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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 131 out of 3,524

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VAERS ID: 1341893 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Texas  
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 EW0170 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Headache, Injection site pain, Lethargy, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: The patient is a healthy 12 year old female with no medical history or problems, she received the COVID Pfizer vaccine #1 on Wednesday, May 19th at 4pm and was asymptomatic at that time. Within about 5 hours, she began to experience extreme lethargy. By the following day, May 20th, she experienced profound lethargy that lasted 36hrs. During this time, she was asleep but arousable with effort, she described general myalgias, moderate left arm pain at injection site, mild headache, no other symptoms. Her profound lethargy lasted through midday on May 21st, upon which time she was able to keep her eyes open and began to regain her strength. By the evening of May 21st, she was fully recovered.


VAERS ID: 1342040 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-16
Onset:2021-05-19
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye disorder, Head discomfort, Headache
SMQs:, Corneal disorders (broad), Retinal disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None. Healthy 12 year old girl.
Preexisting Conditions: None. Healthy 12 year old girl.
Allergies: No known allergies to medication, food, or other products
Diagnostic Lab Data: Today is Sunday. My husband and I will call on 5/24/2021 Monday for our daughter to see a provider.
CDC Split Type:

Write-up: My 12 year old daughter has reported having twitching of the head and right eye. She reports it started last week and continues to this day. The twitching of the head happens as often as every hour or more. The twitching of the right eye is rare. Depending on how fast the twitch happens with her head pain is associated with it.


VAERS ID: 1342106 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Maryland  
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 EW0167 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acoustic stimulation tests abnormal, Deafness unilateral
SMQs:, Hearing impairment (narrow)

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:
Current Illness: None
Preexisting Conditions: None known
Allergies: Mold, Cat Dander, Pollen
Diagnostic Lab Data: 5/20/2021 ENT Care - Hearing test 5/21/2021 ENT Care - Hearing test
CDC Split Type:

Write-up: Sudden hearing loss in Left Ear -15 db to -55 db depending on frequency. Most loss in 500Hz to 1000Hz range. Visited 2 ENT Dr for audiology tests. Recommendation/prescription 60mg daily Prednisone tablets for 7 days, 40mg daily for next 3 days, 20mg for 3 days followed by 10mg for 3 days.


VAERS ID: 1342165 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-15
Onset:2021-05-19
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute myocardial infarction, Myocarditis
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), 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? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Hospital stay from 5/19 - 5/22
CDC Split Type:

Write-up: NSTEMI and myocarditis


VAERS ID: 1342213 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Maryland  
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 (MODERNA)) / MODERNA 024C21A / 2 RA / IM

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

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

Write-up: Had to go the hospital the day after I received my second dose. There was tightness in my chest and I had trouble breathing.


VAERS ID: 1342262 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Michigan  
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 ER2613 / 1 LA / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Heart rate increased, Injection site pain, Malaise, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: I did not go to the doctor.
CDC Split Type:

Write-up: Fatigue, pain around injection side on the day after vaccine during the day. Nothing concerning but right before he went to bed he didn''t feel good. My son thought he had to vomit but couldn''t. He said his HEARTBEAT WAS SO MUCH FASTER than normal. I got so concerned that I slept next to him which I never did before. He fell asleep after 1 h and woke up the next morning and felt fine. I did not go to the doctor because he was feeling well the next day.


VAERS ID: 1342346 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Indiana  
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 006C21A / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Diarrhoea, Dizziness, Fatigue, Gait inability, Pallor, Pyrexia, Skin discolouration, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? Yes
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flonase Allegra
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No we keep him home and pushed fluids
CDC Split Type:

Write-up: The reaction started on Wednesday morning May 19 around 7:00a.m. Vomiting, diarreaha Fainted 3 times vomited again fever 103.2. Slept until the next morning couldn?t keep anything down fainted again. Gave Gatorade Propell and water. Very fatigued couldn?t walk at all. Very dizzy no color on his face very pale lol


VAERS ID: 1342422 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-05-17
Onset:2021-05-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Injection site pain, Injection site pruritus, Injection site swelling, Mobility decreased, Skin warm
SMQs:, Anaphylactic reaction (broad), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Diabetes type 1
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The injection spot became swollen, red, itchy and heated. The pain was preventing normal arm movements. The symptoms started to fade on the 6th day after the vaccination.


VAERS ID: 1342433 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Bell's palsy, Headache, Hypoaesthesia oral, Nausea
SMQs:, Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (broad)

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

Write-up: Day after vaccine I had extreme nausea and head ache. Following day my lips went numb. Woke up the next day to Bell?s palsy (ER diagnosed) steroids seem to be helping. Currently still taking them.


VAERS ID: 1342932 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-04-06
Onset:2021-05-19
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / N/A RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Catheterisation cardiac normal, Chest X-ray abnormal, Computerised tomogram thorax normal, Myocardial necrosis marker increased, Pericarditis, Scan with contrast normal, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zyrtec, multi vitamin, B12
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: elevated enzymes, tachycardia chest xray, ct with contrast and Cath all clear
CDC Split Type:

Write-up: experienced acute pericarditis


VAERS ID: 1342985 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Atrial fibrillation, Blood magnesium, Blood phosphorus, Blood thyroid stimulating hormone, Chest pain, Differential white blood cell count, EGFR status assay, Free thyroxine index, Full blood count, Heart rate increased, Metabolic function test
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Glucosamine, Fish oil
Current Illness: N/a
Preexisting Conditions: No
Allergies: Penicillin
Diagnostic Lab Data: Lab tests: Basic metabolic panel, CBC with auto differential, magnesium, phosphorous, TSH reflex to free T4, eGFR
CDC Split Type:

Write-up: Patient received vaccine at 7:45 pm on 5/19/2021. Chest pain and rapid heart rate occurred approximately 2 hours post vaccine shot. Patient went to ER. Diagnosis was atrial fibrillation with RVR (CMS/HCC). Medication given: Metroprolol 5mg/5ml injection - ADS override pull (10:41pm), sodium chloride 0.9% bonus 1000mL stopped at 5/20 12:36am. Patient spontaneously came out of atrial fibrillation and was released


VAERS ID: 1342996 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-01-11
Onset:2021-05-19
   Days after vaccination:128
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lasix, glucotrol, prinivil, flomax, pravachol, glucophage
Current Illness:
Preexisting Conditions: DM, morbid obesity
Allergies: Bactrim
Diagnostic Lab Data: SARS-COV-2 by NAA positive for COVID-19
CDC Split Type:

Write-up: Pt developed COVID pneumonia requiring intubation after being fully vaccinated in January, 2021.


VAERS ID: 1343007 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 RA / IM

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

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

Write-up: 2nd dose was inadvertently administered on day 23. Patient was scheduled for her second shot on 5/24/21, but came during our clinic on 5/19/21. The pharmacist did not realize until after the dose was administered that she was 5 days early.


VAERS ID: 1343010 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, 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: Fish oil & melatonin
Current Illness: Not to my knowledge
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: About 11 hours following injection experienced body aches, chills, and overall run down feeling. I took 400mg of Ibuprofen every 4 hours starting 4 hours after symptoms on set and was fine 6 hours after first dose.


VAERS ID: 1343089 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Tinnitus, Vertigo
SMQs:, Hearing impairment (narrow), Vestibular disorders (narrow)

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

Write-up: Ringing in the ears and vertigo. I had been experiencing tinnitus since my first vaccine and it increased following the second vaccine. It has not gone away after nearly a week following the second shot. I have been experiencing vertigo since my second shot.


VAERS ID: 1343092 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 RA / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Mild intermittent asthma
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna vaccine administered to individual under age 18. No adverse signs/symptoms to report. Patient will be over 18 years of age for 2nd dose.


VAERS ID: 1343115 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 1 - / IM

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

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

Write-up: 12:30 vaccine administered. 12:35 pt. c/o redness on face and forearms. Benadryl 25mg PO was administered. Pt monitored for thirty minutes. No further c/o redness. Emergency treatment explained if c/o further, or new symptoms, verbalized understanding.


VAERS ID: 1343130 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 AR / IM

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

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

Write-up: Patient received first dose Moderna 4/17/21, second dose Pfizer 5/19/2021. Troubleshooting: Scribe and vaccinator did not look at card to see what was given prior; he did not present card until after vaccine; first vaccine at different location so no clear record. Counseled by staff that he had received two doses of mRNA vaccine and there was no need for a third dose. Possible language barrier, but pt checked Moderna in the computer.


VAERS ID: 1343135 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 AR / SYR

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

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

Write-up: Patient received first dose Moderna 4/17/21, second dose Pfizer 5/19/2021. Troubleshooting: Scribe and vaccinator did not look at card to see what was given prior; she did not present card until after vaccine; first vaccine at another location so no clear record. Counseled by staff that she had received two doses of mRNA vaccine and there was no need for a third dose. Possible language barrier, but pt checked Moderna in the computer.


VAERS ID: 1343137 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 AR / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, Interchange of vaccine products
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: Patient received first dose Moderna 4/02/21, second dose Pfizer 5/19/2021. Troubleshooting: Scribe and vaccinator did not look at card to see what was given prior; she did not present her card until after vaccine although per safety officer "she was actively looking for it." She was approx 20 days late in returning for her appointment and apparently could not tell the vaccinator what vaccine she received. Counseled by staff that she had received two doses of mRNA vaccine and there was no need for a third dose. Per staff, no language barrier; she does not appear to have a record of first dose in the computer.


VAERS ID: 1343138 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Body temperature fluctuation, Chills, Dizziness, Fatigue, Headache, Hyperhidrosis, Injection site rash, Pain, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pantoprazol 40 MG Escitalopram 10 MG Vitamin D MultiVitamin Probiotic WalZyr
Current Illness: None
Preexisting Conditions: Sleep Apnea
Allergies: Penecillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 5/19 PM, soreness. 5/20 AM Woke up full body soreness, headache, chills, blurred vision, exhausted, light headed, 4 inch diameter circle around the vaccine site. 5/20 PM Did not want to move, full body soreness, horrible headache, chills, blurred vision, exhausted, light headed, 4 inch diameter circle around the vaccine site. 5/21 AM Tired, temperature fluctuations, headache, extreme sweating, 4 inch diameter circle around the vaccine site. 5/21 PM Started feeling better, mild headache, 4 inch diameter circle around the vaccine site. 5/22 All Day felt pretty good, 4 inch diameter circle around the vaccine site. 5/23 All Day full energy, 4 inch diameter circle around the vaccine site. 5/24, 4 inch diameter circle around the vaccine site.


VAERS ID: 1343141 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: hypertension, hx of unknown cardiac and neuro issues.
Allergies: Latex, Benadryl
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient mild, transitory speech slurring post-Pfizer #2, per EMS. She indicated no known allergies. Per EMS hx of HTGN, "unknown cardiac" and "unknown neuro" conditions. BP 137/77; HR 78, RR 18, PSO2 98% per EMS report. Four lead EKG uneventful. She declined EMS transport. She was counseled by staff to discuss the reaction with her doct..


VAERS ID: 1343163 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-05-11
Onset:2021-05-19
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019B21A / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anticoagulant therapy, Chest pain, Dyspnoea, Pulmonary embolism
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Patient presented with 3-4 days of increasing shortness of breath/chest pain. Was found to have a pulmonary embolism. started on Heparin drip, transitioned to apixaban after 24 hrs and DCed home


VAERS ID: 1343183 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: The patient requested to be vaccinated while inpatient (swing bed) at hospital. He stated at the time he had not been vaccinated, but upon reporting the vaccine given to a facility that would be accepting the patient as a transfer/ admit they informed hospital staff he was previously vaccinated 4 month earlier. Patient has no side effects or other adverse symptoms, this is being reported as a vaccine error.


VAERS ID: 1343246 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Echocardiogram abnormal, Ventricular dysfunction
SMQs:, Cardiac failure (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: charcot Marie Tooth (foot), myelomeningocyele, neurogenic bowel, spina bifida
Allergies: None
Diagnostic Lab Data: troponin 0.85,
CDC Split Type:

Write-up: chest pain, ECG ST changes, depressed biventricular functions on cardiac echo


VAERS ID: 1343265 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure normal, Cardiac discomfort, Electrocardiogram normal, Hyperhidrosis, Hypoacusis, Palpitations, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: 911 was called to which they did an EKG, blood pressure test and everything came back fine. Waiting to go see a cardiologist.
CDC Split Type:

Write-up: The first 10 minutes everything was fine then started sweating uncontrollably, vision went very white and hearing felt like I was in a tunnel. Felt some pressure in my heart and my heart still feels different, best way to describe it is I feel my heart beating which is something I never had before.


VAERS ID: 1343286 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044B21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023221A / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Rash, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I was taking antibiotics but stopped 2 days before the vaccine
Current Illness: Ureaplasma
Preexisting Conditions:
Allergies: Iodine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vomit 12 hours after the second shot and a rash start after 36 hrs after the second shot, rash still present and increased, coughing also


VAERS ID: 1343305 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Decreased appetite, Headache, Hyperhidrosis, Pain, Pyrexia, Weight decreased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient stated she took 75mg of CBD
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient stated that she had full body aches, serious headache, chills/fever, sweating, no appetite (dropped 4.2 pounds). Side effects started the evening of the shot 5/18/21 and pt states she has gotten better as of 5/20/21. Pt stated she is not 100% but feeling better.


VAERS ID: 1343356 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-23
Onset:2021-05-19
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

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

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

Write-up: Shingles - rash and severe hip pain on set approx 3.5 weeks after vaccine


VAERS ID: 1343379 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-03
Onset:2021-05-19
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 2 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Intermenstrual bleeding, Menstrual discomfort, Muscle spasms
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Dystonia (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: Daily multivitamin, vitamin D, vitamin C, Fish Oil
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Iodine, Shrimp
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pre-menstrual breakthrough bleeding, excessive cramping and discomfort during menstruation. No change in timing of menstruation.


VAERS ID: 1343388 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Chills, Dizziness, Lethargy, Muscle spasms, Nausea, Pain, Pain in extremity, Paraesthesia, Pyrexia, Sensitive skin, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Famotadine, vitamin e, magnesium, Lamotrigine
Current Illness:
Preexisting Conditions: Chronic idiopathic urticaria
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 5-19-21 11am extreme pain in shoulder of left arm. The pain got worse throughout the day. 5pm pain started to move up the left side of my neck and down the left side of my back to where I couldn?t turn. 5-20-21 4am pins and needles, aching, chills, muscle cramps throughout entire body Extreme nausea 12:00pm really bad chills again, Pain throughout entire body hurting, skin down lower back, butt and the back of thighs were very sensitive to touch, fever of 102, lethargic, dizziness. Fever lasted all day 2pm same symptoms as 12pm, as well as vomiting


VAERS ID: 1343414 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW1075 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyprexa 5mg Celexa 40 mg Verapmil 120mg
Current Illness:
Preexisting Conditions:
Allergies: Apriprizole
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received vaccine early. The first dose of the was received 5/7/2021 and was not due for the second dose of vaccine until 5/28/2021. Received second dose of vaccine 5/19/2021


VAERS ID: 1343439 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flomax 0.4mg dibucaine 0.4% Mirtazapine 30mg Olanazapine 5mg
Current Illness:
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was to receive second dose on 5/28/21 and received second dose on 5/19/21


VAERS ID: 1343452 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Peripheral swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), 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: Xanax,prozac,remeron
Current Illness: None
Preexisting Conditions: CLL in remission
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Large area of inflammation on the arm. It has not improved.


VAERS ID: 1343503 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-11
Onset:2021-05-19
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Computerised tomogram abnormal, Deep vein thrombosis, Pain, Pulmonary embolism, Ultrasound Doppler abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: I have been prescribed Xarelto my doctor. Treatment is expected to last 3 to 6 months.
CDC Split Type:

Write-up: I have blood clots in my left leg and some that have spread to my lungs. Pain started on May 19th shortly after waking up. At this time I can put no weight on my left leg. I went to an urgent care on May 23rd. I received an ultrasound and CT Scan.


VAERS ID: 1343577 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-10
Onset:2021-05-19
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Injection site pain, Injection site rash, Injection site swelling, Pain in extremity, Pyrexia, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: two days fever on 5/11 & 5/12 after had the 1st dose on 5/10. The arm pain last for about 2 days. Later, Covid arm happened on 5/19, with rash, swollen & pain around the injection area. The lower arm & hand which had the injection felt soar & numb starting from 5/23 & getting better today, on 5/24. As of today, still can see the redness from the rash although it has been getting much better.


VAERS ID: 1343599 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-19
Onset:2021-05-19
   Days after vaccination:120
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID19 PCR NP swab - Health Clinic 5/22/21
CDC Split Type:

Write-up: Patient received 2nd dose of Pfizer COVID19 vaccine on 1/19/21. Patient reported new onset of COVID like symptoms starting 5/19/21 and tested COVID19 positive on 5/22/21 via PCR NP swab.


VAERS ID: 1343609 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Fatigue, Headache, Myalgia, Pain, Pyrexia, Sneezing, Ventricular extrasystoles
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ventricular tachyarrhythmias (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (broad)

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

Write-up: Fever, fatigue, myalgia (for 24 hours) Frequent premature ventricular contractions (3-4 per minute) (peaked after 12-16 hours then subsided. Some residual still present but not as frequent) Headache (peaked around 12-16 hours) (still present with sneezing coughing or during chaining in head position (standing up or laying down)


VAERS ID: 1343612 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vyvanse 30 mg daily Trintellix 20 mg daily Valtrex 500 mg daily
Current Illness: sinus infection- treated with Zpack and sinus cocktail shot
Preexisting Conditions: none
Allergies: Sulfa drugs
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Headache started about 5-6 hours after injection, intensity increased throughout the next 14-16 hours. Generalized achy muscles lasted for 24 hours. 3 days after injection, skin peeling noted around finger nails and under nailbed.


VAERS ID: 1343701 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chest discomfort, Chills, Feeling cold, Feeling hot, Flushing, Heart rate increased, Hyperhidrosis, Hypoaesthesia, Nervousness, Paraesthesia, Tachycardia, Tremor
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Systemic: Chills-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Numbness (specify: facial area, extremities)-Medium, Systemic: Shakiness-Medium, Systemic: Tachycardia-Medium, Systemic: Tingling (specify: facial area, extemities)-Medium, Systemic: Weakness-Medium, Additional Details: patient was feeling cold, hot, shaky, weak, a heavy chest feeling, numbness in extremities a few minutes after her vaccine. Her pulse went from 80, 99, to 110 after 3 readings. Her BP was normal. Her brother said she just had a unspecified chest procedure. It wans''t noted on her intake. She wasn''t feeling after lying down for 30 minutes with legs propped up and wanted to paramedics to come. They sent her home after another 30 min. She doing well before she left.She went to school day after.


VAERS ID: 1343780 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction, Flushing, Hyperhidrosis, Injection site pain, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Site: Pain at Injection Site-Mild, Systemic: Allergic: Anaphylaxis-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Severe


VAERS ID: 1343793 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac disorder, Dizziness, Fatigue, Flushing, Hyperhidrosis, Hypoacusis, Injection site pain, Lethargy, Visual impairment
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Site: Pain at Injection Site-Medium, Systemic: Cardiac Disorder (diagnosed by MD)-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: Exhaustion / Lethargy-Mild, Systemic: Hearing and vision difficulty-Mild, Systemic: Flushed / Sweating-Mild, Additional Details: Vitals were normal after 30 minutes


VAERS ID: 1343808 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: levothyroxine 25mg
Current Illness: seasonal allergies
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen lymph node near left clavicle, tender and painful to the touch. Lessening but still present at 1 week post vaccine.


VAERS ID: 1343829 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-05-17
Onset:2021-05-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Back pain, Chest pain, Endocarditis, Pain, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Arthritis (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: Progesterone, Estrodiol .05, Adderall 20mg
Current Illness: N/A
Preexisting Conditions: Bulging discs in neck
Allergies: N/A
Diagnostic Lab Data: On 5/20 doctor explained that I had inflamed heart lining and fluid retention around heart. The kept me under observation for 2 days
CDC Split Type:

Write-up: Pericarditis, after experiencing achy joints Excruciating stabbing pain in back through to chest


VAERS ID: 1343882 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / UNK RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Meloxicam, gabapentin, singulair, potassium citrate, zyrtec, daily vitamin, areds2, biotin (skin, hair and nails)
Current Illness:
Preexisting Conditions: Asthma, allergies, scoliosis and legg calve perthis
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash on cheeks


VAERS ID: 1343975 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Angioedema, Lip swelling, Paraesthesia, Peripheral swelling, Swelling face
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Oropharyngeal allergic conditions (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: angioedema (upper lip swelling, periorbital swelling, hand swelling and tingling) the next day


VAERS ID: 1344025 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Chills, Confusional state, Cough, Fatigue, Injection site pain, Injection site reaction, Myalgia, Pyrexia, Retching
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Propranolol Hydroxychoroquine Wellbutrin Zyrtec Pepcid Topi ram ate Cyclobenzprine
Current Illness:
Preexisting Conditions: Solar urticaria Ethers danios syndrome Chiari malformation POTS ADHS aspergers
Allergies: Opiates Sulfa Cipro Cyldamyacin Visible light ( solar urticaria)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna. Injection 2. Fever. Cough. Gagging. Muscle aches. Chills. Confusion. Fatigue. Weakness. Soreness at injection site. Symptoms still persisting 6 days later.


VAERS ID: 1344047 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Electroencephalogram abnormal, Generalised tonic-clonic seizure, Magnetic resonance imaging head normal, Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Multiple sclerosis
Allergies:
Diagnostic Lab Data: MR brain without any new/acute findings to explain seizure. EEG initially with frequent seizure activity, improved s/p levetiracetam and lacosamide.
CDC Split Type:

Write-up: Patient developed generalized tonic clonic seizure several hours after Pfizer vaccine.


VAERS ID: 1344125 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / IM

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

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

Write-up: not enough diluent was withdrawn to reconstitute the pfizer vaccine and as a result the patient received higher concentration of the vaccine than the normal dose


VAERS ID: 1344141 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Axillary mass
SMQs:

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

Write-up: large mass 2in x 2in in L axillae on the side his injection was given. no pain or redness, just fullness


VAERS ID: 1344161 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Alanine aminotransferase increased, Amphetamines negative, Amylase normal, Analgesic drug level, Analgesic drug level therapeutic, Anion gap, Antidepressant drug level, Aspartate aminotransferase normal, Bacterial test, Barbiturates negative, Basophil count decreased, Basophil percentage, Bilirubin urine, Blood albumin normal, Blood alcohol normal, Blood alkaline phosphatase normal, Blood bicarbonate normal, Blood bilirubin decreased, Blood calcium normal, Blood chloride normal, Blood creatine phosphokinase normal, Blood creatinine normal, Blood glucose normal, Blood lactic acid decreased, Blood magnesium normal, Blood osmolarity decreased, Blood pH normal, Blood potassium normal, Blood sodium normal, Blood thyroid stimulating hormone decreased, Blood urea decreased, Blood urine, Chromaturia, Computerised tomogram head normal, Conversion disorder, Crystal urine absent, Drug screen, Emotional distress, Eosinophil count normal, Eosinophil percentage, Fear of injection, Fungal test negative, Glucose urine, Haematocrit normal, Haemoglobin normal, Human chorionic gonadotropin negative, Immature granulocyte count, Laboratory test, Lipase normal, Lymphocyte count normal, Lymphocyte percentage, Mean cell haemoglobin concentration normal, Mean cell haemoglobin increased, Mean cell volume abnormal, Mean platelet volume normal, Monocyte count normal, Monocyte percentage, Neutrophil count normal, Neutrophil percentage, Nitrite urine, Platelet count normal, Protein total normal, Protein urine absent, Psychogenic movement disorder, Red blood cell count normal, Red blood cells urine negative, Red cell distribution width normal, Specific gravity body fluid normal, Speech disorder, Stress, Tachycardia, Tremor, Urinary sediment present, Urine abnormality, Urine ketone body, Urine leukocyte esterase, Urobilinogen urine, White blood cell count normal, White blood cells urine negative, pH urine
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Haematopoietic leukopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Drug abuse and dependence (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hyponatraemia/SIADH (broad), Hypothyroidism (broad), Hyperthyroidism (broad), Depression (excl suicide and self injury) (broad), Proteinuria (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Chronic Anxiety History of "fainting" with ALL needles per family
Allergies: NKDA
Diagnostic Lab Data: Procedure: CT BRAIN W/O Date of Exam: 5/19/2021 PROCEDURE: CT brain without contrast CLINICAL HISTORY: agitation COMPARISON: None. TECHNIQUE: Routine head CT was performed using helical computed tomography without intravenous contrast. Dose modulation was employed for ALARA by means of automated exposure control. FINDINGS: No acute intracranial ischemia or hemorrhage. No midline shift. The parenchymal volume is normal. The gray-white matter differentiation is maintained. The ventricles are normal in size. Exam Date: 05/19/2021 15:06 Exam: CT BRAIN W/O Reason for Exam: agitation Radiology Report - Final Printed on : 05/24/2021 10:44 No calvarial fractures or sinus disease. IMPRESSION: No acute intracranial abnormality. Normal noncontrast CT of the brain. Lab Results: Last Week Test Results Units Reference Range Ordered Collected Status Specific Gravity Normal N 05/19/2021 14:20 Final pH Normal N 05/19/2021 14:20 Final Oxidant Normal N 05/19/2021 14:20 Final5/24/2021 3/9 Lab Results: Last Week Test Results Units Reference Range Ordered Collected Status Creatinine Normal N 05/19/2021 14:20 Final Nitrite Normal N 05/19/2021 14:20 Final Glutaraldehyde Normal N 05/19/2021 14:20 Final Temperature Not Tested - Not rec''d within 3 minutes AB 05/19/2021 14:20 Final Amphetamine Negative N 05/19/2021 14:20 Final Barbiturates Negative N 05/19/2021 14:20 Final Buprenorphine Negative N 05/19/2021 14:20 Final Benzodiazepines Negative N 05/19/2021 14:20 Final Cocaine Negative N 05/19/2021 14:20 Final Methadone Metabolite Negative N 05/19/2021 14:20 Final Methamphetamine Negative N 05/19/2021 14:20 Final Ecstasy Negative N 05/19/2021 14:20 Final Methadone Negative N 05/19/2021 14:20 Final Morphine Negative N 05/19/2021 14:20 Final Phencyclidine Negative N 05/19/2021 14:20 Final Oxycodone Negative N 05/19/2021 14:20 Final Tricyclic Antidepressants Negative N 05/19/2021 14:20 Final Marijuana Negative N 05/19/2021 14:20 Final URINE COLOR Light yellow None Y(None) ellow 05/19/2021 12:33 05/19/2021 13:51 Final5/24/2021 4/9 Lab Results: Last Week Test Results Units Reference Range Ordered Collected Status APPEARANCE OF URINE Clear N 05/19/2021 12:33 05/19/2021 13:51 Final GLUCOSE, URINE Negative N mg/dL Negative (mg/dL) 05/19/2021 12:33 05/19/2021 13:51 Final BILIRUBIN, URINE Negative N mg/dL Negative (mg/dL) 05/19/2021 12:33 05/19/2021 13:51 Final KETONE, URINE Negative N mg/dL Negative, <=5 (mg/dL) 05/19/2021 12:33 05/19/2021 13:51 Final SPECIFIC GRAVITY, URINE 1.015 N 05/19/2021 12:33 05/19/2021 13:51 Final BLOOD, URINE Negative N 05/19/2021 12:33 05/19/2021 13:51 Final PH, URINE 6.5 N 05/19/2021 12:33 05/19/2021 13:51 Final PROTEIN, URINE Negative N mg/dL Negative (mg/dL) 05/19/2021 12:33 05/19/2021 13:51 Final UROBILINOGEN, URINE 0.2 N E.U./dL (E.U./dL) 0.2,1 05/19/2021 12:33 05/19/2021 13:51 Final NITRITE, URINE Negative N 05/19/2021 12:33 05/19/2021 13:51 Final LEUKOCYTE ESTERASE, URINE Negative N None Negative (None) 05/19/2021 12:33 05/19/2021 13:51 Final EPITHELIAL CELLS <=5 N 05/19/2021 12:33 05/19/2021 13:51 Final RED BLOOD CELLS None Seen N 05/19/2021 12:33 05/19/2021 13:51 Final WHITE BLOOD CELLS None Seen N 05/19/2021 12:33 05/19/2021 13:51 Final UBACTERIA Few AB 05/19/2021 12:33 05/19/2021 13:51 Final CRYSTALS None Seen N 05/19/2021 12:33 05/19/2021 13:51 Final MUCOUS Negative N 05/19/2021 12:33 05/19/2021 13:51 Final FUNGUS None Seen N 05/19/2021 12:33 05/19/2021 13:51 Final Urine Set up for Culture No N 05/19/2021 12:33 05/19/2021 13:51 Final Specific Gravity Normal N 05/19/2021 12:33 05/19/2021 13:51 Final pH Normal N 05/19/2021 12:33 05/19/2021 13:51 Final Oxidant Normal N 05/19/2021 12:33 05/19/2021 13:51 Final5/24/2021 5/9 Lab Results: Last Week Test Results Units Reference Range Ordered Collected Status Creatinine Normal N 05/19/2021 12:33 05/19/2021 13:51 Final Nitrite Normal N 05/19/2021 12:33 05/19/2021 13:51 Final Glutaraldehyde Normal N 05/19/2021 12:33 05/19/2021 13:51 Final Temperature Not Tested - Not rec''d within 3 minutes AB 05/19/2021 12:33 05/19/2021 13:51 Final Amphetamine Negative N 05/19/2021 12:33 05/19/2021 13:51 Final Barbiturates Negative N 05/19/2021 12:33 05/19/2021 13:51 Final Buprenorphine Negative N 05/19/2021 12:33 05/19/2021 13:51 Final Benzodiazepines Negative N 05/19/2021 12:33 05/19/2021 13:51 Final Cocaine Negative N 05/19/2021 12:33 05/19/2021 13:51 Final Methadone Metabolite Negative N 05/19/2021 12:33 05/19/2021 13:51 Final Methamphetamine Negative N 05/19/2021 12:33 05/19/2021 13:51 Final Ecstasy Negative N 05/19/2021 12:33 05/19/2021 13:51 Final Methadone Negative N 05/19/2021 12:33 05/19/2021 13:51 Final Morphine Positive AB 05/19/2021 12:33 05/19/2021 13:51 Final Phencyclidine Negative N 05/19/2021 12:33 05/19/2021 13:51 Final Oxycodone Negative N 05/19/2021 12:33 05/19/2021 13:51 Final Tricyclic Antidepressants Negative N 05/19/2021 12:33 05/19/2021 13:51 Final Marijuana Negative N 05/19/2021 12:33 05/19/2021 13:51 Final WHITE BLOOD COUNT 5.89 N 10^3/ul 4.00 - 10.50 (10^3/ul) 05/19/2021 12:33 05/19/2021 12:37 Final5/24/2021 6/9 Lab Results: Last Week Test Results Units Reference Range Ordered Collected Status %NEUT 66.3 N % 40.0 - 75.0 (%) 05/19/2021 12:33 05/19/2021 12:37 Final %LYMPH 25.0 N % 20.5 - 45.5 (%) 05/19/2021 12:33 05/19/2021 12:37 Final %MONO 6.1 N % 0.0 - 10.0 (%) 05/19/2021 12:33 05/19/2021 12:37 Final %EOSIN 1.9 N % 0.9 - 2.9 (%) 05/19/2021 12:33 05/19/2021 12:37 Final %BASO 0.5 N % 0.2 - 1.0 (%) 05/19/2021 12:33 05/19/2021 12:37 Final % IMMATURE GRAN 0.2 N % 0.0 - 1.0 (%) 05/19/2021 12:33 05/19/2021 12:37 Final #NEUT 3.9 N 10^3/ul 1.5 - 7.5 (10^3/ul) 05/19/2021 12:33 05/19/2021 12:37 Final #LYMPH 1.5 N 10^3/ul 1.1 - 4.4 (10^3/ul) 05/19/2021 12:33 05/19/2021 12:37 Final #MONO 0.4 N 10^3/ul 0.3 - 0.8 (10^3/ul) 05/19/2021 12:33 05/19/2021 12:37 Final #EOSIN 0.1 N 10^3/ul 0.00 - 0.20 (10^3/ul) 05/19/2021 12:33 05/19/2021 12:37 Final #BASO 0.0 N 10^3/ul 0.00 - 0.10 (10^3/ul) 05/19/2021 12:33 05/19/2021 12:37 Final # IMMATURE GRAN 0.01 N 10^3/ul 0.00 - 0.10 (10^3/ul) 05/19/2021 12:33 05/19/2021 12:37 Final RED BLOOD COUNT 4.45 N 10^6/ul 3.50 - 5.80 (10^6/ul) 05/19/2021 12:33 05/19/2021 12:37 Final HEMOGLOBIN 14.1 N gm/dL 11.5 - 16.0 (gm/dL) 05/19/2021 12:33 05/19/2021 12:37 Final HEMATOCRIT 43.4 N % 37.0 - 47.0 (%) 05/19/2021 12:33 05/19/2021 12:37 Final MCV 97.5 H fl 80.0 - 96.0 (fl) 05/19/2021 12:33 05/19/2021 12:37 Final MCH 31.7 N PG 28.0 - 36.0 (PG) 05/19/2021 12:33 05/19/2021 12:37 Final MCHC 32.5 L % 33.0 - 39.0 (%) 05/19/2021 12:33 05/19/2021 12:37 Final RDW 12.7 N % 11.5 - 14.5 (%) 05/19/2021 12:33 05/19/2021 12:37 Final PLATELET COUNT 196 N 10^3/ul 150-450 (10^3/ul) 05/19/2021 12:33 05/19/2021 12:37 Final MPV 10.3 H fl 6.1 - 9.2 (fl) 05/19/2021 12:33 05/19/2021 12:37 Final5/24/2021 7/9 Lab Results: Last Week Test Results Units Reference Range Ordered Collected Status MAGNESIUM 1.8 N mg/dL 1.8 - 2.4 (mg/dL) 05/19/2021 12:33 05/19/2021 12:37 Final ACETAMINOPHEN 0.0 L mcg/mL 10 - 30 (mcg/mL) 05/19/2021 12:33 05/19/2021 12:37 Final CK 132 N U/L 26 - 192 (U/L) 05/19/2021 12:33 05/19/2021 12:37 Final ALCOHOL <3 N mg/dL 0 - 50 (mg/dL) 05/19/2021 12:33 05/19/2021 12:37 Final AMYLASE 65 N U/L 25 - 115 (U/L) 05/19/2021 12:33 05/19/2021 12:37 Final LIPASE 69 L U/L 73 - 393 (U/L) 05/19/2021 12:33 05/19/2021 12:37 Final SODIUM 139 N mmol/L 136 - 145 (mmol/L) 05/19/2021 12:33 05/19/2021 12:37 Final POTASSIUM 4.1 N mmol/L 3.5 - 5.1 (mmol/L) 05/19/2021 12:33 05/19/2021 12:37 Final CHLORIDE 103 N mmol/L 98 - 107 (mmol/L) 05/19/2021 12:33 05/19/2021 12:37 Final BICARBONATE 23.9 N mmol/L 21 - 32 (mmol/L) 05/19/2021 12:33 05/19/2021 12:37 Final ANION GAP 16.2 N mmol/L 5.0 - 20.0 (mmol/L) 05/19/2021 12:33 05/19/2021 12:37 Final GLUCOSE 90 N mg/dL 74 - 106 (mg/dL) 05/19/2021 12:33 05/19/2021 12:37 Final BUN 9 N mg/dL 7 - 18 (mg/dL) 05/19/2021 12:33 05/19/2021 12:37 Final CREATININE 0.8 N mg/dL 0.6 - 1.3 (mg/dL) 05/19/2021 12:33 05/19/2021 12:37 Final ALBUMIN 4.2 N gm/dL 3.4 - 5.0 (gm/dL) 05/19/2021 12:33 05/19/2021 12:37 Final BILIRUBIN, TOTAL 0.50 N mg/dL 0.10 - 1.00 (mg/dL) 05/19/2021 12:33 05/19/2021 12:37 Final CALCIUM 9.2 N mg/dL 8.5 - 10.1 (mg/dL) 05/19/2021 12:33 05/19/2021 12:37 Final TOTAL PROTEIN 7.7 N gm/dL 6.4 - 8.2 (gm/dL) 05/19/2021 12:33 05/19/2021 12:37 Final ALK PHOS 64 N U/L 46 - 116 (U/L) 05/19/2021 12:33 05/19/2021 12:37 Final AST 31 N U/L 15 - 37 (U/L) 05/19/2021 12:33 05/19/2021 12:37 Final ALT 41 N U/L 12 - 78 (U/L) 05/19/2021 12:33 05/19/2021 12:37 Final5/24/2021 8/9 Lab Results: Last Week Test Results Units Reference Range Ordered Collected Status OSMOLALITY 276 N mOsm/kg 275 - 295 (mOsm/kg) 05/19/2021 12:33 05/19/2021 12:37 Final ASPIRIN (Salicylate) 0.4 L mg/dL 2.8-20.0 (mg/dL) 05/19/2021 12:33 05/19/2021 12:37 Final HCG, SERUM Negative N 05/19/2021 12:33 05/19/2021 12:37 Final TSH 0.981 N uIU/ml 0.358 - 3.740 (uIU/ml) 05/19/2021 12:33 05/19/2021 12:37 Final LACTIC ACID, PLASMA 2.3 H mmol/L (mmol/L) 0.4 - 2.0 05/19/2021 12:33 05/19/2021 12:37 Final
CDC Split Type:

Write-up: Patient is a 15 yo female with a history of anxiety, recent ankle sprain, and no other known medical history who presents to ED today after she developed persistent shaking movements after her COVID 19 vaccination today. Medical work up has been thorough and has resulted negatively, including blood work, UDS, CT Head. She has remained slightly tachycardic, though she has also been moving continuously for several hours. Her physical exam is notable for several indicators of psychogenic origin, including demonstrating variability in tremor frequency (head, legs and arms vacillating it variable rates over time), distractability from motor tasks (head or arms stop shaking when asked to focus on moving her legs, for example). Her speech has also been affected, but this is also variable and she is at times using only 1 word sentences and other times responding more completely. Certainly she may have suffered a psychological stress today as she is fearful of needles and has a history of vasovagal response and her mother notes recent overwhelm with school performance, though this is not unusual for her. If medical work up continues to be negative, it may be reasonable to conclude she is suffering a conversion disorder "FINAL DIAGNOSIS: Conversion reaction after a Covid 19 vaccine. Patient To be transferred via ground ambulance."


VAERS ID: 1344215 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023A21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Mobility decreased, Pain in extremity
SMQs:, Parkinson-like events (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: Hydrochlorothiazide 25mg daily and phentermine 37.5mg daily in morning
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient came in today complaining her arm is still sore. She said that it hurts to lift it above her head and when she tries to rotate it. I am not sure when this started. She was very sore the day after her shot. We asked her to ice it for a few days.


VAERS ID: 1344253 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-05-17
Onset:2021-05-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Metabolic function test, Oedema, Urine analysis
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Rapid B-12 Energy 200 mcg/spray orally Align Extra Strength as per manufacturer guidelines EQ Multivitamin Gummies
Current Illness: none
Preexisting Conditions: Developmental Speech/Language disorder
Allergies: none
Diagnostic Lab Data: CMP and UA- normal results Provider is currently discussing any need for consult with cardiology
CDC Split Type:

Write-up: patient is experiencing pitting edema to her feet and ankles starting 2 days post covid19 vaccination


VAERS ID: 1344353 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Tinnitus
SMQs:, Hearing impairment (narrow)

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

Write-up: tinnitus


VAERS ID: 1344633 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 - / IM

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

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

Write-up: The patient was under the FDA approved age to receive this vaccine. Patient DOB was not verified and vaccine was provided.


VAERS ID: 1344650 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 09C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Nausea, Pain, Vomiting
SMQs:, Acute pancreatitis (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:
Current Illness:
Preexisting Conditions:
Allergies: No known food or drug allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, muscle ache, nausea, vomiting starting 1 day after vaccination and continuing for 1 week


VAERS ID: 1344892 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-12
Onset:2021-05-19
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Computerised tomogram thorax, Condition aggravated, Dyspnoea, Hypoxia
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations: 3/25/21
Other Medications:
Current Illness:
Preexisting Conditions: OSA on CPAP, Afib, HTN, HLD,
Allergies: Multaq, ?amiodarone
Diagnostic Lab Data: Chest x-ray, and CT scan
CDC Split Type:

Write-up: Patient given first dose of vaccine on 3/25 and was hospitalized on 4/14 with SOB and acute hypoxia, with interstitial lung disease. She underwent bronchoscopy and thought it was related to amiodarone toxicity, despite only 1 month exposure. Her amiodarone was discontinued and she was sent on steroid taper with improvement. She received 2nd dose of Moderna vaccine on 5/12. Became symptomatic again on 5/19 with SOB and hypoxia again. Currently being admitted. Concerning for vaccine induced Interstitial lung disease


VAERS ID: 1345026 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood creatine phosphokinase MB increased, Blood test, Chest pain, Chills, Cough, Echocardiogram abnormal, Electrocardiogram ST segment elevation, Enterovirus test, Headache, N-terminal prohormone brain natriuretic peptide increased, Pericardial disease, Pyrexia, Troponin increased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), 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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: EKG, Echocardiograms, blood tests , Enterocirus panel.
CDC Split Type:

Write-up: 5/19/2021: Fever, Chills, headache, cough. 5/20/2001: Chills persist, fever & headache resolve 5/21 /2021 at 0300: Severe Chest pain, fever recurs, admitted to hospital where ST elevation seen on EKG, Echocardiogram shows pericardial enhancement, normal function , no abnormalities. troponin high at 832, proBNP high at 308, CKMB 54.6


VAERS ID: 1345405 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Swelling of lymph node in armpit and it was very tender for about 6 days, now resolved 1 week out


VAERS ID: 1345442 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-05-14
Onset:2021-05-19
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chest discomfort, Dyspnoea, Exercise tolerance decreased, Fatigue, Feeling abnormal, Heart rate increased, Myalgia, Palpitations
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (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: Nexium
Current Illness: None
Preexisting Conditions: None
Allergies: Allergic to Septra
Diagnostic Lab Data: None. The facility on base did not want to see me and run any tests ?unless the symptoms got worse.?
CDC Split Type:

Write-up: I began having strange heart palpitations in the late afternoon, 5 days after receiving the vaccine. On the morning of the 6th day, I had an elevated heart rate, chest tightness and shortness of breath. It was difficult to have a conversation without having to constantly stop to take a deep breath, to ?catch up.? My lungs felt like they had substantially less capacity with a deep breath than before the symptoms presented. I had extreme fatigue, joint and muscle pain. On the 7th day, I woke up with the same symptoms, and decided to go back to bed due to continues extreme fatigue. After waking up, I felt somewhat better, until later in the evening, when all the aforementioned symptoms came back. The following morning (8th day) I felt much better, and decided to go on a mountain bike ride to see how my heart and breathing felt. I noticed some decreased cardiovascular performance, but not as bad as the previous days. Later that evening, the shortness of breath and elevated heart rate came back. On the 9th day, the elevated heart rate was noticeably better, and the shortness of breath was still present, but not as bad as before. My blood pressure remained elevated and I have been unable to get it below 135/80 range. Same issues on the 10th day. Today, on the 11th day, I attempted to go run and found that my cardiovascular conditioning was the worst I have ever experienced in my life, without exaggeration. I had difficulty with a pace and duration that I would normally complete with ease before being vaccinated. I had to cut it short, as I was having difficulty breathing and my lungs were burning. I hope that these symptoms subside and are not permanent. I was hesitant to get the vaccine for a very long time, but decided to do it based of off removal of the mask mandates for vaccinated personnel. If I could go back knowing I would feel this way, I would never have allowed this vaccine to be injected in my body. I am a healthy, athletic 31 year old male, and now I feel like I am in the worst shape of my life. I feel awful.


VAERS ID: 1345444 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-04-29
Onset:2021-05-19
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bell's palsy
SMQs:, Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: lisinopril, metformin, pravastatin, tamsulosin
Current Illness:
Preexisting Conditions: diabetes, hypertension, BPH
Allergies: shellfish
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Bells Palsy right face. We are just starting oral corticosteroids.


VAERS ID: 1345445 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray normal, Chest discomfort, Chest pain, Dysphagia, Electrocardiogram normal, Laboratory test normal, Oropharyngeal pain, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (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: 5/19/2021 EKG Labs Chest X-ray
CDC Split Type:

Write-up: Chest pain shortly after the vaccination. Swallowing and throat. Long lasting and was sent to the emergency room. Labs and EKG were normal. Sore throat lasting up to five days after the vaccine. Tightness in throat and chest experienced


VAERS ID: 1345456 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-05-14
Onset:2021-05-19
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 1 LA / SYR

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

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

Write-up: I started to feel symptoms 9 days after my first shot. I woke up to the normal soreness from the injection, but it was itchy and had a few small warm bumps. Throughout the night into the following next two days the site grew from quarter size to 4-6?, with hotness, itching, redness and slight pain. I took Benadryl and ibuprofen once daily to help with the itching and pain, and it seems the rash peaked on Saturday, May 23rd, and started to go away drastically by Sunday, May 24th, evening, with little to almost no rash Monday, May 25th.


VAERS ID: 1345709 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:2021-05-19
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Expired product administered, Product temperature excursion issue
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: USJNJFOC20210537665

Write-up: EXPIRED VACCINE RECEIVED; PRODUCT TEMPERATURE EXCURSION ISSUE (PUNCTURED VIAL LEFT OUT BEYOND 6 HOURS ADMINISTERED); This spontaneous report received from a pharmacist concerned multiple patients. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: Unknown) .5 ml, 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 expired vaccine received. On 19-MAY-2021, the subject experienced product temperature excursion issue (punctured vial left out beyond 6 hours administered). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the expired vaccine received and product temperature excursion issue (punctured vial left out beyond 6 hours administered) was not reported. This report was non-serious. The suspected product quality complaint has been confirmed to be voided: yes. no pqc criteria has been identified. based on the PQC evaluation/investigation performed. This report was associated with product quality complaint: 90000180101.


VAERS ID: 1345710 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Connecticut  
Vaccinated:0000-00-00
Onset:2021-05-19
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210537707

Write-up: NIGHT SWEATS; FEVER; FATIGUE; This spontaneous report received from a patient concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose, start therapy date were not reported 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 night sweats. On 19-MAY-2021, the subject experienced fever. On 19-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 recovered from night sweats, fever, and fatigue on 19-MAY-2021. This report was non-serious.


VAERS ID: 1345725 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Michigan  
Vaccinated:0000-00-00
Onset:2021-05-19
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood glucose, Body temperature, Influenza like illness, Nausea, Pyrexia, Retching
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Non-smoker
Preexisting Conditions: Comments: The patient had no known allergies and had no history of drug abuse or illicit drug usage.
Allergies:
Diagnostic Lab Data: Test Date: 20210519; Test Name: Blood glucose; Result Unstructured Data: Not Reported; Test Date: 20210519; Test Name: Body temperature; Result Unstructured Data: up to 101.9; Comments: up to 101.9 last night (19-MAY-2021) about 21:00; Test Date: 20210520; Test Name: Body temperature; Result Unstructured Data: up to 102.9
CDC Split Type: USJNJFOC20210539095

Write-up: DRY HEAVING; NAUSEA; HIGH FEVER; FLU LIKE SYMPTOMS; This spontaneous report received from a patient concerned a 68 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included non-smoker, and non alcohol user, and other pre-existing medical conditions included the patient had no known allergies and had no history of drug abuse or illicit drug usage. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 042A21A, expiry: UNKNOWN) dose was not reported, administered on 19-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 19-MAY-2021, the subject experienced flu like symptoms. On 19-MAY-2021, the subject experienced high fever. Laboratory data included: Blood glucose (NR: not provided) Not Reported, and Body temperature (NR: not provided) up to 101.9. Treatment medications included: paracetamol. On 20-MAY-2021, the subject experienced dry heaving. On 20-MAY-2021, the subject experienced nausea. Laboratory data included: Body temperature (NR: not provided) up to 102.9. Treatment medications included: prochlorperazine. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from flu like symptoms, dry heaving, and nausea, and had not recovered from high fever. This report was non-serious.


VAERS ID: 1345735 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Florida  
Vaccinated:0000-00-00
Onset:2021-05-19
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Fall, Lip injury, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Trypanophobia
Preexisting Conditions: Medical History/Concurrent Conditions: Syncope
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210540040

Write-up: SYNCOPE; CUT ON LIP FROM THE FALL; FELL; This spontaneous report received from a pharmacist concerned a 27-year-old female. The patient''s height, and weight were not reported. The patient''s past medical history included syncope (when she had blood draw), and concurrent conditions included fear of syringes. Patient was not pregnant at the time of reporting. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 205A21A, and expiry: 23-JUN-2021) dose was not reported, 1 total administered on 19-MAY-2021 for prophylactic vaccination into Right Deltoid. No concomitant medications were reported. On 19-MAY-2021 HCP (Health Care Practitioner) reported that the patient experienced syncope after receiving the vaccine. Patient fell face down for about 5 seconds from a sitting position seconds after receiving the shot. HCP called 911. The patient experienced cut on lip from the fall. Emergency medical services mentioned it was syncope and patient did not need to go to the hospital as patient seemed to have fully recovered. HCP reported the patient mentioned this had happened to her before when she had a blood draw. She had a fear of syringes. Emergency medical services advised patient to lie down for blood draws and shots in the future. HCP did not administer any other medications to the patient. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from syncope on 19-MAY-2021, and the outcome of fell and cut on lip from the fall was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0. 20210540040-COVID-19 VACCINE AD26.COV2.S- Syncpoe. 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: 1345739 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-05-19
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Injection site pain, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210540124

Write-up: SHARP PAIN IN ARM (INJECTION SITE ARM); TENDERNESS AT INJECTION SITE; This spontaneous report received from a patient concerned a patient of unspecified age and sex. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported) dose was not reported, administered on 18-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 tenderness at injection site. On 20-MAY-2021, the subject experienced sharp pain in arm (injection site arm). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the tenderness at injection site and sharp pain in arm (injection site arm) was not reported. This report was non-serious.


VAERS ID: 1345746 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-05-19
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Nausea, Vaginal haemorrhage
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: USJNJFOC20210540290

Write-up: HEAVY MENSTRUATION; IRREGULAR SPOTTING; NAUSEA; This spontaneous report received from a patient concerned a 27 year old female. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 201A21A, expiry: 23-JUN-2021) dose was not reported, administered on 11-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 19-MAY-2021, the subject experienced heavy menstruation. On 19-MAY-2021, the subject experienced irregular spotting. On 19-MAY-2021, the subject experienced nausea. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from nausea on 20-MAY-2021, had not recovered from heavy menstruation, and the outcome of irregular spotting was not reported. This report was non-serious.


VAERS ID: 1345748 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-05-19
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Asymptomatic COVID-19, Coronavirus test, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 20210517; Test Name: Coronavirus test; Result Unstructured Data: Positive
CDC Split Type: USJNJFOC20210540308

Write-up: SUSPECTED CLINICAL VACCINATION FAILURE; ASYMPTOMATIC COVID-19; This spontaneous report received from a patient via a company representative (Social Media) concerned a male of unspecified age. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. Per procedure, no follow up will be requested for this case. No concomitant medications were reported. On 17-MAY-2021, Laboratory data included: Coronavirus test (NR: not provided) Positive. On 19-MAY-2021, Wednesday morning, the patient had suspected clinical vaccination failure and asymptomatic covid-19. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the suspected clinical vaccination failure and asymptomatic covid-19 was not reported. This report was serious (Other Medically Important Condition). This report was associated with product quality complaint: 90000180202. The suspected product quality complaint has been confirmed to be void: N based on the PQC evaluation/investigation performed.; Sender''s Comments: V0: 20210540308-COVID-19 VACCINE AD26.COV2.S-Suspected Clinical Vaccination Failure. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS.


VAERS ID: 1345754 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Unknown  
Location: Nevada  
Vaccinated:0000-00-00
Onset:2021-05-19
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Poor quality product administered
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: USJNJFOC20210540466

Write-up: GAVE THE VACCINE 9 HOURS AFTER DRAWING THE VACCINE; This spontaneous report received from a pharmacist concerned a 33 year old of unspecified sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, and batch number: 203A21A expiry: 23-JUN-2021) dose was not reported, administered on 19-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 19-MAY-2021, the subject experienced gave the vaccine 9 hours after drawing the vaccine. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of gave the vaccine 9 hours after drawing the vaccine was not reported. This report was non-serious.


VAERS ID: 1345764 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: South Dakota  
Vaccinated:0000-00-00
Onset:2021-05-19
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Fluid retention, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210541518

Write-up: SWELLING IN BOTH LEGS AND FEET; FLUID RETENTION; This spontaneous report received from a consumer concerned a 57 year old female. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 042A21A, and batch number: 042A21A expiry: 21-JUN-2021) dose was not reported, administered on 07-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 19-MAY-2021, the subject experienced swelling in both legs and feet. On 19-MAY-2021, the subject experienced fluid retention. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from swelling in both legs and feet, and fluid retention. This report was non-serious.


VAERS ID: 1345767 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-05-19
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Headache, Hypersomnia, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210519; Test Name: Body temperature; Result Unstructured Data: 101 F
CDC Split Type: USJNJFOC20210541677

Write-up: SPENT ALMOST 30 HOURS IN BED; EVERYTHING HURT FROM TEETH TO TOES; MASSIVE HEADACHE (THINK ELECTRIC PINK HAND GRENADE); FEVER OF 101 (F); This spontaneous report received from a patient via a company representative concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: Unknown) dose, start therapy date were not reported 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 spent almost 30 hours in bed. On 19-MAY-2021, the subject experienced everything hurt from teeth to toes. On 19-MAY-2021, the subject experienced massive headache (think electric pink hand grenade). On 19-MAY-2021, the subject experienced fever of 101 (f). Laboratory data included: Body temperature (NR: not provided) 101 F. The action taken with covid-19 vaccine was not applicable. The patient was recovering from spent almost 30 hours in bed, fever of 101 (f), and everything hurt from teeth to toes, and had not recovered from massive headache (think electric pink hand grenade). This report was non-serious.


VAERS ID: 1345783 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-05-19
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chills, Dizziness, Fatigue, Nausea, Paraesthesia, Pyrexia, Vision blurred
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Drug allergy; Heartburn
Preexisting Conditions: Comments: The patient was on unspecified acid-reflux medication. The patient was not pregnant at the time of report.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210544469

Write-up: DIZZINESS; BLURRY VISION; FEVER; FATIGUE; TINGLY ALL OVER HER BODY; CHILLS; NAUSEA; This spontaneous report received from a consumer concerned a 33 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included heartburn, and allergic to codeine, and other pre-existing medical conditions included the patient was on unspecified acid-reflux medication and was not pregnant at the time of report. The patient experienced drug allergy when treated with pantoprazole, and oseltamivir phosphate 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: 204A21A, and expiry: 23-JUN-2021) dose was not reported, administered on 19-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 19-MAY-2021, the subject experienced tingly all over her body. On 19-MAY-2021, the subject experienced chills. On 19-MAY-2021, the subject experienced nausea. On 20-MAY-2021, the subject experienced fever. On 20-MAY-2021, the subject experienced fatigue. On 21-MAY-2021, the subject experienced dizziness. On 21-MAY-2021, the subject experienced blurry vision. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from tingly all over her body, chills, and nausea on 20-MAY-2021, and fever, and fatigue on 21-MAY-2021, and had not recovered from dizziness, and blurry vision. This report was non-serious.


VAERS ID: 1345786 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Delaware  
Vaccinated:0000-00-00
Onset:2021-05-19
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Military       Purchased by: ?
Symptoms: Injection site erythema, Injection site swelling, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Patient had no known allergies.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210544502

Write-up: INJECTION SITE SWELLING IN LEFT ARM 4 TO 5 INCHES WIDE AND 2 INCHES LONG; INJECTION SITE RED IN LEFT ARM 4 TO 5 INCHES WIDE AND 2 INCHES LONG; FEVERISH; This spontaneous report received from a patient concerned a 49 year old female. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included patient had no known allergies. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 17-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 injection site swelling in left arm 4 to 5 inches wide and 2 inches long. On 19-MAY-2021, the subject experienced feverish. On 19-MAY-2021, the subject experienced injection site red in left arm 4 to 5 inches wide and 2 inches long. The action taken with covid-19 vaccine was not applicable. The patient had not recovered from injection site swelling in left arm 4 to 5 inches wide and 2 inches long, and injection site red in left arm 4 to 5 inches wide and 2 inches long, and the outcome of feverish was not reported. This report was non-serious.


VAERS ID: 1346502 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-01-25
Onset:2021-05-19
   Days after vaccination:114
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027L20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Agitation, Anxiety, COVID-19, Condition aggravated, Exposure to SARS-CoV-2, Hypoxia, SARS-CoV-2 test positive
SMQs:, Asthma/bronchospasm (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol Xanax Symbicort Zyrtec lovenox Neurontin Haldol Synthroid
Current Illness: None known
Preexisting Conditions: Hypothyroidism anxiety asthma HTN Chronic kidney disease CHF
Allergies: Sulfa drugs codeine pravastatin
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient received both doses of her the COVID-19 vaccine well-over a month ago, however multiple people at her assisted living facility have tested positive for COVID-19 in the last week or 2. She tested positive for COVID-19 on May 13th. She has been requiring a small amount of oxygen at her facility over the past few days, however her hypoxia acutely worsened yesterday, May 19th. She has had significantly worsened agitation and anxiety over the past week


VAERS ID: 1346515 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-05-16
Onset:2021-05-19
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Strong Dizziness/ Headache
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Did not go to Doctor because no pain just let it take it?s course. If it did not clear, I would have went to ER.
CDC Split Type:

Write-up: On 05/19/21 experience slur speech with words. I see and think of the word/words clearly but when pronunciation they came out incorrect . ( Irritated slurred) no pain . It lasted several days not until Monday May 24, 2021. I felt normal.


VAERS ID: 1346560 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Erythema, Hypoaesthesia, Hypoaesthesia oral, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: I remember feeling chills after one flu shot years ago but nothing like this
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: About 20 minute after vaccine was administered I felt a subtle numbness feeling to the right of my mouth. Then it was felt on most of my right cheek. It lasted the whole day and the next morning it was mostly gone. Since then my right eyelid and under eye have been a little red which isn''t normal for me. Some tingling in right leg felt as well. Mainly concerned about the face sensation and not sure if I should proceed with second shot.


VAERS ID: 1346563 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pharyngeal swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin C, calcium, multivitamin, and hair, skin and nails multivitamin, lysine
Current Illness: none
Preexisting Conditions: hypothyroid, GERD, RA, osteoarthritis, osteoporosis, hyperlipidemia, hypertension, sleep apnea
Allergies: erythromycin penicillin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient was given the moderna vaccine and waited in clinic the requested 15minutes. Patient was fine when she left the office. She advised when she got home about 5 or so minutes later, she started to feel like her throat was swelling. Denied any trouble breathing, she kept drinking water to make sure her throat was still open. She took 2 large teaspoons of liquid benadryl. She never went to ER or called the office until 5/24/2021. After the benadryl started working she felt better and did not have any further symptoms.


VAERS ID: 1346709 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-17
Onset:2021-05-19
   Days after vaccination:63
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NA / 1 - / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NA / 2 - / SYR

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

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

Write-up: Client began having shortness of breath on 5/19. She was admitted to the ER on 5/21 at Hospital for further evaluation and requiring oxygen.


VAERS ID: 1346750 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 RA / IM

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

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

Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA - About 10 minutes after receiving her second dose of the Pfizer covid-19 vaccine, pt experienced full body itching and ear itching. Pt reported a history of skin allergies and sensitivity to detergent. No history of adverse reactions to any other vaccine. Recommended pt be observed for an additional 15 mins (she waited for 30 mins total). After a total of 30 mins in the observation area pt felt comfortable leaving and symptoms resolved.


VAERS ID: 1346789 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Balance disorder, Diarrhoea, Dizziness, Ear pain, Gait disturbance, Nausea, Rash, Skin warm, Tinnitus, Vertigo
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow), Vestibular disorders (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: 05/19/21 Rash, 05/20/21 Earache (resolved 05/22/21), 05/21/21 Diarrhea (resolved 05/21/21),05/23/21 dizziness,nausea,ringing in the ear ,room spinning,not able to balance and walk(still not resolved as of 05/24/21) Arm warm to touch still not resolved as of 05/24/21.Advised to see MD if condition does not resolve.


VAERS ID: 1346820 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Anaphylactic reaction, Cough, Dry mouth, Dysphonia, Electrocardiogram T wave inversion, Hyperhidrosis, Immediate post-injection reaction, Lip swelling, Mouth swelling, Nausea, Rash, Speech disorder, Swelling face, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Dementia (broad), Parkinson-like events (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Other ischaemic heart disease (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ? ALPRAZolam 0.5 MG Oral Tablet TAKE ONE TABLET BY MOUTH THREE TIMES A DAY FOR 90 DAYS, 90 days, 0 refills ? Bystolic 5 MG Oral Tablet 1 PO ONCE A DAY, 30 days, 0 refills ? Claritin 10 MG Oral Tablet 0 days, 0 refills ? Cromolyn Sod
Current Illness:
Preexisting Conditions: - Allergic Rhinitis - Pollen Anxiety Disorder Nos Arthropathy Multiple Sites - Chronic Pain Syndrome - Common Migraine W/o Aura Chronic W/ Intract Migraine W/ Status Migrainosus Costochondritis (Tietze''s Syndrome) Dermatitis, unspecified - chest ? Easy Bruising Tendency - Ehlers-danlos Syndrome Hypermobile Endometriosis Familial (Benign Essential) Tremor Fasciculations - Fatigue Gait - Swing Phase Foot Drop Right Gastroparesis Hemorrhoids Internal - Herniated Disc (L4 - L5) - Herniated Disc (L5 - S1) Lower Back Pain Chronic Major Depression, Recurrent with Melancholia - Mast Cell Activation Disorder Idiopathic - Postural Orthostatic Tachycardia Syndrome - Rectal Prolapse - Sacroiliitis - Skin Symptoms - rash - changes locations & severity (unknown triggers) - Spondylosis Lumbosacral Region - Tachypnea, not elsewhere classified - Temporomandibular Dislocation - Temporomandibular Joint-pain Dysfunction Syndrome Tenosynovitis De Quervain''s
Allergies: ? (SSRI) Selective Serotonin Reuptake Inhibitors Reaction: Myalgia''s ? ARTIFICIAL SWEETENERS Reaction: Nausea, Vomiting, Diarrhea, Migraines ? Bandaging Tape Reaction: Skin Rashes, Hives, SKIN BLISTERS ? Bisoprolol Fumarate Reaction: DIBILITATING FATIGUE (Severe) ? CeleBREX Reaction: Asthma, Shortness of Breath ? Dilaudid Reaction: Skin Rashes, Hives ? Meloxicam Reaction: Hives, Skin Rashes, anaphylaxis ? Morphine Derivatives Reaction: Skin Rashes, Hives ? NexIUM Reaction: Nausea (Moderate to Severe) ? predniSONE Reaction: MCAS ACTIVATION ? Tramadol Reaction: Skin Rashes (Mild to Moderate) ? Protonix Reaction: Vasovagal Syncope
Diagnostic Lab Data: Epi-pen at home, Received IV Benadryl, Epi, and Pepcid. Discharged after 3 hours observation in ER
CDC Split Type:

Write-up: Anaphylaxis: 1:45pm- Immediately upon receiving vaccine noted dry mouth 1:45-2:15pm- Waited at facility to monitor for reactions. Dry mouth sx increased and noted increased sweating from under arms. Cleared to go home as no other sx noted. 3:00-5:00pm- intermittent dry cough started 5:00-6:30pm- interior mouth, cheeks, lips and tongue started to feel like they were swelling, took 2 Benadryl 6:30pm-7:00pm- tongue, lips. and cheeks swelling increased. Lisp when speaking. 7:23pm Took 1st Epi-pen and headed to ER. On route to ER chest developed rash and voice became hoarse with episodes of nausea. In ER hands and forearms showed rash. Received IV Benadryl, Epi, and Pepcid. Discharged after 3 hours observation.


VAERS ID: 1346835 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Lip swelling, Paraesthesia oral, Throat irritation, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (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? 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: Allergic to Ativan, PCN, Sulfa , Cefdinier
Diagnostic Lab Data:
CDC Split Type:

Write-up: With in 5 minutes patient began having throat itching, tongue tingling, and lips swelling. Face broke out in hives and patient was shivering.


VAERS ID: 1346846 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-15
Onset:2021-05-19
   Days after vaccination:93
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Asymptomatic COVID-19, Oropharyngeal pain, SARS-CoV-2 test
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), COVID-19 (narrow)

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

Write-up: Reason for COVID test was symptomatic with sore throat and as outlined by CDC.


VAERS ID: 1346879 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-10
Onset:2021-05-19
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram cerebral normal, Arteriogram carotid normal, Bell's palsy, Chest X-ray normal, Dysarthria, Facial paralysis, Magnetic resonance imaging head normal, Perfusion brain scan normal
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hearing impairment (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: lexapro, lipitor, lamictal, synthroid, lopressor, protonix, neurontin, remeron, meclizine, renal caps, miralax
Current Illness: None
Preexisting Conditions: hypothyroidism, hypertension, gerd, obesity
Allergies: codeine, procaine, aspirin
Diagnostic Lab Data: CT Cerebral Perfusion 5/19/21- no significant defects CT CTA Head Stroke 5/19/21-no occlusion disease CT CTA Neck Stroke 5/19/21- no significant aortic arch plaque Chest Portable 5/19/21- no significant defects MR Brain W/O contrast 5/20/21- no evidence of restricted diffusion to suggest acute infarction
CDC Split Type:

Write-up: Pt presented to ER with right sided facial droop and slurred speech in the am on 5/19/21. At 9pm on 5/18/21 family reports patient was "normal". CT and MRI were clear of stroke. Newly diagnosed with Bell''s Palsy.


VAERS ID: 1346895 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK AR / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Anaemia, Asthenia, Disorganised speech, Dizziness, Headache, Troponin increased, Urinary tract infection, Vision blurred
SMQs:, Haematopoietic erythropenia (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: anemia
Preexisting Conditions: Acute on chronic CHF, DM type 2, PVD, CKD stage 3, ventricular tachycardia
Allergies: Augmentin, Dilaudid, wygesic,ketamine, propoxyphene
Diagnostic Lab Data: Sent to hospital, diagnosis acute on chronic anemia, chronic elevated troponin, UTI (catheter associated)
CDC Split Type:

Write-up: Approximately 30 minutes after vaccine resident c/o dizziness, right sided headache, blurry vision, weakness. Resident also talking but making no sense.


VAERS ID: 1346953 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 1st covid shot , mild hives x2d
Other Medications: prozac, concerta and multivit
Current Illness: none
Preexisting Conditions: adhd, ocd, learning disabilities
Allergies: sulfa
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Hives all over head, neck and face started same day as receiving the covid inj. was taking Benadryl and benadryl anti-itch creme. still having 5 days later and brought her in to be seen by provider. provider thought this was very strange reaction as hive were only on the head and neck. provider did take photos for chart. Patient was then put on benadryl, pepcid, zyrtec and a steriod ointment for her scalp.


VAERS ID: 1347037 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall
SMQs:, Accidents and injuries (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: Pfizer-BioNTech COVID-19 Vaccine EUA. About 30 minutes after receiving his first dose of the Pfizer covid-19 vaccine, pt fell as a result of, "loosing his footing." Pt fell on his left arm and was able to stand back up using his cane. Pt''s wife was with him and stated that he has had an increased incidence of falling lately and has an appointment with his physician to discuss. Both the pt and his wife believe that the fall was not as a result from the vaccine. However, since the fall happened shortly after receiving his vaccine am reporting.


VAERS ID: 1347054 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 LA / IM

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

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

Write-up: patient called pharmacy and complained that his arm still hurt 6 days after initial vaccination


VAERS ID: 1347084 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-26
Onset:2021-05-19
   Days after vaccination:82
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 AR / SYR

Administered by: Public       Purchased by: ?
Symptoms: Deep vein thrombosis, Pain in extremity, Ultrasound Doppler abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Junel Fe 1.5/30, Celecoxib 200mg, Spironolactone 50mg, Cimzia, Otezla,
Current Illness: none
Preexisting Conditions: Psoriatic Arthritis, Fibromyalgia
Allergies: Mild Latex
Diagnostic Lab Data: Ext Lower Venous Doppler Unilat US
CDC Split Type:

Write-up: DVT in Peroneal vein in left leg. diagnosed 05/24/2021. Went to ER with pain in left Calf. Pain onset was 5 days prior to ER visit (05/19/2021).


VAERS ID: 1347206 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-05-05
Onset:2021-05-19
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ferrous sulfate, Trulicity, HCTZ, Metformin, Celexa, trazodone, Losartan, Pravastatin, calcium, Vitamin D3, Omeprazole, Baclofen
Current Illness:
Preexisting Conditions: DM, HTN, gastric bypass, osteoporosis, elevated PTH, anxiety, Depression
Allergies: Phenergan,, Neosporin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Rash began on posterior L neck 5/19/21. Gradually progressed to L arm then Left breast Left stomach left thigh. Then began on right after 5-6 days. Raised papular and macular erythematous areas. Pruritic. Started Prednisone taper and triamcinolone cream today .


VAERS ID: 1347265 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lactation disorder
SMQs:, Functional lactation disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline 50 MG, prenatal, vitamin D
Current Illness: None
Preexisting Conditions: PCOS, GAD
Allergies: Bactrim
Diagnostic Lab Data:
CDC Split Type:

Write-up: Decrease in breast milk supply from 8-10oz in a given sitting to 3-4oz.


VAERS ID: 1347338 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-17
Onset:2021-05-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

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

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

Write-up: Patient had paresthesia and elbow pain.


VAERS ID: 1347357 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-16
Onset:2021-05-19
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin, Terazosin, apixaban, diltiazem,, fexofenadine hydrochloride , acetaminophen
Current Illness: None
Preexisting Conditions: Atrial fibrillation, high triglycerides
Allergies: None known
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Hive like rash that covers my whole body except for palms and bottom of my feed. Heavy rash on front and back of torso. Heavy rash on back of neck. Rash similar to hives. I have never had a rash like this my entire life. There is itching and mild pain when pressure is applied to the rash area. I am now at day 7 with this rash and it has not shown signs of going away.


VAERS ID: 1347408 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 2 LA / IM

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

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

Write-up: The entire outer forearm, starting about an inch below the vaccination site, all the way down to the elbow, turned red and would itch. This began the next day after the vaccination and has persisted for the past six days. I have applied Hydrocortisone creme 1% two or three times every day and that helps relieve the itch, but the swelling and redness continues.


VAERS ID: 1347497 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Appendicitis, Computerised tomogram abdomen abnormal
SMQs:, Retroperitoneal fibrosis (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: CT scan 5/20/2021
CDC Split Type:

Write-up: Accuse appendicitis


VAERS ID: 1347550 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Injection site pain, Injection site swelling, Pyrexia, SARS-CoV-2 test negative
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (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: Meloxican 7.5mg tablet take 2 tablets daily. Montelukast sodium 10mg tablet at bedtime Temazepam 30mg one capsule at bedtime Estratest full strength one pill, once daily. Bupropion hcl XL 300mg capsule once daily. Gabapentin 300mg one ca
Current Illness: None
Preexisting Conditions: No
Allergies: Sulfa
Diagnostic Lab Data: Covid test sent today 5/25/2021
CDC Split Type:

Write-up: Severe swelling and pain at injection site. 24 hours after injection I had fatigue and fever 100.4


VAERS ID: 1347559 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Gout, Headache, Nausea, Pain in extremity, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Baby aspirin, Nexium, MVI, Vit. D, amlodipine 10 mg
Current Illness: None
Preexisting Conditions: HTN
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Headache, Chills, Fever, Nausea, Left Hallux Pain for 2 days (Gout)


VAERS ID: 1347610 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site pruritus, Injection site pustule, Injection site swelling, Myalgia, Nausea, Pyrexia, Vision blurred
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Injection site was left arm below the shoulder around the tricep. The injection site began itching several hours after injection. Itching was low in intensity. The injection site swelled noticeably. I went to sleep but I woke around 4 AM with an intense headache, nausea, slightly blurred vision, and a fever. Throughout the remaining day my fever got up to 101F. Other symptoms included muscle ache and fatigue. The injection site began intermittently pulsating/twitching the evening of 5/20/21. On Friday morning 5/21 the intermittent twitching spread to my left fingers. The blurry vision, headache, and nausea gradually went away. All symptoms were gone by morning of 5/22. I did not take any medication throughout.


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