasal swab (COVID-19 virus test) on 27Apr2021, and the result was negative. Outcome of the event s was not recovered. The events assessed serious as these caused hospitalization, disability and was life threatening. Information on the lot/batch number has been requested.


VAERS ID: 1285178 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-27
Onset:2021-04-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Cough, Ear pain, Injection site pain, Nasal congestion, Oropharyngeal pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Site: Pain at Injection Site-Mild, Systemic: Fever-Mild, Systemic: Pin the throat/ear and back (only on right side) , coughing -Mild, Additional Details: patient complaining of pain in the back on the right side since Day 1. Fever developed on 2nd day, but recovered. Also pain in throat/ear, stuffy nose, and coughing, but minor.


VAERS ID: 1285261 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-04-06
Onset:2021-04-27
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Activated partial thromboplastin time, Angiogram cerebral, Arteriogram carotid, Borrelia test, Calcium ionised, Computerised tomogram head, Computerised tomogram neck, Differential white blood cell count, Electrocardiogram, Facial paralysis, Full blood count, Headache, International normalised ratio, Magnetic resonance imaging head, Metabolic function test, Prothrombin time, Scan with contrast
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin D. 5000
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Basic Metabolic panel 4/29/2021 CBC W Auto Differential 4/29/21 CT Heat Without Contrast 4/29/21 CTA Head with Contrast 4/29/21 CTA Neck with Contrast 4/29/21 EKG 12-lead 4/29/21 Calcium Ionized 4/30/21 APTT 4/30/21 Protime- INR 4/30/21 CBC W/ Auto Differential 4/30/21 Comprehensive Metabolic Panel 4/30/21 Lyme Disease Acute Reflexive panel 4/30/21 MRI Brain without Contrast 4/30/21
CDC Split Type:

Write-up: Headache Bilateral facial palsy 30 days after administration of vaccine


VAERS ID: 1286245 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-03-10
Onset:2021-04-27
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: A little after two weeks after vaccination I developed a extremely disgusting metallic taste in my mouth. I can no longer eat food without being disgusted and wanting to spit it out and it has not gone away


VAERS ID: 1287855 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-27
Onset:2021-04-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / UNK - / -
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. - / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Feeling abnormal, Headache, Nausea, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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:
Current Illness: Prophylaxis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: US0095075132105USA000165

Write-up: Caller reports still feeling "off'' and "out of it" the next morning; Caller reports experiencing body shudders, uncontrollable shaking, nausea and a pounding headache.; nausea; head pounding/ pounding headache; This spontaneous report was received from a 36-year-old female patient reporting on herself. There was no information about the patient''s concomitant medications, concurrent conditions or medical history provided. On 10-APR-2021, she was vaccinated with SARS-CoV-2 vaccine (unspecified) (exact dose, route of administration, anatomical location, lot # and expiration date were not reported) for prophylaxis. On 27-APR-2021, the patient was vaccinated with a first dose of HPV rL1 6 11 16 18 31 33 45 52 58 VLP vaccine (yeast) (GARDASIL 9) injected into upper left arm (exact dose, route of administration, lot # and expiration date were not reported). Indication reported as first annual appointment since the expanded age indication. On the same day, she experienced body shudders, uncontrollable shaking, nausea and pounding headache. On 28-APR-2021 in the morning, the patient was still feeling "off" and "out of it". On the same day in the evening, she recovered from the events. It was reported that she did not sought medical attention. Causality assessment was not provided.


VAERS ID: 1288112 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-04-05
Onset:2021-04-27
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0171B21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Fungal infection, Hypertonic bladder, Renal impairment
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Retroperitoneal fibrosis (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: EFFEXOR; METFORMIN; JARDIANCE; JANUVIA [SITAGLIPTIN PHOSPHATE]
Current Illness: Diabetes
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: kidneys and bladder overworking; kidneys and bladder overworking; yeast infection due to "kidneys and bladder overworking; This spontaneous case was reported by a consumer and describes the occurrence of RENAL IMPAIRMENT (kidneys and bladder overworking) in a 62-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 0171B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Diabetes. Concomitant products included METFORMIN for Diabetes, VENLAFAXINE HYDROCHLORIDE (EFFEXOR), EMPAGLIFLOZIN (JARDIANCE) and SITAGLIPTIN PHOSPHATE (JANUVIA [SITAGLIPTIN PHOSPHATE]) for an unknown indication. On 05-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) .5 milliliter. On 27-Apr-2021, the patient experienced RENAL IMPAIRMENT (kidneys and bladder overworking) (seriousness criterion medically significant), HYPERTONIC BLADDER (kidneys and bladder overworking) and FUNGAL INFECTION (yeast infection due to "kidneys and bladder overworking). At the time of the report, RENAL IMPAIRMENT (kidneys and bladder overworking), HYPERTONIC BLADDER (kidneys and bladder overworking) and FUNGAL INFECTION (yeast infection due to "kidneys and bladder overworking) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. concomitant medication includes unknown once weekly injection. Company Comment: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. Diabetes could have played a causative factor on the event renal impairment; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. Diabetes could have played a causative factor on the event renal impairment


VAERS ID: 1288124 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-27
Onset:2021-04-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Peripheral swelling, Swelling face, Wheezing
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Wheezing; Swelling of her face; Swelling of her hands and feet; Swelling of her hands and feet; This spontaneous case was reported by a consumer and describes the occurrence of WHEEZING (Wheezing), SWELLING FACE (Swelling of her face), the first episode of PERIPHERAL SWELLING (Swelling of her hands and feet) and the second episode of PERIPHERAL SWELLING (Swelling of her hands and feet) in a 59-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 006C21A) for COVID-19 vaccination. No Medical History information was reported. On 27-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 27-Apr-2021, the patient experienced WHEEZING (Wheezing) (seriousness criterion life threatening), SWELLING FACE (Swelling of her face) (seriousness criterion life threatening), the first episode of PERIPHERAL SWELLING (Swelling of her hands and feet) (seriousness criterion life threatening) and the second episode of PERIPHERAL SWELLING (Swelling of her hands and feet) (seriousness criterion life threatening). At the time of the report, WHEEZING (Wheezing), SWELLING FACE (Swelling of her face) and the last episode of PERIPHERAL SWELLING (Swelling of her hands and feet) outcome was unknown. mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was withdrawn on an unknown date. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No relevant concomitant medications were provided. The patient took 2 doses of diphenhydramine hydrochloride, cetirizine, and famotidine. On 28-Apr-2021, the patient was feeling better. Company Comment: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.


VAERS ID: 1288533 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-21
Onset:2021-04-27
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001CR1A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Headache, Mental impairment
SMQs:, Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: LOPRESSOR; LATANOPROST
Current Illness:
Preexisting Conditions: Comments: No medical history was provided by the reporter.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: couldn''t think of words; Severe headache - mostly on left side; severe chills; This spontaneous case was reported by a consumer and describes the occurrence of MENTAL IMPAIRMENT (couldn''t think of words) in an 80-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 001CR1A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No medical history was provided by the reporter. Concomitant products included METOPROLOL TARTRATE (LOPRESSOR) and LATANOPROST for an unknown indication. On 21-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 27-Apr-2021, the patient experienced MENTAL IMPAIRMENT (couldn''t think of words) (seriousness criterion medically significant), HEADACHE (Severe headache - mostly on left side) and CHILLS (severe chills). On 28-Apr-2021, MENTAL IMPAIRMENT (couldn''t think of words), HEADACHE (Severe headache - mostly on left side) and CHILLS (severe chills) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No laboratory details was given. No treatment information was given. Patient stated two occurrences of this type of episode on 27 Apr 2021 and 28 Apr 2021. Company comment: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. Further information has been requested; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. Further information has been requested


VAERS ID: 1289030 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-25
Onset:2021-04-27
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / 1 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: pre procedure screening for covid test was positive no symptoms


VAERS ID: 1289067 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-04-08
Onset:2021-04-27
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Injection site bruising, Tinnitus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Hearing impairment (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: Claritin-D 24 hour, flonase nasal spray, azelastine nasal solution, montelukast, multi-vitamin
Current Illness: none
Preexisting Conditions: allergies
Allergies: codine/codone
Diagnostic Lab Data:
CDC Split Type:

Write-up: Developed tinnitus in my right ear that has not gone away. Onset of that condition happened around April 26-27. I do not normally have this condition. Also, received allergy shots in each arm since my vaccination, and both have resulted in large welt and subsequent bruising which has not occurred in the past year of having the same injections.


VAERS ID: 1289777 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-03-16
Onset:2021-04-27
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose normal, COVID-19, Chest discomfort, Chills, Dizziness, Ear pain, Fatigue, Headache, Malaise, Pain in extremity, Productive cough, Pyrexia, SARS-CoV-2 test positive, Sputum discoloured
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: levothyroxine PO QD metformin PO QD
Current Illness:
Preexisting Conditions: Asthma DM Type 2 Hypothyroidism Depression Anxiety Bipolar
Allergies: Trileptal - rash
Diagnostic Lab Data: See above
CDC Split Type:

Write-up: J&J COVID-19 Vaccine EUA J&J Dose 3/16/21 (1805018) COVID Positive 5/3/21 5/3/21: Presented to ED. 35-year-old female presents the ER with chief complaint of cough. Patient stated symptoms started 1 week ago. Fiancee has similar symptoms. Other associated symptoms include pleuritic chest discomfort, lightheaded upon standing, fever 102, chills, bilateral ear pain, headache, general malaise, bilateral leg pain, and fatigue. Cough is described as productive producing yellow green phlegm. No prior history of DVT or PE. No recent travels or surgeries. Patient is on Depo. She has no reports of unilateral leg pain or swelling. Patient is a diabetic type 2 with blood sugars running in the 170s 2 days ago. Normal is 100-200. She takes metformin and glipizide. She also has a history of anxiety, depression, bipolar, hypothyroidism. Discharged to home with albuterol, doxycycline, prednisone.


VAERS ID: 1290037 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-04-08
Onset:2021-04-27
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Exposure during pregnancy, Facial paresis, Guillain-Barre syndrome, Lumbar puncture abnormal, Neurological symptom, Paraesthesia, Rash
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Demyelination (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: prenatal vitamins, Zoloft
Current Illness: none
Preexisting Conditions: depression, factor V Leiden heterozygous
Allergies: No known allergies
Diagnostic Lab Data: Lumbar puncture with elevated protein
CDC Split Type:

Write-up: Patient is 30 yo G1P0 at approximately 27 weeks gestation. Her pregnancy was complicated by depression on Zoloft. She reported an all-over body rash a week after the vaccine. Approximately 2 weeks later, she presented with neurological symptoms with L facial weakness, now with significant bifacial paresis and bilateral hand paresthesias concerning for Guillain Barre Syndrome which was confirmed on lumbar puncture.


VAERS ID: 1290078 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-04-27
Onset:2021-04-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Breast pain, Chills, Dizziness, Dyspnoea exertional, Facial pain, Feeling hot, Headache, Hormone level abnormal, Hyperhidrosis, Hypotension, Intermenstrual bleeding, Malaise, Mood altered, Muscle tightness, Nausea, Pain, Pain in jaw, Pollakiuria, Pyrexia, Sleep disorder, Syncope, Thirst
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Dystonia (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Lipodystrophy (broad), Osteonecrosis (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: notes: times are approximate. I got the vaccine on day two of my period. I moved my arm a lot after getting the vaccine. My arm did not hurt, even though the rest of my body ached. 4-27-21 2:45pm: got the vaccine in my left arm. 4pm: felt fine. slightly more energy, clearer head than usual. this good mood and clear head only lasted a few hours. it ended before other symptoms began. 9pm: minor body aches, but not in arm where I got the vaccine. minor chills, shivering. 10pm: began to feel worse. moderate body aches, chills, dizzy. 10:40pm: suddenly felt much worse. severe chills, shaking, dizzy, then felt very hot, nausea. vasovagal syncope. sudden low blood pressure. did not actually faint since I know how to prevent fainting. took ginger, drank a lot of water, got ready for bed. lying in bed. felt nauseas for a few hours. this was the most uncomfortable symptom. frequent peeing. thirsty, but water went right through me. sweating. could not really sleep, not totally awake either. felt horrible. after a few hours, still lying in bed. nausea mostly went away. headache, muscle pain in jaw and face were the worse symptoms at this time. frequent peeing. thirsty, but water went right through me. sweating. felt like someone had turned the heat up. when I checked, the heat was off. felt like I had a fever for a few hours. 4-28-21 1:45pm: got out of bed. feel better than the previous night, but generally unwell. short of breath when moving. fatigue. 6pm: dizzy, weak. 4-29-21: 3pm: mild headache, feel mildly hot. 4-30-21: 10pm: tense muscles, especially in my face and head. 5-1-21: sore breasts. 5-4-21: hormones feel unbalanced. PMS symptoms, but it is a few days after my period ended. intense negative moods, spotting, sore breasts.


VAERS ID: 1290768 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-30
Onset:2021-04-27
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Computerised tomogram, Dyspnoea, Eye swelling, Fatigue, Generalised tonic-clonic seizure, Ocular hyperaemia, Pain in extremity, Pyrexia, Sluggishness, Urine analysis normal
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: ADD
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: several blood tests; Test Result: Inconclusive ; Result Unstructured Data: No results were provided; Test Name: chest X-ray; Test Result: Inconclusive ; Result Unstructured Data: No results were provided; Test Name: CT scan; Test Result: Inconclusive ; Result Unstructured Data: No results were provided; Test Name: urine tests; Test Result: Inconclusive ; Result Unstructured Data: No results were provided
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Grand mal seizure; "extreme sluggishness; "swollen eyes, they were basically swollen shut; dark and red coloration around his eyes/his eyes were red; difficulty breathing; sore arm; fatigue; he had a high fever just by touching him, he was extremely warm to the touch.; This spontaneous case was reported by an other caregiver (subsequently medically confirmed) and describes the occurrence of GENERALISED TONIC-CLONIC SEIZURE (Grand mal seizure) in a 21-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 002C21A and 020B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included ADD. On 30-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 27-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 27-Apr-2021, the patient experienced SLUGGISHNESS ("extreme sluggishness), EYE SWELLING ("swollen eyes, they were basically swollen shut), OCULAR HYPERAEMIA (dark and red coloration around his eyes/his eyes were red), DYSPNOEA (difficulty breathing), PAIN IN EXTREMITY (sore arm), FATIGUE (fatigue) and PYREXIA (he had a high fever just by touching him, he was extremely warm to the touch.). On 28-Apr-2021, the patient experienced GENERALISED TONIC-CLONIC SEIZURE (Grand mal seizure) (seriousness criteria hospitalization, medically significant and intervention required). The patient was hospitalized from 28-Apr-2021 to 28-Apr-2021 due to GENERALISED TONIC-CLONIC SEIZURE. On 28-Apr-2021, GENERALISED TONIC-CLONIC SEIZURE (Grand mal seizure) had resolved. At the time of the report, SLUGGISHNESS ("extreme sluggishness), EYE SWELLING ("swollen eyes, they were basically swollen shut), OCULAR HYPERAEMIA (dark and red coloration around his eyes/his eyes were red), DYSPNOEA (difficulty breathing), PAIN IN EXTREMITY (sore arm), FATIGUE (fatigue) and PYREXIA (he had a high fever just by touching him, he was extremely warm to the touch.) had not resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Blood test: (Inconclusive) No results were provided. On an unknown date, Chest X-ray: (Inconclusive) No results were provided. On an unknown date, Computerised tomogram: (Inconclusive) No results were provided. On an unknown date, Urine analysis normal: (Inconclusive) No results were provided. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medication were reported. Treatment included Advil for fever, Maxipime, Keppra for seizure prevention and normal saline. Action taken with mRNA-1273 in response to the event was Not Applicable Company Comment: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. This case was linked to US-MODERNATX, INC.-MOD-2021-098517, MODERNATX, INC.-MOD-2021-097451 (E2B Linked Report).; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. MODERNATX, INC.-MOD-2021-098517:Case for dose 1 MODERNATX, INC.-MOD-2021-097451:Cross linked case


VAERS ID: 1292401 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-12
Onset:2021-04-27
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anosmia, COVID-19, Chills, Dysgeusia, Headache, Nasal congestion, Rhinorrhoea
SMQs:, Taste and smell disorders (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

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

Write-up: contracted COVID infection chills;headache;anosmia/dysgeusia;congestion/rhinorrhea


VAERS ID: 1294017 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:2021-04-27
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Injection site bruising, Injection site discolouration, Injection site pain
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ACETYLSALICYLIC ACID
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Arthritis (occasionally takes ASA (acetylsalicylic acid) for arthritis); Non-smoker; Smoker (quit in 2004); Comments: The patient had no other bruises recently or petechia, chest pain, leg or abdominal pain, difficulty breathing, headache or blurred vision and no allergies.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210504285

Write-up: BRUISING AT INJECTION SITE; DARKER DISCOLORATION ON OUTSIDE AND A LIGHTER COLOR ON INSIDE OF BANDAGE; PAIN AT INJECTION SITE; This spontaneous report received from a patient concerned a 54 year old male. The patient''s height, and weight were not reported. The patient''s past medical history included arthritis, and smoker, and concurrent conditions included non-smoker, and other pre-existing medical conditions included the patient had no other bruises recently or petechia, chest pain, leg or abdominal pain, difficulty breathing, headache or blurred vision and no allergies.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 206A21A, expiry: 23/JUN/2021) dose was not reported, administered on 27-APR-2021 for prophylactic vaccination. Concomitant medications included acetylsalicylic acid for arthritis. On 27-APR-2021, the subject experienced pain at injection site. On 29-APR-2021, the subject experienced bruising at injection site. On 29-APR-2021, the subject experienced darker discoloration on outside and a lighter color on inside of bandage. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from bruising at injection site, had not recovered from pain at injection site, and the outcome of darker discoloration on outside and a lighter color on inside of bandage was not reported. This report was non-serious.


VAERS ID: 1294053 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-04-27
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207AZ1A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210507698

Write-up: OVERWHELMING METAL TASTE IN MOUTH; This spontaneous report received from a patient concerned a 40 year old of unspecified sex. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 207AZ1A, expiry: UNKNOWN) dose was not reported, administered on 10-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On 27-APR-2021, the subject experienced overwhelming metal taste in mouth. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from overwhelming metal taste in mouth. This report was non-serious.


VAERS ID: 1257453 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-04-23
Onset:2021-04-26
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Head discomfort, Nausea, Vertigo
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: liver damage
Allergies: iodine, sulfites, gluten
Diagnostic Lab Data: none
CDC Split Type:

Write-up: dizziness, vertigo, nausea, head pressure


VAERS ID: 1257639 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-19
Onset:2021-04-26
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Redness and swelling at injection site one week after vaccine. Area is warm to touch


VAERS ID: 1257729 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 1 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Ear discomfort
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 described feeling dizziness, lightheaded, and sensation of ears being swollen.


VAERS ID: 1258048 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-04-07
Onset:2021-04-26
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / UNK LA / IM

Administered by: Pharmacy       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: bisoprolol w hctz vit d atorvastatin levothyroxine losartan glipizide amlodipine fluoxetine
Current Illness:
Preexisting Conditions:
Allergies: codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shortness of breath not urgent. recommended patient call physician or get examined by medical facility today.


VAERS ID: 1258621 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / N/A LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood glucose increased, Cardiac arrest, Cardiac monitoring abnormal, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: Cardiac monitor, IV, blood glucose (107), transport to ER via ambulance.
CDC Split Type:

Write-up: Syncopal episode with spontaneous recovery. Second syncopal episode associated with 15 seconds of asystole on cardiac monitor.


VAERS ID: 1258699 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / N/A LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cardiac monitoring, Dizziness, Electrocardiogram, Heart rate irregular
SMQs:, Anticholinergic syndrome (broad), Cardiac arrhythmia terms, nonspecific (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unk
Current Illness: unk
Preexisting Conditions: unk
Allergies: NKDA
Diagnostic Lab Data: Cardiac monitor, ECG, transport via ambulance to ER
CDC Split Type:

Write-up: Lightheaded, irregular heart rate/rhythm


VAERS ID: 1258879 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-12
Onset:2021-04-26
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye swelling, Facial pain, Hypoaesthesia
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: PATIENT CALLED TODAY AND SPOKE WITH PHARMACIST AND TOLD THAT SHE HAVE RIGHT SIDE OF HEAD IS NUMB. PAIN IN CHEEKBONE. EYES ARE SWALLON. PHARMACIST TOLD HER TO SEE HER PRIMAMARY DOCTOR AND CHECK OUT THESE SYMPTOMS.


VAERS ID: 1259456 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / N/A LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Electrocardiogram, 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Valsartan 80 mg daily, Albuterol 1-2 puffs as needed, Zyrtec 10 mg daily
Current Illness: Hypertension, medication started 2 weeks ago.
Preexisting Conditions: HTN, asthma
Allergies: NKDA
Diagnostic Lab Data: As above
CDC Split Type:

Write-up: Syncopal episode after receiving vaccine. Regained consciousness, but had persistent dizziness. IV established with 250cc bolus. Positive orthostatic. EKG with possible RBBB. Additional 250 cc NS, transport to ER via ambulance.


VAERS ID: 1259464 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK LA / IM

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

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

Write-up: Patient had a syncope episode and failed sitting. While trying to stand patient had another episode and was slided down on the floor by the nurses. Paramedic came and attended to patient. Patient recovered after few minutes and family member pick patient to home.


VAERS ID: 1259560 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-04-08
Onset:2021-04-26
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Thrombosis, Ultrasound scan abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Skin Cancer Sleep Apnea
Allergies:
Diagnostic Lab Data: Ultrasound - 4/26/21
CDC Split Type:

Write-up: ultrasound the left lower extremity shows extensive occlusive lower extremity DVT involving multiple veins. Labs otherwise unremarkable, patient appears well, denies chest pain or shortness of breath. He had the J+J vaccine less than 3 weeks ago.


VAERS ID: 1259979 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-23
Onset:2021-04-26
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Headache, Injection site pain, Ocular hyperaemia
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Glaucoma (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: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt called the office reporting injection site pain, headache, and right eye redness. Started with the red eye then injection site arm hurting/pain, and headache. Pt was told to go to her PCP and/or the emergency room to be seen and treatment.


VAERS ID: 1260781 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-04-01
Onset:2021-04-26
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Deep vein thrombosis, Fibrin D dimer increased, Pain in extremity, Thrombosis, Ultrasound Doppler abnormal
SMQs:, Haemorrhage laboratory terms (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Flomax
Current Illness:
Preexisting Conditions: Cervical stenosis Lumbar stenosis BPH
Allergies: Amoxicillin, codeine
Diagnostic Lab Data: RLE ultrasound, elevated D dimer 4/26
CDC Split Type:

Write-up: posterior tibial vein non-occlusive thrombus. RLE pain starting 4/23, diagnosed 4/26


VAERS ID: 1260977 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-22
Onset:2021-04-26
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysphagia, Dyspnoea, Muscle spasms, Trismus
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dystonia (narrow), 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), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Intense muscle cramp in left side of neck/jaw. Causing inability to swallow and difficulty breathing. Severe for 5 minutes, moderate for over 1.5 hours currently.


VAERS ID: 1260983 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Incorrect product formulation administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Dose 1: 3/24/2021; Moderna; Lot #012A21A Dose 2: 4/26/2021; Pfizer; Lot #ER8736 Patient received Dose 2 of Covid-19 Vaccine series as Pfizer instead of Moderna. Patient made aware following vaccine administration, denies any physical symptoms at time of incident. No adverse event or side effects noted during 15 minute waiting period. Departs without toxic appearance or distress. Advised regarding best practice to not re-administer Moderna Dose 2 at this time.


VAERS ID: 1260999 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pruritus, Skin warm
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Allergy maintenance injection Unknown type or brand, years ago
Other Medications: Metformin, Atorvastatin, Verapamil, Famotidine, Nortriptyline, Fluticasone Propionate
Current Illness: Bladder infection
Preexisting Conditions: Diabetes, Seasonal allergies
Allergies: Topamax
Diagnostic Lab Data:
CDC Split Type:

Write-up: Itchy face, neck and upper chest. Face is warmer on side that is the itchiest. Injection was at 11:14 am, symptoms started at 7:00 pm. I took 10 mg of Cetirizine Hydrochloride at 8:00 pm. It is now 9:27 and symptoms have subsided a bit.


VAERS ID: 1261001 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Dyspnoea, Headache, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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: Adderall, Prozac, montelukast, flint stone chewable vitamins, vitamin d
Current Illness:
Preexisting Conditions: Asthma, depression, anxiety, adhd
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tightness in chest, extreme nausea, dizziness, headache, shortness of breath. After receiving the vaccine I had these symptoms for the rest of the day, as of this writing I am still feeling mostly nausea and the tightness in my chest has died down.


VAERS ID: 1261021 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-24
Onset:2021-04-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Bright red circle area about 2? in diameter at injection site,, sore, heat


VAERS ID: 1261022 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-19
Onset:2021-04-26
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus, Injection site rash, Injection site warmth, Post-acute COVID-19 syndrome
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omeprozole 40mg 1SID Fluoxetine 40mg 1SID Bupropione HcL XL 300mg 1 SID Clonazapam 1mg 1 TID prn Atenolol 50mg 1 SID Seroquel ER 300mg 1 SID PM Trazadone 150mg 1 SID PM Cetirizine 10mg SID Melatonin 20mg SID PM
Current Illness: None
Preexisting Conditions: Fibromyalgia, Lyme?s disease, arthritis, GERD
Allergies: None known
Diagnostic Lab Data: None
CDC Split Type:

Write-up: ?COVID arm? I developed an itchy, hot, round red rash at the injection site 7 days after the vaccine.


VAERS ID: 1261027 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-25
Onset:2021-04-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Headache, Postmenopausal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: Post menopausal period, persistent head ache.


VAERS ID: 1261036 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-04-24
Onset:2021-04-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / UNK LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Injection site pain, Injection site pruritus, Injection site rash, Injection site swelling, Injection site warmth
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? 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: Rash ~ 2.5x2.5 inch below the injection site, itchy, tender to touch, a bit swollen, a bit warm


VAERS ID: 1261045 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-17
Onset:2021-04-26
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pantaprozole (40mg), Senna (8.6mg)
Current Illness: N/A
Preexisting Conditions: Gastrotestinal issues that started May 2020 - ulcerated duodenum -- obstruction resolved Nov 2020
Allergies: Bee Venom; strawberries; wool
Diagnostic Lab Data: N/A - will discuss with primary care doctor on 27 April.
CDC Split Type:

Write-up: Right Shoulder was sore starting evening of 17 April and most of the day on 18 April. Rash developed today (26 April) approximately 1.5 to 2 inches diameter (red dots).


VAERS ID: 1261961 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Dyskinesia, 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), Dyskinesia (narrow), 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: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: UNKNOWN
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1455 1ST DOSE PFIZER VACCINE ADMINISTERED 1457 PT WITH LOSS OF CONSCIOUSNESS, WITH ARMS AND LEGS JERKING MOVEMENTS. AMMONIA INHALANT USED, PT AROUSED AFTER STERNAL RUB AND INHALANT. ORIENTED TO SITUATION PROVIDED. PT STATES "I''M SO EMBARRASSED, I FELT THAT COMING ON" 911 CONTACTED AND PT ASSISTED TO STRETCHER. 1458 BP 137/81 HR 72. PT DENIES ANY OTHER COMPLAINTS. DOES CONFIRM HE WAS ANXIOUS ABOUT INJECTION AND WAS SCARED HE WOULD FAINT. 1500 EMS HERE, BP128/80 HR 92. PT REFUSED TRANSPORT WITH EMS AFTER DISCUSSION WITH EMTS. 1530 PT STATES FEEL OK TO LEAVE WITH GIRLFRIEND DRIVING. BP 165/64 HR 65. DENIES ANY COMPLAINTS. INSTRUCTED TO CALL 911 OR SEEK MEDICAL ATTENTION IF NEEDED. VOICED UNDERSTANDING.


VAERS ID: 1261967 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Vision blurred, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Visual Changes/Disturbances-Mild, Additional Details: Patient''s wife called into the pharmacy about 3 hours after the patient recieved their vaccine. Patient''s wife reported that the patient was experiencing blurred vision. No other symptoms were reported and patient''s wife answered no when asked if the patient was experiencing trouble breathing, rash/hives, dizziness, nausea/vomiting etc.


VAERS ID: 1261968 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Vermont  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Hypotension, Pallor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Sweating, dizziness, paleness, low bp,


VAERS ID: 1261973 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 1 LA / IM

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

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

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


VAERS ID: 1261976 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 1 LA / IM

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

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

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


VAERS ID: 1262136 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Erythema, Injection site erythema, Injection site pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (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:
Current Illness: n/a
Preexisting Conditions: asthma
Allergies: seasonal
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: erythema and pruritis to left arm around immediate site of the vaccine, monitored for 30min and appeared to improve - erythema almost completely resolved, no rash presented anywhere else and pt had no respiratory symptoms and felt fine. Recommended Benadryl 25-50mg if itching persisted and advised follow-up for additional care if symptoms worsened. Called to follow up the next day and check on the pt, had initially improved but then worsened and had redness and hives to both arms, then to back, neck and chest. pt took Claritin (about an hour or more after benadryl) and symptoms improved over several hours - they did not seek additional medical attention and today pt is back to baseline. She never had any wheezing, coughing, swelling or difficulty swallowing - no respiratory symptoms at all. Given the rash worsened to chest and back and symptoms took $g4hrs to resolve, recommended she NOT return for her second dose due to increased risk of a more severe allergic reaction. Notified PCP and recommended f/u with PCP for any additional questions or concerns.


VAERS ID: 1262165 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-24
Onset:2021-04-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA OU6B21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Spironolactone, vitamin D3, Vitamin B-12 complex, Claritin daily allergy pill, Omega-3 supplement, Ovasitol (inositol) supplement, Curcumin supplement
Current Illness: None
Preexisting Conditions: Polycystic Ovarian Syndrome
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Hardness and redness at injection site, 48+ hours after injection. Itchy at injection site, warm to touch, sore to touch.


VAERS ID: 1262198 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-04-16
Onset:2021-04-26
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Chills, Headache, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: headache, chest pain, fever/chills


VAERS ID: 1262213 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-04-25
Onset:2021-04-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Discomfort, Fatigue, Headache, Irritability, Malaise, Nausea, Pain in extremity, Rash
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine (75mg), Amitriptyline (30 mg), riboflavin, biotin, Lysine, Osteo Stim suppliments, Valacyclovir, Vitamin D3
Current Illness: none
Preexisting Conditions: migraines, hypothyroidism, hepatic cysts
Allergies: mold
Diagnostic Lab Data:
CDC Split Type:

Write-up: I received my vaccine in the left arm in the mid-afternoon on Sunday and experienced little discomfort the rest of the day with some soreness in the arm before bed. The following morning i felt unwell and my arm was extremely sore. It took some focus and energy to move. I took 500 mg acetaminophen 3x and Ondansetron 1x over the day due to feeling nauseous, low-grade headache, tiredness and a general feeling of being unwell. I felt noticeably irritable. My arm was sore to the touch and in the late afternoon i noticed i had a mild rash across the back of my arm starting below my deltoid muscle and spread out and down close to my elbow. It was not a bright red but the area was remarkably sensitive, so much so that i felt i should report the reaction because ive never had a noticeable reaction to a vaccine so i became mildly alarmed. I put no creams on the rash nor did i take additional meds. The following day (today) it has decreased significantly in sensitivity and has faded so much so that if you don''t look for it, you cant easily see it.


VAERS ID: 1262224 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-03-30
Onset:2021-04-26
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028D21D / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Induration, Lymphadenopathy
SMQs:, Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin Levothyroxine Seroquel Lamotrigine Fluoxetine
Current Illness: None
Preexisting Conditions: Diabetes Bipolar PTSD
Allergies: Penicillin Dilaudid
Diagnostic Lab Data: None at this time. Just discovered it yesterday.
CDC Split Type:

Write-up: I have a lymph node that is right below my left clavicle that is as hard as an uncooked green pea.


VAERS ID: 1262239 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-25
Onset:2021-04-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Oropharyngeal pain, Pain
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

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

Write-up: Body aches, chills, sore throat


VAERS ID: 1262241 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Paraesthesia oral, Throat tightness, Tongue pruritus
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad)

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

Write-up: PT was administered their 2nd dose of Pfizer, and started experiencing symptoms about 15 minutes later. Stated that they have history of anxiety, and was having a tightness in their throat. Also was feeling a tingling and itching on their tongue. PT was administered PO antihistamine 50mg. PT cleared the site after waiting additional time under their own power.


VAERS ID: 1262247 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Injection site pain, Mobility decreased
SMQs:, Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Systemic: Weakness-Medium, Additional Details: patient reports feeling a jolt in her arm (possible due to nerves) during administration. After vaccination finished her arm felt weak. She still has movement in her arms but says it just feels weak and harder to move her arm.


VAERS ID: 1262264 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Dizziness / Lightheadness-Severe, Systemic: Nausea-Severe


VAERS ID: 1262266 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Dizziness / Lightheadness-Severe


VAERS ID: 1262279 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, Injection site pain, Motor dysfunction, Pain, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (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: Site: Pain at Injection Site-Medium, Additional Details: pt recieved covid vaccine today...verified location of the shot and it is right in the right deltoid of the right arm. pt immidiately after felt pain at the injection site that radiates to her hand. it has persisted for at least 30 minutes while we monitored pt in store. pt says its hard to hold things because of pain by forearm. referred pt to see primary care to see if any additional treatment is needed


VAERS ID: 1262294 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Flushing, Hyperhidrosis, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypersensitivity (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: Systemic: Flushed / Sweating-Mild, Systemic: Shakiness-Mild, Additional Details: Patient has been fasting and did not mention to immunizer that she passed out twice today because she is not eating anything only water. Paramedics came and check on her and patient was stable and recovered at the time.


VAERS ID: 1262312 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Blood pressure measurement, Fall, Flushing, Head injury, Headache, Heart rate, Hyperhidrosis, Oxygen saturation, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Fainting / Unresponsive-Medium, Systemic: Fell from chair and hit head on floor - small gash on bridge of nose-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Headache-Medium, Systemic: Hypotension-Medium, Systemic: Weakness-Medium, Additional Details: Within 5 minutes of vaccination, pt fell from sitting position in chair to the ground. Pt hit his head and had small gash on bridge of nose. When I got to him, his eyes openned and he knew what happenned. Called 911. He laid on ground while we had NP check blood pressure, pulse, and O2 levels. Pt was stable and walked out with EMS to be checked out.


VAERS ID: 1262333 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-25
Onset:2021-04-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 1 - / -

Administered by: School       Purchased by: ?
Symptoms: Asthenia, Chills, Nausea
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Chills, weakness , nausea day 1. Rested all day. Day 2, a little nausea and weakness.


VAERS ID: 1262340 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-25
Onset:2021-04-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Chills, Fatigue, Nasopharyngitis
SMQs:

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

Write-up: Chills that night until the next morning, head cold and tiredness the next day, Treated with acetaminophen


VAERS ID: 1262348 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (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: Systemic: Dizziness / Lightheadness-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Vomiting-Medium, Additional Details: Patient sat for 30 minutes and drank some fluids that went home with Mother


VAERS ID: 1262364 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-04-25
Onset:2021-04-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Diarrhoea, Headache, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

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

Write-up: Nausea for 24 hours Vomiting once Fever for 6 hours Headache for 24 hours Diarrhea for 24 hours


VAERS ID: 1262400 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-04-01
Onset:2021-04-26
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

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

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

Write-up: Area of injection has a raised bump with break outs around it


VAERS ID: 1262422 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-16
Onset:2021-04-26
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / UNK RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Back pain, Pain in extremity, Thrombosis
SMQs:, Retroperitoneal fibrosis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ASPIRIN 81MG TAB CHEW TAB CHEW 1 TABLET(S) EVERY DAY BY ORAL ROUTE(Indications for Use: heart health) Pharmacy Active 12/18/2020 09:00 3/27/2021 There is a black box warning associated with this order. Please click to view details. FUROS
Current Illness: NONE
Preexisting Conditions: E03.9 HYPOTHYROIDISM, UNSPECIFIED 3/25/2019 Present on Move-in 9/12/2019 RJjemba update F03.90 UNSPECIFIED DEMENTIA WITHOUT BEHAVIORAL DISTURBANCE 3/25/2019 Present on Move-in 9/12/2019 RJjemba update Z91.81 HISTORY OF FALLING 3/25/2019 9/12/2019 RJjemba update M62.81 MUSCLE WEAKNESS (GENERALIZED) 3/25/2019 Present on Move-in 9/12/2019 RJjemba update H54.0 BLINDNESS, BOTH EYES 3/25/2019 5/15/2020 ZColburn update M84.459A PATHOLOGICAL FRACTURE, HIP, UNSPECIFIED, INITIAL ENCOUNTER FOR FRACTURE 3/25/2019 5/21/2020 ZColburn update F05 DELIRIUM DUE TO KNOWN PHYSIOLOGICAL CONDITION 3/25/2019 5/21/2020 ZColburn update M19.90 UNSPECIFIED OSTEOARTHRITIS, UNSPECIFIED SITE 3/25/2019 5/21/2020 ZColburn update S72.352D DISPLACED COMMINUTED FRACTURE OF SHAFT OF LEFT FEMUR, SUBSEQUENT ENCOUNTER FOR CLOSED FRACTURE WITH ROUTINE HEALING
Allergies: nka
Diagnostic Lab Data: UNKNOWN
CDC Split Type:

Write-up: RESIDENT COMPAINED OF PAIN TO BILATERAL THIGHS AND LOWER BACK SENT TO ER. NOTIFIED BY ER, PATIENT HAS BLOOD CLOTS IN ABDOMIN


VAERS ID: 1262449 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-01
Onset:2021-04-26
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Haematuria
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine Atorvastatin Carvedilol Finesteride Losartan Mirtazepine Novolog insulin Basalgar insulin
Current Illness: None
Preexisting Conditions: Hypertension Diabetes Peripheral vascular disease
Allergies: Unknown
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Initiating on 26 April 2021, the patient experienced gross hematuria. There were no other symptoms associated with the hematuria. On 27 April 2021 with additional hydration the patient experienced decreased hematuria with no other symptoms.


VAERS ID: 1262515 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-04-25
Onset:2021-04-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Fatigue
SMQs:, Arthritis (broad)

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

Write-up: Fatigue.. Joint pain


VAERS ID: 1262546 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Chills, Headache, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

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

Write-up: Chest pain Nausea Headache Achy Chills


VAERS ID: 1262699 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-05
Onset:2021-04-26
   Days after vaccination:52
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK RA / IM

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

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

Write-up: Patient tested positive more than 14 days post vaccination.


VAERS ID: 1262737 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-26
Onset:2021-04-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (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: ANXIETY, DIZZINESS TX: HYDRATE, SNACK/REPOSITION/COLD COMPRESS SX: RESOLVED NO TRANSPORT


VAERS ID: 1263057 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-04-25
Onset:2021-04-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Fatigue, Headache
SMQs:

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

Write-up: Bad headache and chills as well as fatigue


VAERS ID: 1263266 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-11
Onset:2021-04-26
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Anticoagulant therapy, Deep vein thrombosis, Fibrin D dimer increased, Pulmonary embolism, Ultrasound Doppler abnormal
SMQs:, Haemorrhage laboratory terms (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril, Rosuvastatin
Current Illness: None
Preexisting Conditions: Hypertension, Hyperlipidemia
Allergies: Codeine
Diagnostic Lab Data: 04/26/2021: D-Dimer = 4080, CTA Chest = small distal peripheral pulmonary emboli, Doppler RLE = extensive deep vein thrombosis involving the superficial femoral and popliteal veins
CDC Split Type:

Write-up: Pulmonary embolism, Deep vein thrombosis - treating with Eliquis


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