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

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



Case Details (Reverse Sorted by Onset Date)

This is page 130 out of 3,524

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VAERS ID: 1334314 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Paraesthesia, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: lansoprazole, hyoscyamine, hydroxyzine
Current Illness: none
Preexisting Conditions: "stomach migraines" causing vomiting
Allergies: no known food or drug allergies
Diagnostic Lab Data: none yet
CDC Split Type:

Write-up: VOMITING (unsure if due to chronic condition though he hasn''t vomited in at least 3 weeks) and ''TINGLY'' LEGS- not quite pins and needles, no numbness, no pain, just aggravating tingling sensation


VAERS ID: 1334350 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Eye movement disorder, Fear of injection, Incoherent, Loss of consciousness, Nervousness, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: PATIENT WAS EXTREMELY NERVOUS, STATED DOES NOT LIKE NEEDLES. WITHIN 2 MINUTES FELT CHEST TIGHTNESS, LIGHTHEADEDNESS, STARTED SHAKING AND EYES ROLLED UP BEFORE PASSING OUT. COME TO WITHIN A FEW SECONDS BUT WAS NOT COHERENT. COULDN''T ANSWER BASIC QUESTIONS AND LOOKED AS IF WAS GOINT TO PASS OUT AGAIN. COULD NOT STAND, TALK ETC. HE WAS LIKE THIS FOR 10 MINUTES OR SO. CALLED 911 THEY STATED TO LAY PATEINT CAREFULLY ON THE FLOOR TO RECOVER BLOOD FLOW UNTIL THEY COULD GET THERE. PATEINT STARTED COMING BACK AROUND WITHIN THE NEXT 5 MINUTES. MOTHER REFUSED LEAVING IN AMBULANCE BELIEVED SON WOULD BE FINE.


VAERS ID: 1334374 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Dyspnoea, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: patient states she has allergies to many things and has used an epipen in the past
Diagnostic Lab Data:
CDC Split Type:

Write-up: Stated she felt her throat closing up, SOB and anxiety. Was given 1 injection of epinephrine, declined calling an ambulance and was take to local ER by grandparent.


VAERS ID: 1334379 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 1 RA / IM

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

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

Write-up: two different Vaccines provided


VAERS ID: 1334392 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest X-ray, Chest discomfort, Cough, Dizziness, Face oedema, Full blood count, Headache, Pruritus
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Buspar 15mg Depo-Provera injection melatonin 10mg sertraline 50mg
Current Illness: none
Preexisting Conditions: Congenital Factor IX disorder MDD PTSD fatty liver disease, non-alcoholic amenorrhea back pain primary insomnia herpes simplex anxiety nephrolithiasis, uric acid methamphetamine use
Allergies: none
Diagnostic Lab Data: CBC, CXR. 05/20/21
CDC Split Type:

Write-up: R facial edema and pruritus, headache, chest pressure, dizziness, cough. Treated with diphenhydramine 50mg IM in clinic, Benadryl at home.


VAERS ID: 1334426 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Pallor, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Pt reported dizziness/lightheadedness, was pale & sweating. Began to shake as he was moved from wheelchair to bed. Last meal was several hours prior (BP 93/48; HR 65). Similar sx w/previous vaccines, afraid of needles. Pt transferred to gurney, legs elevated. Ate crackers & juice. Able to walk w/out difficulty & waited for father to pick him up. Released in stable condition (BP 120/54; HR 87)


VAERS ID: 1334427 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Extra dose administered
SMQs:, Medication errors (narrow)

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

Write-up: Janssen COVID Vaccine dose administered on 5-19-21. When entering into alert it was discovered Patient received a COVID vaccine dose on 4-10-21, unknown trade name, lot EW0158.


VAERS ID: 1334440 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-01
Onset:2021-05-19
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Confusional state, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
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: No
Current Illness:
Preexisting Conditions: Asthma
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Violent shaking, low grade fever and confusion


VAERS ID: 1334468 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

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

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

Write-up: Patient was 16 years old at the time of vaccination. No adverse events known at this time. No signs or symptoms of an allergic response observed during post vaccine observation period.


VAERS ID: 1334472 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Dizziness, Feeling hot, Hyperhidrosis, Hypoaesthesia, Muscle rigidity, Nausea, Paraesthesia, Paralysis, Screaming
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Escitalopram 5mg/day
Current Illness: None
Preexisting Conditions: None, though patient is gluten and lactose sensitive.
Allergies: Severely allergic to pine nuts. Needs epi pen
Diagnostic Lab Data: No medical or laboratory tests were performed at Hospital on 5/19/2021
CDC Split Type:

Write-up: Shot given 11:58am. Within 2 minutes symptoms began with feeling symptoms: nauseous, hot forehead. I asked CVS for the nurse to help. By 12:01 patient was feeling extreme pain in her stomach, was sweating profusely, felt tingling sensation from head down to her stomach (including her arms and hands). Patient began screaming in pain. Her hands became rigid and paralyzed. She was completely unable to move both hands. Patient was able to feel if someone was touching her hands. Her face began tingling and feeling numb. Patient was lying down and almost passed our. I asked CVS to call 911 and if they should administer an epi pen. The epi pen was not administered. I (mother) went w/ child in the ambulance to Hospital. EMT monitored her vitals, which were normal. Patient was still unable to move her hands until after she was admitted to Hospital. Patient did not receive any IV r medication at Hospital. The sensation in her hands slowly came back with the numbness subsiding after about 1.5 hours in the ER. Patient was discharged at about 2:00pm on 5/16/2021.


VAERS ID: 1334505 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 LA / IM

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

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

Write-up: patient felt faint, did not pass out entirely


VAERS ID: 1334511 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 1 LA / IM

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

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

Write-up: Child under the age of 12 (guardian completed form with incorrect DOB and stated 12, but when confirmed dob in ehr, dob is incorrect).


VAERS ID: 1334512 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Feeling abnormal, Hallucination, visual, Pain
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (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:
Preexisting Conditions: Audio Hallucinations, generalized anxiety disorder
Allergies: slight pineapple allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Body aches, loopiness, visual hallucination. The hallucination occurred around 10 hrs after the vaccination was administered while patient sat in a dark room. Patient (age 13) has a history of audio hallucinations, but no visual ones


VAERS ID: 1334594 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Malaise, Seizure, Thirst, Vision blurred
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: We are seeing a neurologist on June 16th per my doctor''s request
CDC Split Type:

Write-up: After receiving vaccine, we were told to sit and wait 10 minutes before leaving. About 7 minutes into waiting, my son said he was thirsty and not feeling that good. we started to walk to get a water and he totally blacked out and exhibited mild like seizure activity. After he "came too", he complained of blurry vision and still didn''t feel good as we waited for ambulance. Once ambulance came he was feeling a little better. Vitals all checked out good and were declined going to hospital. He doesn''t remember anything that happened in Pharmacy, except that he thought he was going to die.


VAERS ID: 1334623 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Headache, Pain
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 headache body aches


VAERS ID: 1334628 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Posture abnormal, Presyncope, Respiratory arrest, Seizure, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Dystonia (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

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

Write-up: Patient had a vasovagal response and fainted a few minutes after her injection. She was unconscious, not breathing for a few seconds as her head fell to her chest, but resumed breathing when we opened her airways. Her body seized upon taking in air and 911 was called. She regained consciousness before the paramedics arrived and her vitals were within normal limits when they checked her. Pt went home on her own with mom.


VAERS ID: 1334637 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 1 LA / IM

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

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

Write-up: Patient gave inaccurate DOB prior to being vaccinated. Consent signed with inaccurate information. Came back to the registration table approximately 10 minutes after the vaccine was administered and acknowledged error and asked to correct the record. Patient did not have any symptoms following vaccination. We asked her to wait in observation for an additional 15 minutes, no adverse reaction noted.


VAERS ID: 1334638 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-07
Onset:2021-05-19
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Rapid CoVID
CDC Split Type:

Write-up: Positive Test 5/20/2021 after J&J vaccine on 5/7/2021


VAERS ID: 1334678 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-01
Onset:2021-05-19
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, Pericarditis, Troponin increased
SMQs:, Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune 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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Minocycline
Current Illness: None
Preexisting Conditions: Acne
Allergies: None
Diagnostic Lab Data: Troponin peak 9.81 three days after second vaccine
CDC Split Type:

Write-up: NSTEMI/Troponin elevation/pericarditis


VAERS ID: 1334799 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Kentucky  
Vaccinated:0000-00-00
Onset:2021-05-19
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Alcohol use; Seasonal allergy
Preexisting Conditions: Medical History/Concurrent Conditions: Non-smoker; Comments: Patient had no drug abuse or illicit drug usage,
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210537384

Write-up: GENERAL FATIGUE; HEADACHE; INJECTION SITE PAIN; This spontaneous report received from a consumer concerned a 25 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included alcohol consumption (socially, about once per week), non smoker, and grass, tree and pollen allergy, and other pre-existing medical conditions included patient had no drug abuse or illicit drug usage. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: Unk) dose was not reported, administered on 18-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. The batch number was not reported and has been requested. On 19-MAY-2021, the subject experienced general fatigue. On 19-MAY-2021, the subject experienced headache. On 19-MAY-2021, the subject experienced injection site pain. Treatment medications (dates unspecified) included: acetylsalicylic acid, and paracetamol. The action taken with covid-19 vaccine was not applicable. The patient had not recovered from general fatigue, and injection site pain, and the outcome of headache was not reported. This report was non-serious.


VAERS ID: 1334803 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:2021-05-19
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Non-smoker; Ulcerative colitis (Patient taking Methylamine)
Preexisting Conditions: Comments: The patient had no known drug allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210537608

Write-up: BOTH EYES ARE SWOLLEN/PUFFY/LEFT EYE MORE SWOLLEN; FACE WAS SWOLLEN (SWOLLEN CHEEKS); DARK RED COLOR AROUND EYES; CHEST TIGHTNESS; This spontaneous report received from a patient concerned a 26 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included ulcerative colitis, non-alcohol user, and non-smoker, and other pre-existing medical conditions included the patient had no known drug allergies. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 205A21A expiry: 23-JUN-2021) dose was not reported, administered on 18-MAY-2021 12:45 for prophylactic vaccination. No concomitant medications were reported. On 19-MAY-2021, the subject experienced both eyes are swollen/puffy/left eye more swollen. On 19-MAY-2021, the subject experienced face was swollen (swollen cheeks). On 19-MAY-2021, the subject experienced dark red color around eyes. On 19-MAY-2021, the subject experienced chest tightness. Treatment medications included: diphenhydramine hydrochloride. The action taken with covid-19 vaccine was not applicable. The patient was recovering from chest tightness, and had not recovered from both eyes are swollen/puffy/left eye more swollen, face was swollen (swollen cheeks), and dark red color around eyes. This report was non-serious.


VAERS ID: 1334836 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 1 LA / IM

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

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

Write-up: Moderna vaccine was expiring at 4:22AM on 5/19/21 (but it was till in the refrigerator), on the same day at about 11 AM the pharmacist inject patient with the expired vaccine. Attention was brought to patient the following day, no adverse side effect per patient. A pharmacist spoke with a representative at Moderna (case #MOD21-091951), we were advised against revaccination. We will follow up with patient in the next week.


VAERS ID: 1334852 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

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

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

Write-up: Vaccinated at 11 years of age; Client registration indicated incorrect Date of Birth (12 years). Registration and consent to vaccinate completed by parent with verification of Correct Age to Receive COVID-19 Pfizer BioNTech vaccine and verification that child belongs to vaccine eligibility group. Client age verified at clinic twice, in registration and at vaccination station. Client (child) stated date of birth both times to separate nurses at the clinic. Client vaccinated as a 12 year old.


VAERS ID: 1334859 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Hypoacusis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Pt c/o feeling dizzy, muffled hearing & sweating. Pt escorted to observation and placed on cot in supine position. Pt''s VS obtained by clinical staff and (EMS) called. EMS assessed and monitored pt. VS WNL. Medical incident duration from onset to medically cleared by EMS was 7 minutes. Pt reports "I am feeling much better." Pt cleared by EMS that it was safe to go home and driven by her mother.


VAERS ID: 1336011 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-21
Onset:2021-05-19
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: parents made an online covid 19 vaccine appointment and filled out an electronic consent form with a DOB came in on 04/21/2021 to get her first dose and we administered her with Moderna covid vaccine. When she returned on 05/19/2021 to get her second dose, she filled out another paper consent form with her real DOB . That''s when we realized we administered Moderna covid vaccine to a 17 year old . No adverse events to report.


VAERS ID: 1336030 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye pruritus, Eye swelling, Lacrimation increased, Migraine, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Lacrimal disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient got the vaccine at around 1 pm and around 6.30 pm patient had her eyes swelling up and itching and watering. She got a migraine too. She almost could not see as her eyes were shutting off. She thought she is having an allergic reaction and took two Benadryl. Today when she woke up her eyes are the same swollen and maybe 1/2 inch open. She is feeling nausea also. So patient called the pharmacy to inform . She wanted to see if she can take benadryl. she was advised to taken benadryl and also call her doctor and if the symptoms worsen to call 911 or go to hospital. She was advised to inform her family member who was not at home to let her situation be known so they can keep an eye on it.


VAERS ID: 1336117 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

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

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

Write-up: Patient developed significant and tender left axillary lymph node swelling and left upper chest swelling


VAERS ID: 1336131 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-07
Onset:2021-05-19
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prilosec 20 mg
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin, tetracycline, sulfa antibiotic, and aspirin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: A mild rash has appeared about 4.5 inches below injection site on my upper left arm. Strangely, the rash is rectangular in shape, about 4 inches long by 1 inch wide. The rash itched only once, is not painful, and is very warm to the touch. I have not treated the rash, as it has not been bothersome.


VAERS ID: 1336150 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: History of Guillain-Barre Syndrome after an influenza vaccine
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies: had GBS from influenza vaccine no other allergies
Diagnostic Lab Data: none
CDC Split Type:

Write-up: rash on extremities and trunk, occurred 1 day after vaccine, resolved with Benadryl, no other symptoms


VAERS ID: 1336153 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness transient, Deafness, Dizziness, Hyperhidrosis, Immediate post-injection reaction, Tinnitus
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Syncope, age 15, hep B
Other Medications:
Current Illness: None
Preexisting Conditions: Anxiety, ptsd
Allergies: allergic to penicillin. Vegan diet for 6 years.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dizzy, full body sweat, temporary loss of hearing and sight. Symptoms came on 1 minute after injection and lasted for 20 minutes. Lingering ringing and dizziness 24 hours after.


VAERS ID: 1336291 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Wisconsin  
Vaccinated:0000-00-00
Onset:2021-05-19
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210537319

Write-up: PARTIAL DOSE ADMINISTERED; This spontaneous report received from a pharmacist concerned a female of unspecified age. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: unknown) dose was not reported, administered on 19-MAY-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 19-MAY-2021, the subject experienced partial dose administered. The action taken with covid-19 vaccine was not applicable. The outcome of partial dose administered was not reported. This report was non-serious.


VAERS ID: 1336292 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Nevada  
Vaccinated:0000-00-00
Onset:2021-05-19
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816022 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood glucose abnormal, Blood glucose increased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Diabetic
Preexisting Conditions: Comments: The patient reported that he has 128-138 mg/dl as normal range for blood sugar.
Allergies:
Diagnostic Lab Data: Test Date: 20210519; Test Name: Blood sugar abnormal; Result Unstructured Data: 446
CDC Split Type: USJNJFOC20210537343

Write-up: ELEVATED BLOOD SUGAR LEVEL 446; This spontaneous report received from a patient concerned a 72 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included diabetic, and other pre-existing medical conditions included the patient reported that he has 128-138 mg/dL as normal range for blood sugar. The patient was previously treated with prednisone for drug used for unknown indication. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1816022, expiry: Unknown) dose was not reported, administered on 19-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 19-MAY-2021, 15 minutes after having lunch the patient experienced elevated blood sugar level 446 mg/dL. She reported that she had meatballs, butter noodles, and angel fruit cake with cabbage, also for beverage had ice-tea with no sugar. Laboratory data included: Blood sugar abnormal (NR: not provided) 446 mg/dL. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from elevated blood sugar level 446 mg/dL. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0: 20210537343-Covid-19 vaccine ad26.cov2.s - Elevated blood sugar level 446. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: MEDICAL HISTORY.


VAERS ID: 1336480 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-17
Onset:2021-05-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Chills, Pyrexia, Troponin increased
SMQs:, Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: elevated troponins - no other etiology found at this time
CDC Split Type:

Write-up: fever and chills followed by chest pain - elevated troponins


VAERS ID: 1336496 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-17
Onset:2021-05-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW1070 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Breast swelling, Chest pain, Costochondritis
SMQs:, Angioedema (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Severe chest pain. Swollen breast on opposite side of vaccine injection. Urgent care diagnosed with Costochondritis. Severe breast swelling still needs to be diagnosed.


VAERS ID: 1336554 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW 0173 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cough, Dysphonia, Nasal congestion, Paraesthesia oral, Pharyngeal disorder, Rhinorrhoea, Sensation of foreign body, Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Parkinson-like events (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 2016 - Flu vaccination prior to diagnosis of Mast Cell Activation Disorder - Vaccine information unknown. Reaction occurred 30 m
Other Medications: Pepcid, YAZ bcp, Allegra, Vit D3
Current Illness: None
Preexisting Conditions: Mast cell activation disorder diagnosed 2017
Allergies: Mast Cell Activation Disorder - Allergic reactions unpredictable to most products, foods, chemicals, scents, fragrances, physical exertion. Known allergies to Dairy(Casein), soy, gluten, shell fish, tomatoes, IV contrast, aspirin, NSAIDS
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Approximately 20 minutes after injection, I experienced tingling sensation of tongue with mild swelling, pharyngeal pruritis, increased mucus production causing coughing, nasal congestion, and constant throat clearing, globular sensation when swallowing, voice became hoarse. I reported to nurse monitoring patients post injection. Was asked regarding symptoms and told to take medications that I had brought with me. Medications were Pepcid 20 mg, Benadryl 50 mg, Prednisone 10 mg. I was monitored for another 90 minutes. Symptoms began to resolve approximately 30 minutes after taking medications. Full resolution of symptoms occurred approximately 8 hours after taking medications. Followed nurse''s instructions and immediately notified PCPs office upon returning home. PCP recommends to not receive 2nd Pfizer vaccine.


VAERS ID: 1336555 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Bone pain, Fatigue, Impaired work ability, Myalgia, Pyrexia, Sleep disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Osteonecrosis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: On 5/19/2021: Fever of unknown temp beginning at 8pm. Fever caused inability to sleep. Fever broke around 4am. Extreme fatigue and muscle aches that caused inability to work. Began at about noon and continued through midnight. On 5/20/2021: Severe bone/joint pain in the shoulders that caused inability to sleep beginning about 9pm. Pain unmitigated by 800mg ibuprofen and topical analgesic. Minimal relief from icing the area. Pain not in the muscle. Extreme tenderness when pushing on shoulder blades. Minimal tenderness to muscle around shoulder blade. Pain subsided around 4am. Soreness and minimal pain on morning of 5/21/2021.


VAERS ID: 1336601 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

Administered by: Public       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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: BP 105/70, P 70, OX 99%. 5 minutes after vaccine was given the patient c/o dizziness. Was assisted with EMT to observation room. Stable after a few minutes. Left home with mother. Client''s second set of vitals taken while standing stable. Denies additional issues. Refuses to go to hospital. Went home with mother. Assisted to exit by EMT.


VAERS ID: 1336613 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

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

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

Write-up: Severe muscle soreness fatigue started around 7:00. At around 8:30 or 9 I started to get a severe headache and fever. Symptoms lasted through the night. At 4:00am I had a 100.8 fever and by 8:30am my fever was down to 99. I took Advil at 4:00am and 9:00am. Headache was much less severe but lasted throughout the day. Muscle soreness and fatigue were also mostly gone by 8:30am.


VAERS ID: 1336621 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Back pain, Fatigue, Feeling abnormal
SMQs:, Retroperitoneal fibrosis (broad), Dementia (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D, zinc, magnesium, B6, fish oil, multi vitamin, Zyrtec, nexium
Current Illness: None
Preexisting Conditions: Acid reflux, seasonal allergies
Allergies: Sulfa, penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fatigue, back pain, joint pain, lack of mental acuity


VAERS ID: 1336646 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Influenza like illness, Pain
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: Flu symptoms, achiness, nausea, headache for about 24 hours. Went away with the rest and Tylenol


VAERS ID: 1336649 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Nuts, Peanuts, Seafood, Eggs, Coconut, and Strawberries.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills, Muscle Soreness, fever and Severe Headache from about 5:30 p.m. 05-19-2021 - 1:30 p.m. 05-20-2021. Less severe chills, fever, and severe headache from 1:30 p.m. 05-20-2021 - 6:30 a.m. 05-21-2021. Less severe headache continues after shower finished 6:30 a.m. 05-21-2021 until present 05-21-2021.


VAERS ID: 1336650 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Disorganised speech, Dyskinesia, Inappropriate affect, Nervousness
SMQs:, Neuroleptic malignant syndrome (broad), Dementia (broad), Dyskinesia (narrow), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

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

Write-up: Patient had no reaction or side effects for 15 minutes after the shot. After 15 minutes, patient started experiencing uncontrollable movement of her upper arm and shoulder. The uncontrollable movement was mainly in the upper arm. Patient did have some uncontrollable movement in her fingers. Patient also had uncontrollable laugh as well which was not so significant. Patient''s caregiver (mom) also indicated that she had trouble forming a sentence, but as per patient it was due to her being nervous. Patient stayed in the pharmacy for over an hour. Over the time, her symptoms had subside. The uncontrollable laughter was almost gone. Uncontrollable movement of her upper arm had also reduce significantly and patient was very calm after sometime. Patient was alert and able to understand and conscious. Patient was advised to see PCP or pediatrician for further evaluation.


VAERS ID: 1336672 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Headache, Pain
SMQs:, Arthritis (broad)

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

Write-up: Headache, extreme fatigue, body and joint aches.


VAERS ID: 1336674 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Hypotension-Medium, Systemic: Weakness-Medium, Additional Details: Patient started to get lightheaded while sitting in a chair during his post vaccine observation time. He was hypotensive and had lost the color in his face. His mother and I were able to get him over to a bench to lay down, where he also drank a bottle of water. After roughtly 45 minutes he felt strong enough again to walk around and leave.


VAERS ID: 1336713 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: No tests performed to date. Dr. office visit with anti-inflammatories prescribed and followup scheduled with orthopedics group 1-2 weeks later.
CDC Split Type:

Write-up: 12 hours after injection developed adhesive capsulitis in the shoulder of the same arm. Adhesive capsulities remains and is currently being treated. 14 hours after injection developed low grade fever which went away after a few hours.


VAERS ID: 1336715 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

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

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

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


VAERS ID: 1336727 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

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

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

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


VAERS ID: 1336738 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood test abnormal, Erythema, Pain, Platelet count decreased, Pyrexia
SMQs:, Anaphylactic reaction (broad), Haematopoietic thrombocytopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: plt count: 5/19/21 = 5, 5/20/21 = 13, 17, & 18
CDC Split Type:

Write-up: on 5/19, patient with no significant past medical history presented to ED for evaluation of abnormal labs onset. Patient states he had his second dose of Pfizer covid vaccine on 5/18 and felt achy with low subjective fever the night before. On the morning of 5/19, he noticed that he had red spots on his legs so went to Urgent Care where bloodwork was done. The results showed patient''s platelet levels at 2, so was sent to ED.


VAERS ID: 1336884 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

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

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

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


VAERS ID: 1336889 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

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

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

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


VAERS ID: 1336892 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

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

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

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


VAERS ID: 1336927 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 UN / IM

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

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

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


VAERS ID: 1336956 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Unknown  
Vaccinated:1969-01-26
Onset:2021-05-19
   Days after vaccination:19106
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

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

Write-up: STEMI happened shortly after Moderna vaccine


VAERS ID: 1336963 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-04-16
Onset:2021-05-19
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Abortion spontaneous, Exposure during pregnancy, Ultrasound pelvis abnormal, Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal Vitamin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 5/20/21 Pelvic USG 5/20/21 QHCG
CDC Split Type:

Write-up: Patient is a G2P1, received her second Pfizer vaccine on 4/16/21. She began having bleeding on 5/19/21 and had a completed AB confirmed on USG 5/20/21. She was 6 4/7 weeks at the time of her miscarriage.


VAERS ID: 1336998 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Chills, Fatigue, Mobility decreased, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin B-12
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Nausea, chills, fatigue, body aches with unusual and extreme upper back pain. Took Aleve. Too tired and hurting too much to move.


VAERS ID: 1337009 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), 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: Systemic: Fainting / Unresponsive-Mild


VAERS ID: 1337056 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-01
Onset:2021-05-19
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein increased, Computerised tomogram thorax abnormal, Dyspnoea, Hypotension, Immunoglobulin therapy, Interleukin level increased, Leukocytosis, Lung consolidation, Myalgia, Myocarditis, Oropharyngeal pain, Pneumonia, Pyrexia, Respiratory viral panel, SARS-CoV-2 antibody test negative, SARS-CoV-2 test negative, Sepsis, Serology abnormal, Serum ferritin increased, Shift to the left, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: n/a
Current Illness:
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is a 16yo girl admitted on 5/19 with sepsis secondary to myocarditis and pneumonia, s/p IVIG, after presenting with fever, myalgia, sore throat, hypotension, elevated troponin, elevated CRP, and leukocytosis with left shift. Sore throat has been present for about a week and fevers began on 5/17 with a Tmax of 103. On 5/18, she began developing shortness of breath and upon evaluation by the PCP on 5/19, she was admitted. During initial workup on 5/19 upon admission, hospitalist was high concerned as she developed hypotension of 91/48 on 5/20 at 08:35am. CT of chest on 5/20 showed patchy consolidation of the posterior lower lobes bilaterally. At that point, I was contacted and recommended broadening regimen to clindamycin , ceftriaxone, and azithromycin. Upon transfer to Hospital, further serologies were collected which showed leukocytosis with left shift, highly elevated CRP, elevated troponin, elevated IL-6, elevated ferritin, negative Covid abs test, negative RVP, and negative Covid PCR. IVIG (2grams/kg) started on 5/20 at 22:57. Cardio and ID on board and all regular myocarditis infectious workup has been collected. ID consulted for workup and management. Of note, patient received the Covid vaccine on 5/1/21


VAERS ID: 1337129 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol, Zyrtec, Azelastine eye drops, topical Hydrocortisone
Current Illness: None
Preexisting Conditions: Asthma, allergic rhinitis/conjunctivitis, eczema
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Vasovagal syncope with full passing out the following day after the vaccine


VAERS ID: 1337173 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-14
Onset:2021-05-19
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / N/A LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea
SMQs:, 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: n/a
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Received Johnson & Johnson vaccine for Covid 19. Have had diarrhea daily since Wednesday 19th, 5 days after I received the shot. I have a very strong stomach I have not had routine diarrhea ever. I feel this is definitely related to receiving the vaccine.


VAERS ID: 1337188 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

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

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

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


VAERS ID: 1337201 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0002C21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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, notified DOH.
CDC Split Type:

Write-up: Pt received Moderna x2, he is < 18 yo.


VAERS ID: 1337248 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-29
Onset:2021-05-19
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Dyspnoea exertional, Lung opacity, SARS-CoV-2 test negative
SMQs:, Interstitial lung disease (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Infective pneumonia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Glucosamine, Zocor, Viagra, Multivitamin, Zyrtec
Current Illness: COVID 2/2021
Preexisting Conditions: allergic rhinitis, prediabetes, hyperlipidemia
Allergies: Pollen
Diagnostic Lab Data: CTA 05/20/2021 with residual ground glass opacities in comparison to 2/2021 study. COVID PCR 5/20/2021 negative
CDC Split Type:

Write-up: COVID infection 2/2021. Resolution of symptoms. dyspnea on exertion since 1st COVID vaccination that started a few hours after the vaccination and has continued since that time.


VAERS ID: 1337337 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Electrolyte imbalance, Malaise, Nausea, Pain in extremity, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Day of 2nd dose, patient reports a sore arm. Day following second dose, patient reports dizziness, malaise, nausea, vomiting, general weakness. Reported to ED and was admitted to hospital for IV fluids to treat electrolyte imbalance secondary to vomiting. Patient spent one overnight in hospital and was discharged without further complication. Patient is now at home and called me to make the report.


VAERS ID: 1337405 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 UN / IM

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

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

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


VAERS ID: 1337406 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: mushroom capsules, berberine; pomagrante concnrete, tart cherry capsules, metoproyol, nevium
Current Illness:
Preexisting Conditions:
Allergies: bactrium, tetracycline, poison ivy
Diagnostic Lab Data:
CDC Split Type:

Write-up: fever headache


VAERS ID: 1337429 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: TRETINOIN CREAM, CLINDAMYCIN GEL, MAGNESIUM, MELATONIN, LATUDA, ZIPRASIDONE, LEVOTHYROXINE, BUSPIRONE, DIVALPROEX, DESMOPRESSIN , GUANFACINE
Current Illness:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is under 18 years old (Moderna not approved for this age); received first dose from this location; administered second dose per Moderna dosing schedule


VAERS ID: 1337474 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Exposure during pregnancy, Unevaluable event
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (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: Claritin and prenatal vitamins
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: I am currently 19 weeks pregnant. My due date is around 10/21. I had my second dose of the Covid 19 vaccine yesterday 5/19/21 at 10:05 am. I had it administered on the right arm and I left right after. I got a call from the pharmacist right when I left, stating that he didn?t believe I got the vaccine, either that it was empty to begin with or that it broke open. He said that he came to this conclusion because he didn?t feel any resistance when he gave me the shot. I went back in after ending the phone call and he administered another full dose of 0.3ML into the same right arm.


VAERS ID: 1337494 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWQ170 / 2 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Incorrect product formulation administered
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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Seasonal Allergies
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient received a COVID-19 vaccine at the COVID vaccination clinic. The vaccines were shipped to vaccine site, by 2 employees who were hosting the vaccination clinic. The vaccination were alarming in transport and both Pfizer and both told of the employees stated that the vaccines were no longer viable and should not be given to the patients. Due to a lack of and miscommunication, 5 patients received the vaccines.


VAERS ID: 1337501 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Chills, Headache, Hyperhidrosis, Impaired work ability, Loss of personal independence in daily activities, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Within 12 hours of getting the shot, I developed periods of chills and periods of fevers and profuse sweating. 15-16 hours after the shot I had headaches that prevented me from doing any activity. I missed one day of work for the headaches I?m particular. My body was sore but the worst feeling was the intensity of the headache. Two days after the shot, a mild headache remains.


VAERS ID: 1337562 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816022 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Blood cannabinoids, Blood electrolytes, Confusional state, Gait disturbance, Headache, Lip swelling, Metabolic function test, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: OTC Deep Sea Nasal Spray PRN
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: ASA Allergy
Diagnostic Lab Data: The did a CBD and Metabolic/Electrolyte Panel.
CDC Split Type:

Write-up: Patient initially reported symptoms of body aches to jail officer at 10:00 and requested ice pack. Jail nurse provided details of symptoms at 12:15 am 5/20/21 as the following report from officer "He (jail officer) said he had the following symptoms: severe body pain, muscles felt like they were burning, confusion, severe headache. Officers noted lip swelling, weakness, and confusion. They had to help him walk. According to ED notes he was given Benadryl, Ibuprofen and a bag of fluids. They (ED) did a CBD and Metabolic/Electrolyte Panel."


VAERS ID: 1337583 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-16
Onset:2021-05-19
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Catheterisation cardiac abnormal, Chest pain, Coronary artery disease, Echocardiogram normal, Myocarditis, Sleep disorder, Troponin increased
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none.
Current Illness:
Preexisting Conditions: none.
Allergies:
Diagnostic Lab Data: Left heart catheterization 05/20/2021 (due to troponin elevation and chest pain) with mild CAD, 30% in Ramus, otherwise normal. Transthoracic Echocardiogram 05/21/2021 with normal LVEF, normal diastolic function, no valvular abnormalities.
CDC Split Type:

Write-up: sudden onset of chest pain 05/19/2021 night into 05/20, unable to sleep. Troponin elevated on arrival to ER. He received his 2nd dose of Pfizer CoVID vaccination on Sunday 05/16/2021. Diagnosed with acute myocarditis, probable cause post-CoVID vaccination.


VAERS ID: 1337617 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Heart rate increased, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: a few days of being "seasonal allergies"
Preexisting Conditions: no
Allergies: Zithromax
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Child had hives on all 4 extremities, no flank or head. No additional body system complaints. VVS except for elevated pulse of 118. Pt was assessed in the presence of mother. They agreed to administer Benadryl 25mg po - brought to site by mother, given at 1710. Child remained for full 30 minutes, rash subsided but did not disappear. No additional complaints/concerns noted. Pulse decreased to 103 with no discomfort or distress. both reviewed indications for calling PCP and/or EMS. Mother noted that pt''s sister has anaphylaxis allergies and the family is well versed in management and has EpiPens. Pt''s MD was contacted following day and advised parents that she may receive the second dose of Pfizer. Her symptoms have completely resolved with no adverse effects.


VAERS ID: 1337627 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache, Hiccups, Pain in extremity
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Phenytoin 100mg?4
Current Illness: None
Preexisting Conditions: Epilepsy
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Immediate & 1st hour: dizziness & sore arm; all day off & on: hiccups & slight headache


VAERS ID: 1337662 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Epistaxis, Thrombosis
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (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: finasteride 1mg Flonase unknown antihistamine
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient developed a nose bleed lasting from 7:10pm to 7:40pm on the evening that he received his vaccine. He coughed up a silver dollar sized blood clot around 7:35pm. He was feeling fine the following day, but had another nose bleed that started at bedtime the night after his vaccine. Patient''s wife called on call doctor and was told to pinch his nose, which they''d been doing for 35 minutes and to go to ER if needed. Patient saw doctor, who told him to stop using Flonase for a few days.


VAERS ID: 1337704 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 1 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 2 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Decreased appetite, Feeling cold, Feeling hot, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Strattera 80 mg, Bupropion HCL 300 mg ER, Guanfacine 2 mg ER, Sertraline HCL 175 mg, Fexofenadine Hydrochloride 180 mg
Current Illness:
Preexisting Conditions: Anxiety, ADD, Depression
Allergies: environmental, dogs, cats
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme Nausea (48 hours), Loss of appetite (48 hours), Hot & Cold Chills.


VAERS ID: 1337718 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-28
Onset:2021-05-19
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: cephalexin
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient developed a blood clot


VAERS ID: 1337769 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Influenza like illness, Pain in extremity, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Flu like symptoms, fatigue, mild fever, arm soreness, headache. But mostly a large rash all over my torso front and back, arms and legs


VAERS ID: 1337840 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Hypoaesthesia, Mobility decreased, Muscle spasms, Muscular weakness, Radiculitis brachial
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Tendinopathies and ligament disorders (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Vaccinated roughly around 4pm on 5/19/21. a few hours later had painful cramp that made his arm draw in for about 30 minutes. that relaxed and since then he has had numbnes and weakness in the right hand. I believe brachial neuritis.


VAERS ID: 1337881 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Chills, Decreased appetite, Diarrhoea, Dizziness, Fatigue, Nausea, Pain, Retching
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (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: Abilify 10mg, Cymbalta 60mg, Loratadine 10mg, Flonase
Current Illness: none
Preexisting Conditions: none
Allergies: no
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Chills, Body Aches, Diarrhea, Nausea, Dry Heaving, Weakness, Dizziness, Fatigue, Loss of Appetite


VAERS ID: 1338156 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-18
Onset:2021-05-19
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / N/A LA / IM

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

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

Write-up: No adverse reactions noted-client was vaccinated and did not meet the age requirement for administration of Moderna vaccine at the time of administration. Client is following up with his primary care physician regarding receiving 2nd dose or starting another vaccine series that is appropriate for clients age.


VAERS ID: 1338355 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-16
Onset:2021-05-19
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Troponin 11.56, LVEF 31%, global hypokinesis
CDC Split Type:

Write-up: myocarditis


VAERS ID: 1338362 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Humalog, Flonase, Levothyroxine, Omega 3 fish oil supplement
Current Illness: None
Preexisting Conditions: Type 1 diabetes, hypothyroidism
Allergies: None. Seasonal allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Hives in the evenings that started around 24 hours later. No anaphylactic response


VAERS ID: 1339070 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre 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: Claritin D 24 hrs
Current Illness:
Preexisting Conditions:
Allergies: Amoxicillan
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I experienced numbness in my right hand. It switched between my hand and 2 middle fingers. Since I have had covid, my nose would run off and on. My head would hurt and I always had some type of congestion and high bpm. When I received the shot, my congestion and runny nose dried up. It felt as if the shot was pulling something through my veins and drying up the congestion instantly and clearing up my head congestion as well.


VAERS ID: 1339095 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-05-14
Onset:2021-05-19
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Dizziness, Dysmenorrhoea, Fatigue, Gastrointestinal disorder, Heavy menstrual bleeding, Insomnia, Vertigo
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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: Adderall, Zoloft
Current Illness: none
Preexisting Conditions: none
Allergies: ammoc8
Diagnostic Lab Data:
CDC Split Type:

Write-up: dizziness and vertigo on and off since 5/18; evening of 5/18 had intense digestive issues and diarrhea; period started suddenly at this time as well and extremely heavy with clots, very intense cramping, period will be like this for about 8 hours and then stop and start again about 8-12 hours later; fatigued but can''t sleep


VAERS ID: 1340234 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Michigan  
Vaccinated:0000-00-00
Onset:2021-05-19
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Back pain, Body temperature, Chills, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (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: Test Date: 20210519; Test Name: Body temperature; Result Unstructured Data: 103 F
CDC Split Type: USJNJFOC20210537614

Write-up: BACK ACHE; CHILLS; FEVER; 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 (suspension for injection, intramuscular, batch number: Unknown) dose was not reported, administered on 19-MAY-2021 for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On 19-MAY-2021, the subject experienced back ache. On 19-MAY-2021, the subject experienced chills. On 19-MAY-2021, the subject experienced fever. Laboratory data included: Body temperature (NR: not provided) 103 F. The action taken with covid-19 vaccine was not applicable. The patient had not recovered from fever, back ache, and chills. This report was non-serious.


VAERS ID: 1340239 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-05-19
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Dizziness, Feeling cold, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Cigarette smoker (1/2 a pack of cigarette a day)
Preexisting Conditions: Medical History/Concurrent Conditions: Total hysterectomy; Comments: The patient had no known allergies. The patient was not pregnant at the time of vaccination.
Allergies:
Diagnostic Lab Data: Test Date: 20210519; Test Name: Body temperature; Result Unstructured Data: 101.1 F; Test Date: 20210519; Test Name: Body temperature; Result Unstructured Data: 101.5 F; Test Date: 20210519; Test Name: Body temperature; Result Unstructured Data: 100.9 F
CDC Split Type: USJNJFOC20210538534

Write-up: LIGHT HEADED; FELT COLD; FEVER; This spontaneous report received from a patient concerned a 64 year old female. The patient''s height, and weight were not reported. The patient''s past medical history included full hysterectomy, and concurrent conditions included no alcohol use, and cigarette smoker, and other pre-existing medical conditions included the patient had no known allergies. the patient was not pregnant at the time of vaccination. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 206A21A, expiry: UNKNOWN) dose was not reported, administered on 19-MAY-2021 11:00 for prophylactic vaccination. No concomitant medications were reported. On 19-MAY-2021, the subject experienced light headed. On 19-MAY-2021, the subject experienced felt cold. On 19-MAY-2021, the subject experienced fever. Laboratory data included: Body temperature (NR: not provided) 101.1 F, 100.9 F, 101.5 F. The action taken with covid-19 vaccine was not applicable. The patient was recovering from fever, light headed, and felt cold. This report was non-serious.


VAERS ID: 1340258 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Washington  
Vaccinated:0000-00-00
Onset:2021-05-19
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Chills, Discomfort, Dizziness, Fatigue, Insomnia, Malaise, Nausea, Pain, Pain in extremity
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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: Fruit allergy
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210540036

Write-up: UNCOMFORTABLE; FATIGUE; TOTAL BODY ACHES; CAN''T SLEEP; DIZZY; UNWELL; CHILLS; LEFT ARM IS SORE AT INJECTION SITE; WEAK; FELT NAUSEOUS; This spontaneous report received from a patient concerned a 41 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included pineapple allergy. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 203A21A, and batch number: 203A21A expiry: UNKNOWN) dose was not reported, administered on 19-MAY-2021 for an unspecified indication. No concomitant medications were reported. On 19-MAY-2021, the subject experienced total body aches. On 19-MAY-2021, the subject experienced can''t sleep. On 19-MAY-2021, the subject experienced dizzy. On 19-MAY-2021, the subject experienced unwell. On 19-MAY-2021, the subject experienced chills. On 19-MAY-2021, the subject experienced left arm is sore at injection site. On 19-MAY-2021, the subject experienced weak. On 19-MAY-2021, the subject experienced nausea. On 20-MAY-2021, the subject experienced uncomfortable. On 20-MAY-2021, the subject experienced fatigue. Treatment medications (dates unspecified) included: paracetamol. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from unwell, dizzy, nausea, can''t sleep, chills, uncomfortable, left arm is sore at injection site, total body aches, weak, and fatigue. This report was non-serious.


VAERS ID: 1340686 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-05-14
Onset:2021-05-19
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Public       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Menstrual disorder
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: No
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Heavy period started 3 weeks ahead of anticipated.


VAERS ID: 1340823 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-21
Onset:2021-05-19
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Increased tendency to bruise, Platelet count decreased
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Platelet count 55 Thousand/uL reference rage 140-400
CDC Split Type:

Write-up: Low platelet count, 50, *way* below normal. Bruises easily. We will seek care from a blood specialist and a liver specialist.


VAERS ID: 1341017 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO172 / 2 LA / -

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein increased, Chest pain, Echocardiogram abnormal, Electrocardiogram ST segment elevation, Fibrin D dimer, Myocardial infarction, Myocarditis, Troponin
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Advair Claravis Prilosec
Current Illness: none
Preexisting Conditions: none
Allergies: amoxicillin
Diagnostic Lab Data: 5/22 troponin elevated to 8.0 then to 10. 5/22 EKG ST elevation, Echo cardiogram with prominent posterior coronary at the origin 5/22 D-dimer 0.55 elevated, CRP 7.4 elevated.
CDC Split Type:

Write-up: COVID-19, mRNA, LNP-S, PF (PFIZER-BIONTECH) 5/19/2021 (17 Y) , 4/28/2021 (17 Y) Severe chest pain, Requiring hospitalization for pain management and MI/Myocarditis therapy.


VAERS ID: 1341024 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-03-29
Onset:2021-05-19
   Days after vaccination:51
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute myocardial infarction, C-reactive protein normal, Catheterisation cardiac abnormal, Chest pain, Coronary ostial stenosis, Echocardiogram abnormal, Ejection fraction decreased, Electrocardiogram abnormal, Myocarditis, Sinus bradycardia, Troponin I increased
SMQs:, Cardiac failure (narrow), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Disorders of sinus node function (narrow), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (narrow), Other ischaemic heart disease (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None known
Preexisting Conditions: No chronic health conditions
Allergies: Sulfa
Diagnostic Lab Data: Troponin I 5/19/21: 5.61ng/mL (peaking at 15.68 on 5/20/21) CRP 5/20/21: 2.90mg/dL ECG 5/19/21: ST elevation II/III/aVF w/ sinus brady Echo 5/20/21: LVEF 55% w/ basal inferolateral wall motion abnormality Cardiac cath 5/19/21: 95% ostial stenosis
CDC Split Type:

Write-up: Patient with no known past medical history received his 2nd dose of Pfizer COVID-19 vaccine on 3/29/21 presented 5/19/21 with sudden chest pain presented to ED via EMS with acute inferior ST elevation MI. Cardiac cath reveled 95% ostial stenosis not consistent with ECG changes. Treated for myopericarditis with NSAIDs and steroids with resolution of chest pain.


VAERS ID: 1341092 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abortion spontaneous
SMQs:, Termination of pregnancy and risk of abortion (narrow)

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

Write-up: Miscarriage in first trimester of pregnancy day after receiving vaccine.


VAERS ID: 1341146 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: ACCORDING TO SIIS PATIENT GOT PFIZER COVID 19 VACCINATION AT SAMS CLUB ON MAY 5, 2021. PATIENT CAME TO OUR PHARMACY ON 05/19/2021 AND GOT A JANSSEN VACCINATION. PATIENT MARKED ON OUR FORM THAT HE HAD NOT HAD ANY OTHER COVID VACCINES PREVIOUSLY. WE CALLED THE SAMS CLUB AND THEY VERIFIED PATIENT DEMOGRAPHICS THAT HE GOT THE PFIZER VACCINE FROM THEM. CALLED PATIENT AND ASKED HIM AND HE STILL SAYS HE HAS NOT PREVIOUSLY GOTTEN ANY OTHER COVID VACCINATIONS AND DENIES GETTING A DOSE OF PZIFER ON 5/5/21. NO ADVERSE REACTIONS REPORTED.


VAERS ID: 1341189 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blindness, Cardioversion, Dizziness, Dyspnoea, Electrocardiogram abnormal, Palpitations, Supraventricular tachycardia
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Retinal disorders (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: leg swelled double it''s size due to MMR
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Allergy to tree nuts
Diagnostic Lab Data: 5/19/21- evaluation by paramedics, Fire and Rescue, ECG done showing heart rate of 220. Paramedics were able to convert his heart back to a normal rhythm once IV was initiated. 5/19/21- Evaluation in the Emergency Department. Patient was observed to make sure that he was stable and had no further SVT. 5/21/21- Evaluation by Cardiologist, ECG done again as well as an Echocardiogram. Diagnosis of SVT event made.
CDC Split Type:

Write-up: Patient developed SVT (supraventricular tachycardia) approximately 29 hours after receiving the COVID vaccine. Patient has no prior history of SVT or any other cardiac related events. Patient was engaged in a basketball game when the SVT occurred. Patient has been involved in multiple competitive sports since the age of four without any prior incident related to exercise. He felt like he could not breathe, his heart was racing, he became dizzy, began to lose his vision and I took him to the local fire station for evaluation.


VAERS ID: 1341409 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Pain in extremity
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), 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 reported
Current Illness: None reported
Preexisting Conditions: None reported
Allergies: None reported
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient''s parent reported that patient started developing a bruise after her 2nd shot of the pfizer vaccine. Her arm was hurting more from the 2nd dose. After checking in with the parent 2 days after the vaccine, parent reported arm improving. Patient''s parent denies use of NSAIDs prior to vaccination.


VAERS ID: 1341491 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-03
Onset:2021-05-19
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Pancreatitis
SMQs:, Acute pancreatitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pancreatitis


VAERS ID: 1341586 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Dizziness, Feeling hot, Flushing, Headache, Hyperhidrosis, Nausea, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), 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? 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: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Severe, Systemic: Headache-Severe, Systemic: Nausea-Medium, Additional Details: after getting vaccine, pt felt dizzy/lightheaded. pt has had hx of fainting after getting vaccines due to anxiety. pt was very sweaty/hot. laid pt on the ground and instructed her to put legs up on the chair. provided water stated that was helping. nurse, lpn came and checked pts vitals. while we called 911. ambulance came and took her away. mom came back and said daughter was feeling better and did not go to ER


VAERS ID: 1341684 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-05-10
Onset:2021-05-19
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Dizziness, Erythema, Eye irritation, Lip swelling, Pruritus, Rash, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Corneal disorders (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: L-theanine
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: The did blood work at the ER, but they felt like there was no concern that these were side effects from the vaccine. I beg to differ!
CDC Split Type:

Write-up: At day 9 after receiving the vaccination I started to have extremely itchy skin around mi mid area( thighs). At day 10, I was very dizzy/faint in the am. My eyes felt weird and The skin rash /itch was now at my thighs, hands and feet. In the pm my lips started to swell up and I noticed tiny red spots all around my stomach and back( lower and upper back). At that point i went to the ER.


VAERS ID: 1341696 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Deep vein thrombosis, Peripheral swelling, Peripheral vein occlusion, Ultrasound Doppler abnormal
SMQs:, Cardiac failure (broad), Angioedema (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: US Left LE = There is extensive occlusive deep vein thrombosis throughout the left superficial femoral vein, deep femoral vein, popliteal and calf veins, which are noncompressible. No thrombus is identified within the left common femoral vein.
CDC Split Type:

Write-up: 70yo Male. with no significant PMHX. Presents with LLE swelling. States swelling started 1 day after his first moderna covid vaccination. He was found to have extensive DVT LLE. He denies recent travel or prolonged immobilization, he denies injury to the leg, he denies previous blood clots/blood disorder/cancer. This is sooner than I would expect patient to begin having symptoms after DVT after covid vaccination however I have no other clear etiology at this time.


VAERS ID: 1341730 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: C-reactive protein normal, Cardiac imaging procedure abnormal, Chest pain, Myocarditis, Red blood cell sedimentation rate normal, Rheumatological examination, Viral 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)

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: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Cardiac MRI 5/22 shows small area of acute myocarditis ESR and CRP normal viral and rheumatologic labs pending
CDC Split Type:

Write-up: Chest pain episodes 1-3 days after vaccine, Cardiac MRI shows small area of acute myocarditis


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