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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 132 out of 3,524

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VAERS ID: 1347617 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Unknown  
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 - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Dyspnoea, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (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? No
Previous Vaccinations:
Other Medications: Diabetes medication metformin
Current Illness:
Preexisting Conditions: Diabetic
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever cough aching breathless


VAERS ID: 1347633 (history)  
Form: Version 2.0  
Age: 41.0  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood glucose normal, Dizziness, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

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

Write-up: After leaving vaccination site began to feel dizzy and nausea. Returned to vaccine site @ 12:30PM VS BP 145/104, HR 89, OxSat 98%, c/o headache, took Tylenol, has not eaten today. Blood sugar: 71. Banana given, advised to have lunch with protein.


VAERS ID: 1347654 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Minnesota  
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 (MODERNA)) / MODERNA 003C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aphthous ulcer, Chills, Hypoaesthesia oral, Lip blister, Lip swelling, Pyrexia
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: metoprolol succinate 50mg, atorvastatin 10mg, amphetamine-dextroamphetamine ER 20mg
Current Illness:
Preexisting Conditions:
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1 day after vaccination: fever/chills; 2 days after: felt fine but had cankersore; 3 days after: bottom lip numb and swollen; 4 days after: upper lip numb and swollen; 5 days after: both lips numb and swollen with white blisters; after that started taking Benadryl and started feeling better


VAERS ID: 1347726 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Alabama  
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 ER8737 / 2 LA / IM

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

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

Write-up: Patient arrived at the site to get a second dose of COVID-19 Vaccine. The patient informed the site administrator that she had received her first dose in January, but did not have any record of receiving the dose. The site administrator vaccinated the woman with the Pfizer Vaccine without checking the ADPH''s IMMPRINT system. Upon entering information into the database after the vaccination occurred, the data entry consultant informed the vaccine coordinator that the patient received the Moderna vaccine on 01/28/2021 and the Pfizer vaccine on 05/19/2021. The patient has not contacted the site administrator or vaccination clinic with any other health issues related to the mixing of different brands of vaccines.


VAERS ID: 1347825 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-04-27
Onset:2021-05-19
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxin Trazodone Albuterol
Current Illness: Hashimoto?s thyroiditis PCOS
Preexisting Conditions:
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Seizure


VAERS ID: 1347833 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Washington  
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 EW0179-H / 2 LA / SYR

Administered by: Other       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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluoxetine HCL20 MG
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: We have not had any tests at all, nor have we seen a doctor since the tight chest and breathing last week.
CDC Split Type:

Write-up: My 17 year old daughter had her second Pfizer shot on Sunday, May 16 at 10AM. On Wednesday, May 19the she woke up and said that she had a terrible time in the middle of the night with a tight chest and she couldn''t catch her breath. She wouldn''t go to Urgent Care with me so I told her that we had to call the 24 hour nurse line (on the back of the insurance card). I called and she spoke with a nurse, then spoke with a doctor on the phone who told her to go the doctor if her symptoms got any worse.


VAERS ID: 1347883 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-15
Onset:2021-05-19
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Computerised tomogram, Nephrolithiasis, Vaccine positive rechallenge
SMQs:

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: Vascular tumor
Preexisting Conditions: Vascular tumor
Allergies: Banana. Latex. Codine.
Diagnostic Lab Data: Ct scans and hospital stays
CDC Split Type:

Write-up: Kidney stones a week after both shots


VAERS ID: 1348304 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-12
Onset:2021-05-19
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Blood test, Dyspnoea, Fatigue, Gait disturbance, Hypoaesthesia, Limb discomfort, Mobility decreased, Muscular weakness, Pain in extremity, Paraesthesia, Reflex test
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Took to ER on 5/23/21. Generic blood work done and reflex tests done for GBS. Vitals checked. Sent home. Followed up with pediatrician on 5/24/21. Advised to seek a neurologist and report reaction.
CDC Split Type:

Write-up: One week after 2nd dose, developed extreme fatigue, numbness and weakness in both legs, aching/pain in legs, loss of feeling in feet and occasional pins and needles feeling in feet. Some numbness/tingling in hands as well. Difficulty walking, just needs to sit. Difficulty raising arms. Complaints of legs and arms feeling very heavy. Shortness of breath.


VAERS ID: 1348311 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Pennsylvania  
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 023C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Disorientation, Dizziness, Seizure, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Patient had Moderna vaccine administered at 7:16pm and become unresponsive and began convulsing at 7:27pm. When patient came back around, he was disoriented and didn''t know where he was. Patient blood pressure was 131/93 with a pulse of 89. Patient did remember where he was and that he had received his first covid vaccine. He knew the month, day and some other basic questions. The patient stated that before he become unresponsive that he started to feel very lightheaded and woozy. 911 was called and transported the patient to the local hospital for additional testing and evaluation. Upon further discussion with the ER physician, patient was diagnosed with syncope and low potassium.


VAERS ID: 1348855 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-08
Onset:2021-05-19
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / UN

Administered by: Public       Purchased by: ?
Symptoms: Cerebral cavernous malformation, Computerised tomogram, Diplopia, Headache, Magnetic resonance imaging abnormal, Malaise, Mydriasis, Pain, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Congenital, familial and genetic disorders (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Ocular motility disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nexplanon Birth Control, Ibuprofen
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Several MRI and catscans.
CDC Split Type:

Write-up: Shortly after the second vaccination shot, I was feeling unwell and had major body aches and headaches for approx 4 days afterwards. I also had the feeling of a sinus infection that would not stop. About 11 days later I woke up with double vision and could not see properly. My left eye was fully dilated and visibly tilted to a different direction than my right. I went to the hospital and they did several tests and are unsure about what exactly is wrong and caused this and say that it is very rare. They shows in the MRI that there is a cavernous angioma in my brain and they think it is causing the eye issues. My other eye also has unusual blurry distance vision. While in the hospital they tried using 2 different steroids that did not seem to work. They discharged me from the hospital and basically just said to wait and they think it might possibly start to get better in a month. I am not sure what to do at this point and I''m worried it may be a result of the vaccine.


VAERS ID: 1349017 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: South Carolina  
Vaccinated:0000-00-00
Onset:2021-05-19
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Pulmonary embolism, Suspected COVID-19, Thrombosis, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210539965

Write-up: MULTIPLE PULMONARY EMBOLISM; MULTIPLE BLOOD CLOTS; SUSPECTED CLINICAL VACCINATION FAILURE; SUSPECTED COVID-19 INFECTION; This spontaneous report received from a health care professional concerned a 55 year old male. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown, Expiry: Unknown) dose not reported, 1 total, on APR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date, the patient developed multiple pulmonary embolism included multiple blood clots. On 19-MAY-2021, after 4 week of vaccination, the patient was diagnosed with suspected covid-19 infection (suspected clinical vaccination failure) and was not doing well. The patient got hospitalized. Number of hospitalization days was not reported. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the suspected covid-19 infection, suspected clinical vaccination failure, multiple pulmonary embolism and multiple blood clots was not reported. This report was serious (Hospitalization Caused / Prolonged and Life Threatening). This report was associated with product quality complaint number: 90000180239. The suspected product quality complaint has been confirmed to be not voided based on the PQC evaluation/investigation performed.; Sender''s Comments: V0:20210539965-covid-19 vaccine ad26.cov2.s - multiple pulmonary embolism,multiple blood clots,suspected covid 19 infection. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s). V0:20210539965 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: 1349049 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-05-19
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Poor quality product administered, Product storage error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210545170

Write-up: PATIENT RECEIVED THE VACCINE OUTSIDE OF THE RECOMMENDED TEMPERATURE RANGE 46.8 F TO 52.7 F AFTER PUNCTURE; THE VIAL TEMPERATURE WENT FROM 46.8 F TO 52.7 F AFTER FIRST PUNCTURE BETWEEN 11AM- 2:41PM; This spontaneous report received from a pharmacist 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: 206A21A, 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 subject received the vaccine outside of the recommended temperature range 46.8 f to 52.7 f after puncture. On 19-MAY-2021, the subject experienced the vial temperature went from 46.8 f to 52.7 f after first puncture between 11am- 2:41pm. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the patient received the vaccine outside of the recommended temperature range 46.8 f to 52.7 f after puncture and the vial temperature went from 46.8 f to 52.7 f after first puncture between 11am- 2:41pm was not reported. This report was non-serious. This case, from the same reporter is linked to 20210540217.


VAERS ID: 1350381 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-05-17
Onset:2021-05-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Two days after receiving the vaccine, the patient fainted at the home. Has had intermittent shortness of breath, and dizziness


VAERS ID: 1350551 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-05-12
Onset:2021-05-19
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024021A / 1 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: multi vitamin, Losartin, Metropolol.
Current Illness: N/A
Preexisting Conditions: High blood pressure, anxiety
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: First noticed redness, hot to the touch, swelling, rash around injection site and down left arm to above the elbow on Tue. 5/18. Thought it was a bug / spider bite so treated it accordingly. By Fri. 5/21, it had not gotten better so reported it to V-Safe after identifying the symptoms online as "COVID Arm". Started approximately 6 days after the vaccine was administered. Information online states that symptoms should be gone after a couple days but it has now been a week since they first appeared. Left arm is getting better but rash is still visible above the elbow with some tenderness and a little warm to the touch. I wanted to report this due to the length of time I have had it and how long it is taking to clear up.


VAERS ID: 1350567 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose decreased, Heart rate decreased, Hypotension, Musculoskeletal stiffness
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad), Hypoglycaemia (narrow), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: patient previously had this reaction 5 years ago with a flu vaccine, but no information was disclosed prior to receiving the COV
Other Medications: Unknown
Current Illness: None per vaccination administration record
Preexisting Conditions: After EMT arrived, the parents disclosed that the patient previously fainted/ had a vasovagal response 5 years ago and thought she had "grew out of it"
Allergies: None per vaccination administration record
Diagnostic Lab Data: Blood pressure was taken prior to EMS arrival with systolic/diastolic of 91/51 and a pulse of 48.
CDC Split Type:

Write-up: Patient went stiff/possible seizure 5 minutes after getting the vaccine. She came back after approx. 30 seconds. EMS was immediately called and her blood pressure and pulse were both taken prior to EMS arrival. Blood pressure was 91/51 with a pulse of 48. PER EMS, the patients blood sugar was low.


VAERS ID: 1350570 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Electrocardiogram abnormal, Myocarditis, Pericarditis, Pleuritic pain, Pyrexia, Troponin I increased
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), 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), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Patient developed a fever to 103 and pleuritic positional chest pain the day after receiving dose #2. He presented to the ED 2 days later on May 21, 2021. An ECG showed acute pericarditis. His TnI was mildly elevated. An echocardiogram showed mild LV dysfunction with LVEF 40-45%. He was diagnosed with myopericarditis. Treatment included NSAIDS and colchicine and metoprolol. He was not admitted to the hospital.


VAERS ID: 1350577 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-15
Onset:2021-05-19
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine 88 mcg Daily, Mulit-Vitamin Daily, Biotin 10,000 mcg Daily, D3 150 mcg Daily, Multi-Collagen Daily, magnesium 250 mg Daily, Apple Cider Vinegar 450 mg Daily, Fish Oil Supplement 120-0 mg 3XWeek
Current Illness: None
Preexisting Conditions: Graves Disease: Hypothyroidism, postablative Thyroid Ablation Comorbidity
Allergies: Amoxicillin & Ampicillin
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 4 days after getting Janssen shot a lump formed at the injection shot and is tender to touch/ slightly sore when untouched - until that time I had no pain, no soreness, no adverse symptoms at all. The lump is still present on day 11 and is still tendor to the touch. I have not seen anyone regarding this adverse effect as I am hoping it eventually goes away.


VAERS ID: 1350626 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Unresponsive to stimuli, Visual impairment
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: patient received an IV injection (no other information was disclosed) and the patient had a similar reaction as well.
Other Medications: Unknown
Current Illness: None per vaccine administration record
Preexisting Conditions: Patient previously had a fainting episode with an IV but not with any vaccine. Timing of last fainting episode was not disclosed.
Allergies: None per vaccine administration record
Diagnostic Lab Data: Blood pressure was taken with systolic/diastolic being 105/68 and pulse being 70.
CDC Split Type:

Write-up: Patient claimed she saw spots and was then unresponsive to the mother. Blood pressure was taken prior to EMT arrival with blood pressure of 105/68 and pulse of 70. Patient barely ate that day prior to coming in for the vaccine. Mother later disclosed that the patient had a event similar to this prior (date unknown) with the patient after getting an IV injection.


VAERS ID: 1350631 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Death, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bayer baby aspirin
Current Illness: none reported
Preexisting Conditions: Blindness x 20 years
Allergies: none reported
Diagnostic Lab Data: autopsy scheduled, results pending
CDC Split Type:

Write-up: Per daughter, patient, after uneventful vaccine administration and 15 minute observation period, returned home, and father had lunch with wife and daughter. At 1:30, father remained home while daughter and wife went grocery shopping. Upon return from grocery store, approximately 1 hr. 45 minutes later, daughter found father unresponsive in bathtub with small amount of water, faucet off, and father partially clothed. Per daughter, the shower chair had been removed from the tub by her father. Per daughter, an autopsy was planned. Results are pending.


VAERS ID: 1350641 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Condition aggravated, Headache
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:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient stated headache and stomach pains were present soon after getting the shot. Patient had had stomach pains for $g1 year but are now worse. No reports of trouble breathing. Advised to follow up with PCP.


VAERS ID: 1350658 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW050 / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Anaphylactic reaction, Chest X-ray normal, Dizziness, Pharyngeal swelling, SARS-CoV-2 RNA, SARS-CoV-2 antibody test positive, SARS-CoV-2 test negative, Syncope, Throat irritation, Wheezing
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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: birth control, zoloft, Hi-lyte
Current Illness:
Preexisting Conditions: POTS syndrome, familial dysautonomia, migraine cephalgia, dysmenorrhea
Allergies: benadryl, compazine, topamax
Diagnostic Lab Data: 1/22/21: SARS CoV2 RNA Antibodies detected 5/19:21: SARS CoV2 RNA PCR- negative CXR: 5/19: Clear
CDC Split Type:

Write-up: Pt brought to ED w/concerns for allergic rxn immediately following COVID-19 vaccine at PCP office (5/19) where w/in 15 mins, experienced significant lightheadedness, dizziness & throat swelling & itch w/wheezing. In ED, developed brief episodes of syncope and was administered EpiPen, IV fluids, solu-medrol and famotidine w/improvement. After multi doses of epi IM for recurrent symptoms throughout observation, was started on epi drip. Ultimately discharged, however, returned same night with recurrent anaphylactic rxn and was again started on an epinephrine drip and claritin. Of note, pt had previously had COVID on 1/22/2021. Pt discharged w/plans to f/u w/ allergy and immunology at Hospital.


VAERS ID: 1350664 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Disorientation, Feeling abnormal, Palpitations, Tongue disorder
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None, except ointments-Betamethasone, Estradiol.
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: I notified my doctor on 5/23/2021 and his co-worker doctor replied on 5/24/2021 that in the second dose there are more effects and this all should resolve in two weeks. However, I thought it best to report this forward to you.
CDC Split Type:

Write-up: For several days I had racing heart beat and my head felt like it was being reconstructed--not pain, but could feel the reconstruction, but it wasn''t until about 3 days later I noticed my tongue was foamy. I didn''t realize how disoriented I was until someone mentioned that 5 days later. I did attempt to sleep a lot to let the crazy pass over me. I''m now a week later, with only noticing slight head adjustments going on in there, but I was able to work through most of this, although the racing heart beat was the most scary and the head thing was distrubing.


VAERS ID: 1350693 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-04-01
Onset:2021-05-19
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028A21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia, Bell's palsy, Facial paralysis, Hypoaesthesia, Oropharyngeal pain, SARS-CoV-2 test negative
SMQs:, Peripheral neuropathy (broad), Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Farxiga
Current Illness: None
Preexisting Conditions: Diabetes, Hyperlipid, Hypothyroid
Allergies: Side effects to: Statins, Metformin
Diagnostic Lab Data: COVID-19- Negative
CDC Split Type:

Write-up: Began with symptoms of sore throat, loss of taste 05/18/2021- Developed facial drooping and numbness- diagnosed with Bells Palsy 5/21/2021.


VAERS ID: 1350800 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-06
Onset:2021-05-19
   Days after vaccination:102
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray abnormal, Chest pain, Computerised tomogram thorax abnormal, Dyspnoea, Echocardiogram abnormal, Fibrin D dimer, Full blood count, Metabolic function test, Pulmonary embolism, Scan with contrast abnormal, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: atorvastatin 10 mg daily, B complex supplements, tumeric , vitamin C, vitamin D, coenzyme Q 10 prn diazepam, flexeril
Current Illness: None
Preexisting Conditions: dyslipidemia, Osteoarthritis, intermittent back pain, h/o skin cancer (melenaoma and Squamous cell ca)
Allergies: NKDA
Diagnostic Lab Data: Chest CT with and without contrast, Echo, Chest Xray, D Dimer CBC, CMP, (may 19, 20 2021)
CDC Split Type:

Write-up: patient developed an unprovoked (no antecedent ccause) multisegmental Pulmonary embolus. He developed chest pain, Shortness of breath, and tachycardia on Wednesday 19 May 2021 which continued to worsen until he was hospitalized on May 21 and diagnosed with the PE and possible pneumonia.


VAERS ID: 1350820 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-04-07
Onset:2021-05-19
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Arthritis
Allergies: Sulphur
Diagnostic Lab Data: Urgent care on 5/20
CDC Split Type:

Write-up: Shingles outbreak


VAERS ID: 1350847 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Hypoaesthesia, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, bilateral arm numbness and shoulder pain


VAERS ID: 1350848 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-05-17
Onset:2021-05-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Irritability, Mood altered, Suicide attempt
SMQs:, Suicide/self-injury (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad)

Life Threatening? Yes
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: Sertraline 100 mg PO qhs Intuniv 2 mg PO qhs Methylphenidate 5 mg PO daily.
Current Illness: None
Preexisting Conditions: ADHD Generalized Anxiety Disorder
Allergies: Canine Protein Containing Products (2+ reaction on allergy testing) Cat Hair Std Allergenic Ext (Itching) Tree Nut (Swelling)
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1-2 days after administration of vaccine, the patient had a week-long episode of moodiness and irritability. This culminated in a suicide attempt by hanging in his bedroom that was interrupted by his father. There is no prior history of suicide attempts and no other clear, identifiable triggers to this incident. After 7 days, the patient returned to his previous baseline of mood.


VAERS ID: 1350869 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Influenza like illness, Photophobia, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Lens disorders (broad), Corneal disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 2003 Flu vaccine
Other Medications: Klonopin
Current Illness: None known
Preexisting Conditions: None known
Allergies: Shell fish, some antibiotics
Diagnostic Lab Data: No
CDC Split Type:

Write-up: the first 36 hours was normal pain with flu type symptoms, now there''s vision changes and I had to go to the ER because it was really bothering me. They only helped with the anxiety and did an eye exam. It seemed to have gone away some but now it''s coming back and it''s like having dirty contacts in and having hypersensitivity to light and dark textures.


VAERS ID: 1350878 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-01-21
Onset:2021-05-19
   Days after vaccination:118
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Adenovirus test, Alanine aminotransferase increased, Aspartate aminotransferase increased, Asthenia, Atrioventricular block first degree, Blood alkaline phosphatase normal, Blood bilirubin decreased, Blood calcium, Blood chloride increased, Blood creatinine increased, Blood glucose decreased, Blood potassium normal, Blood sodium decreased, Blood urea increased, Bordetella test negative, Bundle branch block bilateral, COVID-19, COVID-19 pneumonia, Carbon dioxide decreased, Chest X-ray abnormal, Chlamydia test negative, Computerised tomogram head normal, Dyspnoea, Electrocardiogram abnormal, Enterovirus test negative, Fall, Fibrin D dimer increased, Haematocrit decreased, Haemoglobin decreased, Human metapneumovirus test, Human rhinovirus test, Hypoxia, Influenza A virus test negative, Influenza B virus test, Influenza virus test negative, Lung infiltration, Lung opacity, Mycoplasma test negative, Platelet count normal, Procalcitonin, Protein total decreased, Pyuria, Respiratory syncytial virus test negative, SARS-CoV-2 test positive, Sinus arrhythmia, Systemic inflammatory response syndrome, Ultrasound Doppler abnormal, Urine analysis abnormal, White blood cell count decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Disorders of sinus node function (narrow), Conduction defects (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Tubulointerstitial diseases (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (narrow), Infective pneumonia (narrow), Dehydration (broad), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: AmLODIPine (NORVASC) 5 mg tablet clopidogrel (PLAVIX) 75 mg tablet dexAMETHasone (DECADRON) 6 mg tablet diclofenac (VOLTAREN) 75 mg EC tablet fesoterodine (TOVIAZ) 8 mg tablet extended release 24 hr LORazepam (ATIVAN) 0.5 mg tablet metFORMI
Current Illness:
Preexisting Conditions: Nervous Cataract Diabetic neuropathy Diabetic retinopathy Respiratory Acute respiratory failure with hypoxia Circulatory Hypertension PVD (peripheral vascular disease) Digestive Diverticular disease of colon Gastroesophageal reflux disease Cobalamin deficiency Colon cancer Small bowel obstruction Musculoskeletal Arthritis Endocrine/Metabolic Hypercholesterolemia Type 2 diabetes mellitus Hypoglycemia Infectious/Inflammatory COVID-19 virus infection Other Ventral incisional hernia Hypovolemia
Allergies: Oxybutynin Ace InhibitorsCoughing FesoterodineItching VerapamilCoughing
Diagnostic Lab Data: 05/19/21 1754 Respiratory virus detection panel Collected: 05/19/21 1443 | Final result | Specimen: Swab from Nasopharynx Adenovirus Not Detected Mycoplasma pneumoniae Not Detected Chlamydophila pneumoniae Not Detected Parainfluenza Not Detected COVID-19 SARS-CoV-2 Overall Result DetectedCritical Enterovirus/Rhinovirus Not Detected Coronavirus Not Detected Respiratory Synctial Virus Not Detected Influenza A Not Detected Bordetella pertussis Not Detected Influenza B Not Detected Bordetella parapertussis Not Detected Metapneumovirus Not Detected Results from last 7 days Lab Units 05/23/21 0605 05/22/21 0544 05/21/21 0506 WBC AUTO K/mcL 6.5 4.5 4.5 HEMOGLOBIN g/dL 11.7 11.1* 11.3* HEMATOCRIT % 36.2 34.8 35.3 PLATELETS K/mcL 225 171 165 Results from last 7 days Lab Units 05/24/21 0447 05/23/21 0605 05/22/21 0544 05/21/21 0506 SODIUM mmol/L -- 136 136 134* POTASSIUM mmol/L -- 4.7 4.7 4.2 CHLORIDE mmol/L -- 110* 110* 108* CO2 mmol/L -- 16* 17* 17* BUN mg/dL -- 47* 45* 38* CREATININE mg/dL -- 1.67* 1.66* 1.70* CALCIUM mg/dL -- 8.1* 8.0* 7.9* TOTAL PROTEIN gm/dL 5.8* 5.8* -- 5.8* BILIRUBIN TOTAL mg/dL 0.3 0.3 -- 0.2* ALK PHOS IU/L 104 96 -- 96 ALT IU/L 48 37 26 25 AST IU/L 47* 46* -- 35 Pertinent Radiology Results: ECG 12-lead: HOSPITAL or TEST FACILITY Once Syncope Result Date: 5/19/2021 Measurements Intervals Axis Rate: 76 P: 13 PR: 239 QRS: -54 QRSD: 120 T: -8 QT: 412 QTc: 463 Interpretive Statements SINUS RHYTHM WITH SINUS ARRHYTHMIA WITH FIRST DEGREE AV BLOCK RIGHT BUNDLE BRANCH BLOCK [120+ ms QRS DURATION, UPRIGHT V1, 40+ ms S IN I/aVL/V4/V5/V6] LEFT ANTERIOR FASCICULAR BLOCK [QRS AXIS <= -45, QR IN I, RS IN II] POSSIBLE ANTERIOR MYOCARDIAL INFARCTION , PROBABLY OLD [30 ms Q WAVE IN V3/V4, OR R < 0.2 mV IN V4] Electronically Signed On 5-19-2021 15:20:20 EDT CT head without contrast Result Date: 5/19/2021 CT HEAD WO CONTRAST IMPRESSION: No acute intracranial pathology. END OF IMPRESSION: INDICATION: trauma trauma. Encounter: Initial. Automatic exposure control was utilized. Prior CT past 12 months: 0. TECHNIQUE: Spiral CT scan through the head from the skull base through the vertex was performed with 5 mm axial reconstructions. Images obtained without contrast. CONTRAST: No contrast was administered. COMPARISON: None available. FINDINGS: Senescent changes with findings of both atrophy and atherosclerotic encephalopathy. There is no abnormal intracranial blood, edema, mass effect, or midline shift. No extra-axial blood or fluid collection is observed. Except for hyperostosis frontalis interna the calvarium is normal. X-ray chest 1 view, Portable Result Date: 5/23/2021 Chest radiograph HISTORY: Hypoxia. Dyspnea. Covid 19 infection with virus detected on 5/19/2021. Comments: Frontal radiograph of the chest was obtained. Comparison is made to the prior study dated 5/19/2021. The heart is enlarged. The mediastinum is within normal limits. There are interstitial alveolar opacities in the bilateral lungs which could be due to pneumonia. This has slightly worsened since the prior study. There is no pneumothorax or pleural effusion. Osseous structures are stable. IMPRESSION: Slight worsening of interstitial alveolar opacities in the bilateral lungs probably the result of pneumonia. Follow-up is recommended. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. X-ray chest 1 view - Portable Result Date: 5/19/2021 XR CHEST 1 VW PORT INDICATION: hypoxemia. Encounter: Initial. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 10/10/2018. FINDINGS: Since the prior study are faint bilateral pulmonary infiltrates. Unchanged is chronic interstitial prominence as well as a calcified granuloma. Mild cardiomegaly and uncoiling of the thoracic aorta is stable. No pneumothorax or failure. IMPRESSIONS: Developing pulmonary infiltrates.: Ultrasound lower extremity venous bilateral Result Date: 5/22/2021 US LOWER EXTREMITY VENOUS BILATERAL IMPRESSION: No deep vein thrombosis of the bilateral lower extremities. END OF IMPRESSION: HISTORY: Elevated d dimer. Covid 19 infection detected on 5/19/2021. Initial encounter. Comment: Ultrasound examination of the bilateral lower extremities was performed utilizing grayscale and color duplex techniques. Permanently recorded images were obtained and stored. The right and left distal external iliac veins, common femoral veins, proximal, mid and distal segments of the femoral veins and popliteal veins demonstrate normal compression, venous waveform and color flow. There is also normal compression and color flow of the bilateral posterior tibialis and bilateral peroneal veins. T
CDC Split Type:

Write-up: ED to Hosp-Admission Discharged 5/19/2021 - 5/24/2021 (5 days) Last attending ? Treatment team Acute respiratory failure with hypoxia DETAILS OF HOSPITAL STAY Presenting Problem/History of Present Illness/Reason for Admission From admission " Patient is a 88 y.o. female who presents to the hospital today withincreasing weakness, falls over the last few days. She has not been eating or drinking well. It appears she recently started a sulfonylurea. EMS arrived blood sugar 58 and upon arrival to the ER blood sugar was 35 and she was lethargic. Given orange juice and a dextrose bolus with improvement of her blood sugar. Room air sat was 88% on room air however she only feels short of breath but she did not wear oxygen at home. Family member has Covid but she does not endorse any contact with them. In ED she was found to be positive for COVID19, with AKI and SIRS and internal medicine was asked to admit the patient." Hospital Course Patient mandatory medical surgical floor. She was found to have acute hypoxic respiratory failure due to COVID-19 pneumonia. She was found to be 88% on room air and was requiring 3 L of nasal cannula oxygen fourth her first 3 days of admission. She received treatment for her viral infection with IV remdesivir as well as IV dexamethasone to complete 5 days. She also was treated with azithromycin and ceftriaxone. However this was later stopped as her procalcitonin level was not negative. Because her urine showed pyuria she was continued on IV ceftriaxone. However her culture only grew 30,000 colonies of E. coli in 50,000 colonies of Streptococcus and get gnosis. She was fully treated for a UTI. She was successfully weaned off of oxygen onto room air on May 23 and remained stable overnight into the day of discharge. She was seen by physical therapy due to her history of ambulatory dysfunction and rehab was recommended for her. However the patient refused she felt that she had enough family support and assistance at home to return home. Home services were also recommended including home physical therapy which the patient also declined. She will need to follow-up with her family doctor in the next 7 days. A referral for pulmonology was also made on the day of discharge for 1-2 days.


VAERS ID: 1350892 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-26
Onset:2021-05-19
   Days after vaccination:54
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Abortion spontaneous, Exposure during pregnancy, Human chorionic gonadotropin, Ultrasound scan
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: prenatal vitamins
Current Illness: NA
Preexisting Conditions:
Allergies: allergic to gluten
Diagnostic Lab Data: ultrasound, HCG quantitative bloodwork
CDC Split Type:

Write-up: I was pregnant when I got my second shot (due date (1/2/2022). I subsequently had a pregnancy loss that started on 5/19/2021.


VAERS ID: 1350917 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-12
Onset:2021-05-19
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 2 LA / SYR

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

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

Write-up: My husband developed shingles


VAERS ID: 1350936 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-25
Onset:2021-05-19
   Days after vaccination:55
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B21-2A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Back pain, COVID-19, Chills, Computerised tomogram head, Diarrhoea, Dyspnoea exertional, Electrocardiogram normal, Headache, Lyme disease, Nausea, Pain, Pyrexia, SARS-CoV-2 test positive, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 mg tablet albuterol HFA (VENTOLIN HFA) 90 mcg/actuation inhaler amLODIPine (NORVASC) 2.5 mg tablet atorvastatin (LIPITOR) 10 mg tablet B2/vits A,C,E/lut/zeaxanth/min (ICAPS ORAL) cholecalciferol, vitamin D3, 50 m
Current Illness:
Preexisting Conditions: Nervous Migraine Respiratory Allergic rhinitis Mild intermittent asthma Obstructive sleep apnea syndrome Circulatory Benign essential hypertension Digestive Diverticular disease of colon Vitamin D deficiency Musculoskeletal Osteochondropathy Endocrine/Metabolic Benign neoplasm of adrenal gland Mixed hyperlipidemia Infectious/Inflammatory Lyme disease COVID-19
Allergies: Bee Venom Protein (Honey Bee)Swelling
Diagnostic Lab Data: Probable COVID-19 Specimen information: Swab / Nares Added: 5/19/2021 by POCT COVID-19 Antigen (Collected 05/19/21) Onset date: 5/19/2021 Resolve Add: Rule-Out COVID-19 and Respiratory Viruses Add: SARS-CoV-2 (related to COVID-19) Add: Rule-Out SARS-CoV-2 (related to COVID-19) Procedure Component Value Ref Range Date/Time CT head without contrast Resulted: 05/23/21 0922 Order Status: Completed Updated: 05/23/21 0922 Narrative: CT HEAD WO CONTRAST IMPRESSION: Normal END OF IMPRESSION: INDICATION: trauma. TECHNIQUE: Head CT was performed without contrast with multiple axial cuts obtained from the base of the skull to the vertex. CONTRAST: None Up-to-date CT equipment and radiation dose reduction techniques were employed. COMPARISON: . FINDINGS: There is no evidence of intracranial hemorrhage, extraaxial fluid collection, mass effect, or midline shift. The ventricles and cisterns are patent and nondilated. The visualized orbits and paranasal sinuses are normal. There is no evidence of acute stroke by CT. Osseous and soft tissue structures are normal.
CDC Split Type:

Write-up: COVID-19 Chills Body aches Fatigue, unspecified type Lyme disease Nausea and vomiting, intractability of vomiting not specified, unspecified vomiting type Acute nonintractable headache, unspecified headache type Dyspnea on exertion Acute midline low back pain without sciatica Diarrhea, unspecified type BMI 28.0-28.9,adult Close exposure to COVID-19 virus Fever, unspecified fever cause Care Coordination Progress Note RN (Registered Nurse) COVID 19 MAB Infusion Navigator Post Infusion Outreach #1 Infusion Date: 05/19/21 ED Course as of May 23 1036 Sun May 23, 2021 1025 EKG shows normal sinus rhythm rate 84 axis of 61. There is no acute ST or T wave changes noted. No signs of ST elevation. [RS] 1032 Patient was given meclizine and Zofran and saline. I reevaluated her. She says she is feeling much better. She is able to stand and walk without any difficulty. I discussed keeping her for MRI as we cannot completely rule out stroke. She verbalizes understanding of this. She still wishes to go home. She will get outpatient follow-up with her family doctor and return for worsening symptoms. We will give her a prescription for meclizine. Medication ? bamlanivimab/etesevimab ? casirivimab ? bamlanivimab


VAERS ID: 1351013 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Brachial plexopathy, Hypoaesthesia, Mobility decreased, Muscular weakness, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Neurologist wants to see me on June 11 2021 to run tests.
CDC Split Type:

Write-up: On May 19 2021 and 8 hours later I could not move or use my right hand. Pain, numbness, weakness still occurring a week later. Went to family doctor on Friday May 21 2021 and she diagnosed me with Brachial plexopathy from receiving the vaccine. Sent me to neurologist.


VAERS ID: 1351016 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-04-11
Onset:2021-05-19
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 7533 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amLODIPine (NORVASC) 5 mg tablet atorvastatin (LIPITOR) 20 mg tablet(Expired) CALCIUM ORAL cyclobenzaprine (FLEXERIL) 5 mg tablet docusate sodium (COLACE ORAL) famotidine (PEPCID) 20 mg tablet hydroCHLOROthiazide (HYDRODIURIL) 25 mg tablet
Current Illness:
Preexisting Conditions: Nervous Mild alcohol use disorder Respiratory Allergic rhinitis Obstructive sleep apnea Circulatory Essential hypertension Digestive Tubular adenoma of colon Gastroesophageal reflux disease Musculoskeletal Osteopenia Sweating increase Presence of right artificial knee joint Endocrine/Metabolic Mixed hyperlipidemia IFG (impaired fasting glucose) Other Depression, controlled Hepatitis C antibody test positive Aftercare following right knee joint replacement surgery
Allergies: RagweedItching, Other (document details in comments)
Diagnostic Lab Data: 05/18/21 0747 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 05/17/21 0845 | Final result | Specimen: Swab from Nasopharynx COVID-19 SARS-CoV-2 Overall Result DetectedCritical
CDC Split Type:

Write-up: Copied from. Topic: Medical Question $g$g May 19, 2021 10:51 AM wrote: Pt was to have a colonoscopy tomorrow and was informed that her Covid test returned with a positive result. Pt had her 2nd Covid vaccine on 4/11/21. Pt has been wearing a mask everywhere and social distanced and has not been exposed to anyone who is Covid +.


VAERS ID: 1351045 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Anxiety, Asthenia, Chills, Decreased appetite, Dizziness, Fatigue, Headache, Pyrexia, Restlessness, Sleep disorder
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Akathisia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (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? 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: Have not yet reported to a doctor but plan to go this afternoon or tomorrow if symptoms persist.
CDC Split Type:

Write-up: I received shot on Tuesday the 18th. The next afternoon I progressively became extremely fatigued and developed a fever and chills. This lasted into the weekend where I developed a severe headache for about 24 hours. After the headache subsided I continued to be fatigued with no appetite and dizziness. I''m unable to be upright for long and am extremely restless at night. I can''t sleep longer than a few hours before I wake up with my body feeling anxious. This is day 8 and I''m still weak and incredibly dizzy struggling to sleep at night.


VAERS ID: 1351081 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

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

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

Write-up: throat tightness/swelling


VAERS ID: 1351118 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-03-31
Onset:2021-05-19
   Days after vaccination:49
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Anticoagulant therapy, Deep vein thrombosis, Exposure during pregnancy, Groin pain, Swelling, Ultrasound Doppler abnormal
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Osteonecrosis (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)

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

Write-up: She is 11 weeks pregnant. On 5/19/2021 began feeling pain in her left groin area. Didn''t think too much about it. 5/20/2021 swelling and pain in left groin area. Went to urgent care. scheduled ultrasound. Blood clot in Left groin detected. Hospitalized and treated for clot with blood thinners.


VAERS ID: 1351120 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test normal, Contusion, Headache, Heart rate decreased, Injection site pain, Laboratory test normal
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad)

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

Write-up: Patient reports a bruise on left wrist appeared the day after vaccine administration (5/19). Followed by new, transient bruises to right abdomen and both ankles. Patient also reports headaches and frequent heartrate drops. Patient went to see Dr. with Health Systems and he reviewed lab work with patient indicating all blood levels are safe. Patient was prescribed pain medication for persisting pain at injection site that began today, 5/26, and encouraged to come back for a check-up in a few weeks.


VAERS ID: 1351122 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-30
Onset:2021-05-19
   Days after vaccination:109
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: COVID positive
CDC Split Type:

Write-up: 5/19/2021 - contracted COVID


VAERS ID: 1351161 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-12
Onset:2021-05-19
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Acetaminophen (TYLENOL) 500 mg tablet; Aspirin 81 mg tablet; Atorvastatin (LIPITOR) 40 mg tablet; Calcium carbonate (CALTRATE 600 ORAL); Candesartan (ATACAND) 16 mg tablet; Levothyroxine (SYNTHROID, LEVOTHROID) 150 mcg tablet; Metformin XR
Current Illness:
Preexisting Conditions: Nervous; Chest pain; Diabetic peripheral neuropathy (CMS/HCC); Abdominal pain; Respiratory; Hypoxia; Circulatory; Grade I diastolic dysfunction; Mild pulmonary hypertension (CMS/HCC); Aortic valve sclerosis; Mild mitral regurgitation by prior echocardiogram; Digestive; Obesity (BMI 30-39.9); Diverticulosis of large intestine without hemorrhage; Nausea and vomiting Foodborne gastroenteritis; Endocrine/Metabolic; Type 2 diabetes mellitus without complication, without long-term current use of insulin (CMS/HCC); Other hyperlipidemia; Hypothyroidism Hypokalemia; Hyponatremia; Other; Elevated LFTs
Allergies:
Diagnostic Lab Data: 05/19/21 1524 COVID-19 (SARS CoV-2,RNA Molecular Amplification) . Collected: 05/19/21 0932 | Final result | Specimen: Swab from Nasopharynx. COVID-19 SARS-CoV-2 Overall Result Detected Critical
CDC Split Type:

Write-up: UNKNOWN.


VAERS ID: 1351259 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-12
Onset:2021-05-19
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: dexlansoprazole (DEXILANT) 60 mg capsule eszopiclone (LUNESTA) 2 mg tablet fexofenadine (ALLEGRA) 180 mg tablet levothyroxine (SYNTHROID) 100 mcg tablet predniSONE (DELTASONE) 5 mg tablet VENTOLIN HFA 90 mcg/actuation inhaler
Current Illness:
Preexisting Conditions:
Allergies: AspirinHives / Urticaria NaproxenHives / Urticaria MorphineItching
Diagnostic Lab Data: 05/19/21 1524 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 05/19/21 0936 | Final result | Specimen: Swab from Nasopharynx COVID-19 SARS-CoV-2 Overall Result DetectedCritical
CDC Split Type:

Write-up: UNKNOWN


VAERS ID: 1351271 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-12
Onset:2021-05-19
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Computerised tomogram head normal, Computerised tomogram thorax normal, Dizziness, Dyspnoea, Hyperhidrosis, Loss of consciousness, Nausea, Scan with contrast, Syncope, Ultrasound Doppler normal
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin 81 mg tablet lisinopriL (ZESTRIL) 40 mg tablet predniSONE (DELTASONE) 20 mg tablet tamsulosin (FLOMAX) 0.4 mg capsule traZODone (DESYREL) 100 mg tablet
Current Illness:
Preexisting Conditions: Neoplasm of uncertain behavior of connective and other soft tissue Benign essential hypertension Coagulation defect (CMS/HCC) Hyperlipidemia
Allergies: Dilaudid [Hydromorphone]Anaphylaxis
Diagnostic Lab Data: 05/19/21 1525 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 05/19/21 0938 | Final result | Specimen: Swab from Nasopharynx COVID-19 SARS-CoV-2 Overall Result DetectedCritical CT angiogram chest pulmonary embolism with and without contrast [3284247929] Resulted: 05/20/21 2125 Order Status: Completed Updated: 05/20/21 2125 Narrative: CTA CHEST PULMONARY EMBOLISM W WO CONTRAST IMPRESSION: 1. Normal CT chest. 2. No evidence pulmonary embolism. 3. No acute airspace disease in the chest. END OF IMPRESSION: INDICATION: Covid positive, high concern for pulmonary embolism TECHNIQUE: 2 mm axial images from the lung apices to the adrenal glands were obtained. Images also viewed in sagittal and coronal reconstruction. 3-D shaded surface display, Maximum Curved Intensity Projection (MIP) and multiplanar reconstructions were performed on an independent workstation and permanently recorded. Images of the chest were also obtained. CONTRAST: 80mL of IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION administered INTRAVENOUS. COMPARISON: 3/8/2015 FINDINGS: Heart and mediastinum: No mediastinal or hilar adenopathy. Heart size normal. Good enhancement pulmonary arteries. No filling defects. Lungs: Clear. No nodules or masses. Pleural space: Clear. Bones: No focal lesions. Soft tissues: Images including the upper abdomen are normal. No axillary lymphadenopathy. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. CT head without contrast [3284247930] Resulted: 05/20/21 2118 Order Status: Completed Updated: 05/20/21 2118 Narrative: CT HEAD WO CONTRAST IMPRESSION: 1. No evidence of acute intracranial hemorrhage or acute cortical-based infarct at this time. 2. No gross intracranial mass. 3. Incidental tiny metal foreign body in right forehead scalp soft tissues END OF IMPRESSION: INDICATION: Multiple syncopal episodes TECHNIQUE: Axial images from skull base to vertex of head were obtained. COMPARISON: None available. CONTRAST: No IV contrast was administered. FINDINGS: Ventricles: Normal. Brain parenchyma: Normal. No areas of abnormal high or low attenuation. Midline shift: None. Mass effect: None. Extra-axial collection: None. Calvarium and skull base: Intact. Soft tissues: Tiny metal foreign body in right frontal scalp soft tissues This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. Ultrasound lower extremity venous left [3284247981] Resulted: 05/20/21 2058 Order Status: Completed Updated: 05/20/21 2058 Narrative: US LOWER EXTREMITY VENOUS LEFT IMPRESSION: No ultrasound evidence of left thigh or proximal calf vein DVT. END OF IMPRESSION: INDICATION: Left leg pain. TECHNIQUE: Grayscale, color-flow, and duplex Doppler sonography of the deep venous system of the left lower extremity was performed. Permanently recorded images were obtained and stored. COMPARISON: None available. FINDINGS: All veins are normally compressible from the common femoral vein to the popliteal vein. Normal color flow and Doppler waveforms. Visualized segments of proximal calf and saphenous vein are also unremarkable. Normal color flow and Doppler signal in the contralateral right common femoral VEIN
CDC Split Type:

Write-up: ED to Hosp-Admission Current 5/20/2021 - present (6 days) Last attending ? Treatment team Syncope and collapse Principal problem History of Present Illness a 66 y.o. yo male presenting to the ED with syncope. Patient is diagnosed with COVID-19. He has passed out twice today. He feels lightheaded and nauseous prior to passing out. He wakes up feeling diaphoretic. Denies chest pain. Admits to shortness of breath and the feeling of difficulty getting a deep breath in. Patient denies history of blood clots, recent unilateral leg swelling or edema, hemoptysis.


VAERS ID: 1351321 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Anion gap, Chills, Dehydration, Hypoaesthesia, Hypokalaemia, Nausea, Toothache
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Dehydration (narrow), Hypokalaemia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Labs notable for anion gap and hypokalemia, suspect related to dehydration, ED administered IV fluids and encouraged PO hydration.
CDC Split Type:

Write-up: Student went to emergency department with compliant of wisdom tooth pain, chills, numbness and nausea on 5/19/21, the day after his second dose of vaccine.


VAERS ID: 1351396 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW 0186 / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Cough, Fatigue, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, Chills, Body Ache, Fatigue, Cough


VAERS ID: 1351420 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Palpitations
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

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

Write-up: Tightness of chest around the heart and heart palatations.


VAERS ID: 1351470 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-14
Onset:2021-05-19
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032B21A / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Adenocarcinoma pancreas, Pancreatic mass
SMQs:, Non-haematological malignant tumours (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient hospitalized on 4/23/21 and 5/19/21. These visits are within 6 weeks of receiving COVID vaccination. Diagnoses were mass of pancreas and pancreatic adenocarcinoma, respectively.


VAERS ID: 1351476 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 2 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Acute myocardial infarction, Chest pain, Electrocardiogram normal, Fibrin D dimer, Myocarditis, Troponin increased
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 5/21/21: troponin 7.42
CDC Split Type:

Write-up: Student started having chest pain the next day on 5/19/2021. Seen at student health on 5/21/21 for atypical chest pain. Had normal EKG. Labs drawn for D-Dimer and troponin. Sent to ED next day when troponin came back at critical level - 7.42. He was admitted from ED to hospital 5/22/21 with myocarditis - discharged on 5/52/21 with final Dx of Non-ST elevation myocardial infarction, Of note he has a twin who was diagnosed with myocarditis last year.


VAERS ID: 1351494 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain upper, Blood test normal, Computerised tomogram abnormal, Dizziness, Hyperhidrosis, Malaise, Movement disorder, Nausea, Neck pain, Pain in extremity, Retching, Subdural haematoma, Troponin normal, Urine analysis abnormal, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Accidents and injuries (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ibuprofen, losartan, tramadol, rovustatin, aspirin, ubidecarenone/vitamin E, hydrochlorothiazide
Current Illness: Was diagnosed with UTI in ED on 05/21/2021
Preexisting Conditions: Pre-Diabetes, ASCVD, osteoarthritis, dysphagia, Schatzki''s ring of distal esophagus, Vit D deficiency, osteopenia, joint pain, HTN, vision changes, hyperlipidemia
Allergies: Ace inhibitors, atorvastatin, duloxetine, gabapentin, meperidine
Diagnostic Lab Data: CT scan showed subdural hematoma UA showed positive E. coli for UTI troponin levels negative Other bloodwork unremarkable
CDC Split Type:

Write-up: Pt called and stated she received her vaccine on 05/18/2021, started having arm and neck pain, nausea, lightheadedness, stomach cramping, on 05/19/2021 in the afternoon. She sat up to get some saltine crackers to help her feel better, and she started to get dizzy. She then remembers trying to hold herself up, and then the next thing she recalls is laying on her back on her kitchen floor. It was then she felt dizzy again and then sat herself up enough so she could vomit 3 times. She also reported having profuse sweating and dry heaves. Her husband found her about 30 minutes later when he returned home from picking up lunch for them. She refused to go in the hospital to get checked out until she called her PCP on 05/21/2021 because she still was not feeling well. They recommended that she go into the ER. She had a CT scan, UA, troponin levels checked, and other blood work. Was treated with IV lactated ringers in the ER, and given meclizine for the dizziness. UA showed positive E. coli, indicative of a UTI. Pt chose to be discharged home instead of staying overnight because she stated she would get plenty of rest at home. Spoke with pt 05/25/2021 after she had called to let us know what happened. Pt has scheduled additional CT scan on 06/08/2021 and follow-up with a neurologist 06/10/2021.


VAERS ID: 1351497 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Dyspnoea, Fatigue, Heart rate increased, Nausea, Pain
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Dehydration (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: Levora birth control pill
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Aside from the usual chills, body aches, etc, I ended up calling my doctor over a separate concerning issue - very high heart rate. I woke up at 8am the day after getting my 2nd Pfizer dose, walked to use the restroom, walked back to bed, and laid back down. Within a couple minutes I noticed my heart felt like it was racing and I was out of breath as if I had just come back from a jog, not a trip to the restroom. Heart rate continued fluctuating from 105-115bpm just laying in bed. Was also feeling fatigued, nauseous, dizzy when standing up, and with slight difficulty breathing. Called advice nurse after 30min of no change. They had me check heart rate manually (had been going off FitBit), and timing was consistent with what FitBit was reading . Nurse advised to keep resting and drink lots of water, scheduled follow-up with a Doctor later in the morning. It should be noted that I had been alternating between water and Pedialyte constantly all day, starting 5/17 through when this happened (and then the next few days as well), so I should not have been dehydrated. Follow-up call with Dr. (on-call Dr., not my usual one) was scheduled for 11:45am, and by then all concerning heart symptoms had passed. The Dr. basically reiterated what the nurse had told me, in keeping up with fluids. And that sometimes temperature change, even if you don''t completely get a fever, can cause a high heart rate. As more information is coming out regarding younger people developing myocarditis after the mRNA vaccines however, I wanted to mention this in case it could possibly be related.


VAERS ID: 1351514 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Cough, Malaise, Pain, Pneumonia, Pyrexia, SARS-CoV-2 test positive, Streptococcus test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Covid positive pneumonia postive
CDC Split Type:

Write-up: 6 hours after she started feeling VERY ill. Body aches, fever, cough. she went to urgent care 3 days later and tested positive for covid. 2 days after that she tested positive for pneumonia. SHe was perfectly healthy before this shot.


VAERS ID: 1351602 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-17
Onset:2021-05-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Computerised tomogram abdomen, Computerised tomogram abnormal, Hydronephrosis, Mass, Pyrexia, Septic shock, Vaginal discharge
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (narrow), Toxic-septic shock conditions (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: morphine, promethazine, apixaban minocycline, and moxifloxacin completed 5/11/21
Current Illness: pelvic abscess with drain placement 4/6/21 and abx: moxifloxacin and minocycline to continue through 5/11/21.
Preexisting Conditions: history of pelvic myofibroblastic inflammatory pseudotumor in the rectovesical pouch s/pTURBT complicated by nonfunction bladder hydronephrosis and recurrent UTIs
Allergies: cyclobenzaprine (anaphylaxis) chlorhexidine (burn, blisters) amoxicllin, meperidine, oxycodone (GI intolerance, N/V) adhesives, fentanyl, latex, biopatch, daptomycin, meropenem, alcohol swabs, tegaderm silver (rash) sulfa (unknown) hydromorphone (urinary retention, GI intolerance)
Diagnostic Lab Data: 5/19 - CT abdomen pelvis: -3.1 x 6.9 cm collection noted with some superior to the bladder and some possible phlegmon developing as well. Some soft stranding is increased with some inflammation likely due to the pseudotumor. -some vaginal drainage is present, likely related to known fistula -s/p IR drainage 05/22 of retropubic abscess with hx of fistula: -+ Ecoli, Efaecalis, strep anginosus -s/p right PCN placement by IR 5/22 for bilateral hydronephrosis
CDC Split Type:

Write-up: Patient presented to ED with increased abdominal pain, vaginal drainage, fever to 39.2, pulse in 140''s and SPB in the 90s, septic shock presumed pelvic abscess. abdominal pain worse than usual with sudden increase 5/17 -5/19. Clinical suspicion for vaccine-related AE is low.


VAERS ID: 1351680 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-04-01
Onset:2021-05-19
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Lethargy, Loss of personal independence in daily activities, Vertigo
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D3, B12 Glucosamine Probiotic
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe dizziness, vertigo, fatigue, lethargy Unable to continue normal routine of activity


VAERS ID: 1351696 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-02-21
Onset:2021-05-19
   Days after vaccination:87
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH E19266 / 2 RA / SYR

Administered by: Public       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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril Carvedilol Statan Lodipine becate Levothyroxine
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Doc visit and prescribe medication for one week
CDC Split Type:

Write-up: Bell?s Palsy on left side of face/eye


VAERS ID: 1351850 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Discomfort, Dizziness, Dyschromatopsia, Hyperhidrosis, Muscle spasms, Tinnitus
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), 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: Daily Marijuana user, 100mg CBD isolate powder/day
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Within 2 minutes of receiving shot, overwhelming deadening of sound, blackness in eyes, full body sweats, full body discomfort, very close to fainting for first 6-8 minutes. As those symptoms started to diffuse severe muscle cramping started in opposite arm of shot, moved thru body. Within 15 minutes the only symptoms left were the muscle cramps. Those continued for several days. Still lingering today, a week later.


VAERS ID: 1352541 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 6W0176 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Blood test, Pain in extremity, Swelling, X-ray
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Pravastatin, Lisinopril, Januvia, Meloxicam, Loratadine, RePHresh Probiotic, Shaklee Stress Relief Complex, Shaklee Mindworks and Shaklee Vitalizer Vitamin Strip
Current Illness: None
Preexisting Conditions: Diabetes, High Blood Pressure, Arthritis, Seasonal Allergies
Allergies: Penicillin
Diagnostic Lab Data: Blood test and Xrays (5/26/2021)
CDC Split Type:

Write-up: Beginning the next day, I started to experience an achy feeling in my upper arm, it traveled down to my lower arm, then by the net day i felt the aching feeling in my wrist. It then went into my other right arm by 3 days post shot. Now all of my joints ache and are uncomfortable all the time (legs and arms). I am having issues picking up heavy items without pain. I feel like I am swollen in all of my joints. I otherwise feel great


VAERS ID: 1352732 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-30
Onset:2021-05-19
   Days after vaccination:50
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nuvaring, Benicar, glucosamine chondroitin, calcium, vitamins
Current Illness: No
Preexisting Conditions: Migraines
Allergies: Dust, mold, and mayflies.
Diagnostic Lab Data: I have shingles.
CDC Split Type:

Write-up: 7 wks after I got shingles, not sure if related.


VAERS ID: 1352737 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: Saline diluent used a second time for a second pfizer vial . No adverse events reported


VAERS ID: 1352740 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: Saline diluent used a second time for a second pfizer vial . No adverse events reported


VAERS ID: 1352744 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: Saline diluent used a second time for a second pfizer vial . No adverse events reported


VAERS ID: 1352747 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Saline diluent used a second time for a second pfizer vial . No adverse events reported


VAERS ID: 1352749 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 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? 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: Saline diluent used a second time for a second pfizer vial . No adverse events reported


VAERS ID: 1352751 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: Saline diluent used a second time for a second pfizer vial . No adverse events reported


VAERS ID: 1352981 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Washington  
Vaccinated:0000-00-00
Onset:2021-05-19
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Pain in extremity
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210536089

Write-up: SLIGHT LEFT SIDE CHEST PAIN BELOW NIPPLE; SORE ARM; This spontaneous report received from a patient concerned a male of unspecified age. 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: 205A21A, and 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 slight left side chest pain below nipple. On 19-MAY-2021, the subject experienced sore arm. The action taken with covid-19 vaccine was not applicable. The patient had not recovered from slight left side chest pain below nipple, and sore arm. This report was non-serious.; Sender''s Comments: V0: Medical assessment comment not required as per standard procedure as the case is assessed as non serious.


VAERS ID: 1353601 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-11
Onset:2021-05-19
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 RA / -

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Eye swelling, Headache, Hypersensitivity, Lip swelling, Paraesthesia, Pruritus, Sneezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SYNTHROID; PLAQUENIL [HYDROXYCHLOROQUINE SULFATE]; METOPROLOL; FAMOTIDINE; ALPRAZ
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure high; Kidney disorder; Lupus erythematosus; Penicillin allergy; Thyroidectomy
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021567892

Write-up: Tingling in face; headache; sneezing; itching; light headness and dizzy; lips swelling; eye swelling; like an allergies; This is a spontaneous report from a contactable consumer (patient). A 66-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE; lot number: EW0173 and expiration date was not reported), via an unspecified route of administration in right arm, on 11May2021 at 10:45 (at the age of 66 years old) as first dose, single for COVID-19 immunization in a hospital. Medical history included stage 3 kidney disease, systemic lupus erythematosus, high blood pressure and thyroidectomy. The patient''s known allergies: penicillin. The patient previously took dilaudid and prednisone; and experienced drug allergy. Concomitant medications included levothyroxine sodium (SYNTHROID); hydroxychloroquine sulfate (PLAQUENIL); metoprolol; famotidine and alprazolam (ALPRAZ). The patient was not pregnant at the time of vaccination and did not receive any other vaccines within 4 weeks prior to the COVID vaccine. Prior to vaccination, the patient was not diagnosed with COVID-19 and since the vaccination, the patient was not tested for COVID-19. The patient experienced tingling in face, headache, sneezing, itching, light headedness/dizzy, lips swelling, eye swelling and had like an allergies on 19May2021 at 09:00. This case was considered non-serious and no treatment was given for these events. The outcome of these events was not recovered at the time of report.


VAERS ID: 1353604 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-05-17
Onset:2021-05-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021569078

Write-up: Vomiting; This is a spontaneous report from a contactable consumer (patient). A 13-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE; lot number: EW0187 and expiration date was not reported), via an unspecified route of administration in left arm, on 17May2021 at 16:45 (at the age of 13 years old) as 1st dose, single for COVID-19 immunization in a pharmacy/drug store. The patient''s medical history was not reported. There were no concomitant medications. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. Prior to vaccination, the patient was not diagnosed with COVID-19 and since the vaccination, the patient was never tested for COVID-19. The patient experienced vomiting on 19May2021. This event resulted in doctor or other healthcare professional office/clinic visit. The event was non-serious. It was reported that the patient received an unspecified treatment for this event. The outcome of the event was recovering at the time of report.


VAERS ID: 1353610 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / UNK RA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Allergy to nuts
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021575948

Write-up: Patient felt dizzy after couple of minutes of receiving the vaccine.; This is a spontaneous report from a non-contactable consumer (patient). A 12-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, solution for injection, Lot Number: EW0185), via an unspecified route of administration at right arm on 19May2021 (at the age of 12-year-old) as unknown, single for COVID-19 immunisation. Medical history included allergies: Cashews. Patient other medical history was none. The patient''s concomitant medications were not reported. Facility where the most recent COVID-19 vaccine was administered was other. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient had not been tested for COVID-19. On 19May2021, patient felt dizzy after couple of minutes of receiving the vaccine. Treatment was not received for the adverse event. Due to event Doctor or other healthcare professional office/clinic visit. The events were assessed as non-serious, did not result in death, not life threatening, did not cause/prolonged hospitalization, not disabling/incapacitating, did not cause congenital anomaly/birth defect. The outcome of the event was recovered in May2021. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1353634 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 1 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Injection site induration, Injection site swelling, Pain of skin, Pruritus
SMQs:, Anaphylactic reaction (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? 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:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Raised, firm, swollen red patch at injection site. Painful to the touch for 3 days after injection. Patch remains sames size 1 week after injection and has become itchy.


VAERS ID: 1353749 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 2 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Body temperature increased, Influenza like illness, Oral herpes
SMQs:, Neuroleptic malignant syndrome (broad), Oropharyngeal infections (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

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

Write-up: 14 hrs after the vaccine, developed flu symptoms. beginning at 14 hrs, started taking temperature and did so every half-hour. At hour 18, temp was 100.9, 30 min later, 101.5, 30 min later, 102.0, 30 min later, 102.7. when temp reached 1019, spouse began to administer cold-wet cloth to heated areas, e.g., stomach and lower back, spouse continued until for 45 min, until temp dropped to 101.5. checked temp every hour after that, until dropped below 100.0. Temp returned to normal roughly 25 hrs after vaccine administration. 68 hrs after vaccine administration, developed cold sores. Normally, the cold sore would manifest in an area no more than 5% of upper lip area, After the COVID vaccine, the cold sore covered 35% of upper lip area, and lasted about 24 hours longer than it normally would. lasted 5 days vice 3 - 4 days, normally.


VAERS ID: 1354151 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-11
Onset:2021-05-19
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anticoagulant therapy, Deep vein thrombosis, 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? Yes
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: Losartan 100 mg Atorvastatin 20 mg Nifedipine ER 90mg ProAir HFA 108mcg
Current Illness: Post-COVID19 dyspnea
Preexisting Conditions: pre diabetes hypertension morbid obesity dyslipidemia
Allergies: no known allergies
Diagnostic Lab Data: Venous doppler of the Right lower extremity. Impression: Deep vein thrombosis involving the mid and distal right femoral vein and the right popliteal vein.
CDC Split Type:

Write-up: acute DVT, oral anti coagulant medication, outcome TBD


VAERS ID: 1354248 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-11
Onset:2021-05-19
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Injection site erythema, Injection site pain, 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), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? 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-Medium, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Systemic: Chills-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Fever-Medium


VAERS ID: 1354318 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Night sweats, Pain
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omeprizol daily, mulit vitamin, Tylenol pm in the evening for aches and chills associated with vaccine
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Still having aches, chills, and sweating at night over a week later. I had the same shot the day before and my issues were gone 48 hours later.


VAERS ID: 1354338 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-17
Onset:2021-05-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Contusion, Lymphadenopathy, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (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: 1 gram valtrex daily; 180mg fexofenadine HCI antihistamine (Allegra) as needed (roughly daily for 3 months prior to vaccine)
Current Illness:
Preexisting Conditions:
Allergies: Typical sensitivity to zinc oxide (sunscreen)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hives located over lymph nodes. The first reaction appeared behind my right knee (54 hours after second dose) which has been the most severe of all occurrences to date and left bruising as the swelling went down. The following week, additional spots appeared and faded from stomach, hips, inner thighs, under arms, right knee, and side of neck. Currently, I have new hives developing on my inner forearm (right) and wrist (left), waistline, hips, back and side of neck. A lymph node at the back of my neck/base of skull is swollen (I have not noticed any other swelling of the lymph nodes themselves, just the skin over top). I have continued taking an antihistamine allergy pill for relief, topical itch cream (Benadryl) has not been noticeably effective.


VAERS ID: 1354341 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Chills, Contusion, Diarrhoea, Fatigue, Food aversion, Headache, Heavy menstrual bleeding, Hot flush, Menstruation irregular, Myalgia, Nausea, SARS-CoV-2 test, SARS-CoV-2 test negative, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Fertility disorders (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Severe swelling, throat closure, severe rash over chest and neck. Any time I get a TDAP. Last known event was 2009
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Eggs, Vicodin, TDAP, first Covid shot
Diagnostic Lab Data: Negative Covid test 05/21/2021. Got another 05/26/2021 awaiting results
CDC Split Type:

Write-up: Period started a week early and is still happening 9 days later (I have never had a period longer than 5 days in my entire life, nor has it ever been early and I tracking meticulously). Extreme fatigue, bruising all over body, sever headache, severe aversion to food, nausea, vomiting, diarrhea, muscle soreness in arms and legs, joint soreness especially in elbows and knees, alternating chills and hot flashes


VAERS ID: 1354392 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-11
Onset:2021-05-19
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Myalgia, Pain, Pruritus, Swelling
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Muscular and surface pain (worse than the previous week), mild swelling, red skin, then itching a few days later. Itching is still present


VAERS ID: 1354470 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C2A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Computerised tomogram, Swelling face
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:
Other Medications: ollie vitamins
Current Illness:
Preexisting Conditions:
Allergies: penicillin
Diagnostic Lab Data: ct scan
CDC Split Type:

Write-up: swelling on eft side of face


VAERS ID: 1354566 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / UNK - / IM

Administered by: Other       Purchased by: ?
Symptoms: Cough, Pruritus, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient reports having a history of allergic reaction with first vaccine. Per patient she reports symptoms of hives, itching and syncope. Patient Pulse ox 98%, Hr 97, BP 114/68. Patient does have a history of allergies, POTTS. Patient felt itching, throat tightness, and cough after second vaccination (similar to first. Patient did not require EPI with first vaccin. On evaluation lungs sound clear, no edema. Patient took Benadryl 50mg and was provided Pepcid 20mg. Patient was observed for 30 minutes. Patient was discharged home with parent.


VAERS ID: 1354582 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

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

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

Write-up: rash and soreness in shoulder. headaches, chills, fatigue, etc.


VAERS ID: 1354596 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tomoxafin, losortin
Current Illness: None
Preexisting Conditions: High blood pressure
Allergies: Sulfa drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Bells Palsy right side of face, symptoms started within 1 hour of injection.


VAERS ID: 1354609 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Reporting vaccine mix-up; Not an ADR Pt was given the Pfizer vaccine as his 2nd dose of a COVID vaccine, however, after administration it was realized he received Moderna for his 1st dose. Pt was not concerned as he had read an article that it may be beneficial to receive 2 different types of COVID vaccines. He felt fine after additional observation/length of stay and went home.


VAERS ID: 1354693 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-05-06
Onset:2021-05-19
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW161 / 2 LA / SYR

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

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

Write-up: Approximately 2 weeks later developed what I thought was hives on left side my neck and left. Lots of itching and it became extremely painful. After visiting the doctor on 5/27/2021, I was advised I had a bad case of shingles. Was given medication for 10 days and steroids.


VAERS ID: 1354716 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-17
Onset:2021-05-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Pain, Rash, 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: Hydrochlorothiazide 25mg daily, Losartan Potassium 100mg daily, Spironolactone 50mg twice a day, Centrum Silver multivitamin daily, Probiotic 10 daily, Zinc 50mg daily, D3 125mcg daily, Iron 65mg daily
Current Illness: N/A
Preexisting Conditions: High Blood Pressure
Allergies: Sulfa and Penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 5/17/21 body aches and fatigue in evening, Slept all 5/18/21. 5/19/21 broke out in rash/hives/itching on neck and head. Took Benadryl and rash and itching went away after 2 hours. 5/20/21 rash returned on head, neck, torso, arms. Took 2 Benadryl and symtoms resolved in about 2 hours. Continue to break out every day including today (resolves with Benadryl). PCP notified today 5/27/21.


VAERS ID: 1354738 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Paraesthesia oral, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad)

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

Write-up: Patient stated prior to vaccine that she had itching and throat tightness after her first Pfizer vaccine from Pharmacy. It was resolved by PO Benadryl. Patient took 25 mg Benadryl PO prior to receiving 2nd Pfizer vaccine. After vaccine, patient reported throat tightness, mouth tingling, and shortness of breath. Epipen 0.3mg SubQ was administered. Patient taken to ER. Given methylprednisolone 125mg x 1 before discharge from ED with prednisone prescription.


VAERS ID: 1354802 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Axillary pain, Dysgeusia, Dysphagia, Ear discomfort, Enlarged uvula, Feeling abnormal, Hyperhidrosis, Lip swelling, Lymph node pain, Lymphadenopathy, Palatal disorder, Retching, Sensory disturbance, Swollen tongue, Tenderness, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal allergic conditions (narrow), 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), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Shingles vaccine, about 5 years ago. It took 3 days before I noticed a problem with my arm. It felt very heavy. When looking
Other Medications: Simvastatin, Omeprazole, OTC CVS brand Zertec
Current Illness:
Preexisting Conditions: Sluggish gall bladder, and hiatal hernia. Constant GERT.
Allergies: Codeine, tomatoes, shellfish, halibut, spinach. These have been verified by doctors. Extremely sensitive to smells - can cause sensation on lips and tongue, sneezing, watery eyes, and/or severe headache. Bought a new shampoo and just the act of rinsing my hair in the shower caused my body to itch all day. ( I assumed it was due to the shampoo suds touching my body.) Decongestants give me an upset stomach.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Immediate extremely strong metallic taste in mouth. Tongue and lips a little puffy. Very inflamed lymph nodes in neck. Metallic taste went to gums, and I could feel the metal taste scallop across my teeth, from left to right. Felt a sweaty sensation on top of head, like I had a bowl on top of my head. Metallic taste started going down my throat. Soft palate swollen causing gagging due to uvula touching my tongue. Could feel the sensation on my head inching its way down my head. It stopped at the hairline above my ears, which made me think that I was getting in feeling in my hair follicles and not a sweaty sensation. Stayed 70 minutes at site. Metallic taste mostly gone. I was told to pick up some Benedryl. As soon as I took it I felt a strong pounding in my ears. When eating dinner I could feel a slight constriction while swallowing. The next morning the lymph nodes in my armpits were extremely sore. Neck lymph nodes stopped being sore Saturday, but are still a little swollen. Lymph nodes in arm pits were better on Sunday, but are still sore if pushed on.


VAERS ID: 1354837 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-04-29
Onset:2021-05-19
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 LA / SYR
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER EW0164 / 2 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Dehydration, Menstruation delayed, Pregnancy test negative
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Fertility disorders (broad), Dehydration (narrow)

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

Write-up: Dehydration over 3- 4 weeks plus delay in menstrual cycle by 10 days so far- hospital Administered pregnancy test is negative. Hormones do not indicate menopause stage. Previous period was 4/22/2021-


VAERS ID: 1354960 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Agitation, Dysgeusia, Frequent bowel movements, Insomnia, Muscle spasms
SMQs:, Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient received a steroid shot within 2 weeks of vaccination
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: After receiving his second Moderna Vaccine the patient developed severe muscle cramps, metallic taste, agitation/loss of sleep, and stomach upset. He noticed an increase in stooling after eating, however stools were solid. The muscle cramps and mood changes mostly subsided after 7 days, however on day 8 (5/27/21) he was still experiencing taste changes, gi upset, and was having difficulty sleeping. I guided the patient on some symptom relieve and instructed him to contact the pharmacy or his doctor if the symptoms worsened or did not resolve within another 7 days. He felt he was on his way to the symptoms improving and would report any changes.


VAERS ID: 1354991 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-07
Onset:2021-05-19
   Days after vaccination:132
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Cerebrovascular accident, Computerised tomogram abnormal, Echocardiogram, Electrocardiogram, Gait inability, Hypoaesthesia, Intensive care, Laboratory test, Magnetic resonance imaging abnormal
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dystonia (broad), Guillain-Barre syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Losartan, levothyroxine,estroldial, protonix,Flonase, singulair, edecrin,Maxalt as needed,
Current Illness: NA
Preexisting Conditions: Hypertension, hypothyroidism
Allergies: Sulga, reglan
Diagnostic Lab Data: multiple labs MRI twice CT twice Echo EKG
CDC Split Type:

Write-up: left side numbness,unable to walk. Went to ER immediately and code stroke was called. Received TPA and went to ICU


VAERS ID: 1355070 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 2 - / 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:

Write-up: gave first dose at age 17 guidance was to proceed and complete second dose as she was in age 16-17 range


VAERS ID: 1355088 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Pain
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: losartan, calcium, vitamin D, zin
Current Illness: none
Preexisting Conditions: since the day I got the vaccine, the area is really red, she feels pain in that area, and it is getting worse every day
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: the area where s


VAERS ID: 1355091 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-05-17
Onset:2021-05-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW167 OR LW167 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Lymphadenopathy, X-ray
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flonase
Current Illness: None
Preexisting Conditions: None
Allergies: Seasonal, Raw carrots, raw Celery
Diagnostic Lab Data: Blood tests and x-ray
CDC Split Type:

Write-up: Large swollen lymph node on top of collar bone


VAERS ID: 1355147 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Chills, Cough, Diarrhoea, Dizziness, Dysgeusia, Headache, Hyperhidrosis, Hypoaesthesia, Lacrimation increased, Lethargy, Lymphadenopathy, Migraine, Muscle spasms, Pain in extremity, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Lacrimal disorders (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: I cannot have the flu shot. Was hospitalized three years in a row.
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Tree nuts, green dye, coconut
Diagnostic Lab Data: None. Kept being told it was "normal".
CDC Split Type:

Write-up: 105 degree temp for 4 days Softball-size lymph node under left arm for 6 days Vomiting/diarrhea for 2 days Headache/migraine for 3 days Whole-body spasms for 4 days Chills/sweats for 3 days Dizziness for 1 week Lethargy for 6 days Complete numbness in pinky and ring finger and side of palm for 5 days Throbbing arm for 7 days Metallic taste in mouth for 1 week Excessive watery eyes for 4 days Hard cough for 5 days Chest tightness/pain for 5 days


VAERS ID: 1355184 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-16
Onset:2021-05-19
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blister, Urticaria, Vaccination site pain, Vaccination site vesicles
SMQs:, Severe cutaneous adverse reactions (broad), 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Started hives on day 3 that turned into painful blister on vaccine arm. Has continued to spread to other parts of my body. Still having new hives and blisters on Day 12. Itchy, red.


VAERS ID: 1355280 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Injection site erythema, Injection site pain, Injection site swelling, Pain, Pain in extremity, 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), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft,Clonazepam,Abilify and Singulair
Current Illness:
Preexisting Conditions: HBP,Depression
Allergies: milk, pollen,cat,dog, roach
Diagnostic Lab Data: Patient was seen at Urgent Care and given prescriptions for ibuprofen 600 gms to take one tablet as 3 times a day as needed and cleomicym 300 mgs to take one capsule 3 times a day for 10 days.
CDC Split Type:

Write-up: Redness, pain and swelling on the area of injection and radiated to all the arm up to the hand.


VAERS ID: 1355327 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 RA / IM

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

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

Write-up: Patient entered birthdate of 2002 at first vaccination, which would have made him 18 years old. When presenting for the 2nd vaccination, he told us his birth year was 2003, which makes him 17 years, and not eligible for Moderna. We completed the series since we started it.


VAERS ID: 1355391 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-07
Onset:2021-05-19
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: adderall, methocarbamol, gabapentin, buspirone, venlafaxine, and cetirizine
Current Illness: N/A
Preexisting Conditions: fibromyalgia
Allergies: penicillin and gluten food
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: itchy rash on top of hands and around wrists


VAERS ID: 1355544 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-04-20
Onset:2021-05-19
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Myalgia, Nausea, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 2000 iu D3, 1000 mcg B12
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore arm for several days from vaccine #1. Chills, muscle aches, nausea, headache, fatigue, sore arm starting 1/2 day after vaccine #2. Continued feeling poorly for 1 1/2 days, a little better the following day, much improvement on the 3rd day.


VAERS ID: 1355785 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-13
Onset:2021-05-19
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038AZ1A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037A21B / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Electrocardiogram ambulatory, Extrasystoles, Heart rate increased, Hypoaesthesia, Sinus rhythm, Sinus tachycardia, Ventricular extrasystoles
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Ventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: clonazepam
Current Illness: none
Preexisting Conditions: none
Allergies: demerol
Diagnostic Lab Data: Type of monitor : 48 hour Holter monitor
CDC Split Type:

Write-up: Felt like couldnt catch breath , skipping feeling in chest went to doctor he placed me on holter monitor. Interpretation: Underlying rhythm is sinus rhythm/sinus tachycardia, heart rate ranges between 58 beats per minute to 149 beats per minute, average heart rate 96 beats per minute. Episodes of sinus tachycardia are seen. QRS duration is within normal limits. Rare, Isolated PVCs. No significant arrhythmias or heart blocks were noted. Patient''s reported symptoms of chest pain, skipped heartbeats, numbness in the hands, shortness of breath correlated with sinus rhythm or sinus tachycardia. Conclusions: 1. Predominant underlying rhythm is sinus rhythm with episodes of sinus tachycardia; average heart rate high normal at 96 beats per minute. 2. No other significant arrhythmias or heart blocks were noted. 3. Patient''s reported symptoms of chest pain, skipped heartbeats, numbness in the hands, shortness of breath correlated with sinus rhythm and sinus tachycardia.


VAERS ID: 1355799 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / SYR

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

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

Write-up: Skin on hands and feet are peeling, both fingers and toes are red, raw and sensitive to the touch


VAERS ID: 1356044 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-12
Onset:2021-05-19
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Diarrhoea, Rash
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Severe diarrhea started on 5/19/2021, with loose stool and/or stomach cramping until 5/24/2021. On 5/23/201, started breaking out with a rash. This rash was diagnosed as shingles on 5/27/2021.


VAERS ID: 1356316 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Decreased appetite, Dyskinesia, Migraine, Myalgia, Nausea, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Dyskinesia (narrow), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Migraine 2 days on day two took 1 Excedrin, nausea and vomiting 2 days, loss of appetite 6 days, joint and muscle pain lower body, back and arms 5 days, involuntary muscle movement 5 days,


VAERS ID: 1356344 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Pruritus, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Trazadone. Escitalipram. Cholestryamine
Current Illness:
Preexisting Conditions:
Allergies: Milk. Nickel
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Severe swelling, redness, pain, itching.


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