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From the 1/21/2022 release of VAERS data:

Found 1,049,249 cases where Vaccine is COVID19 and Patient Did Not Die

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 133 out of 10,493

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VAERS ID: 2001707 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-17
Onset:2021-12-28
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril, Krill-Oil, Allegra
Current Illness: None
Preexisting Conditions: Hyper-tension
Allergies: None Known
Diagnostic Lab Data: n/A
CDC Split Type:

Write-up: Hives beginning on 28 December 2021 and still occurring as of 4 January 2022. Slight reduction with prednisone 5 days, after the five days symptoms worsened. Also taking hydroxyzine, famotidine.


VAERS ID: 2001719 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: New York  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 3 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Blood glucose increased, Chest X-ray, Condition aggravated, Diabetes mellitus, Diabetic ketoacidosis, Intensive care, Laboratory test, SARS-CoV-2 test, Staphylococcus test, Urine ketone body present
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Novolog, Victoza, Lovaza, Losartan, Fiber, Calcium, Repatha, Daily Vitamin and aspirin.
Current Illness: None
Preexisting Conditions: Diabetes, high blood pressure, high cholesterol and anemia.
Allergies: Lortab, statins, Metformin, Lisinopril and hazelnut.
Diagnostic Lab Data: Urgent Care did BG, ketone urinalysis and labs to confirm DKA. ER performed additional testing and started DKA protocol. When admitted to ICU, further testing was done along with chest xray, covid and mersa testing.
CDC Split Type:

Write-up: Three hours after receiving the booster shot, I experienced BG''s in the 480 range and after multiple boluses of 14 units of Novolog, the BG''s just increased. I repeated the insulin bolus twice without any change. Fell asleep and when I awoke, it was no better. Went to Urgent care later that afternoon after drinking more water didn''t help. I was in full DKA which Urgent Care confirmed. Was transferred from Urgent Care to Medical facility where I was admitted and stayed for 4 days.


VAERS ID: 2001737 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045J21A / 3 LA / IM

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

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

Write-up: Moderna vaccine given instead of Pfizer for 16yo female


VAERS ID: 2001763 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-12-18
Onset:2021-12-28
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood culture, Blood lactic acid, C-reactive protein increased, Chills, Discomfort, Dysphagia, Gram stain positive, Nausea, Oedema, Oesophageal spasm, Oesophagogastroduodenoscopy, Papule, Pyrexia, Skin abrasion, Urticaria, Vomiting
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: fluticasone loratadine famotidine
Current Illness: Dermatitis
Preexisting Conditions: Allergic rhinitis Eosinophilic esophagitis Latent EBV
Allergies: No known medication allergies. Likely Legume allergy. Adhesive allergy NOS
Diagnostic Lab Data: Lactic acid 3.9 on admission. Blood culture: no result available Posterior scalp gram stain: gram + rods CRP 138 at discharge and climbing.
CDC Split Type:

Write-up: Intensely pruritic papules on left anterior forearm, contralateral to injection site. Over course of 12 hrs, bilateral arm ''welts'', spreading to buttocks and groin also bilaterally. 20 hrs after onset, shaking chills w/ fever of 101.7---ibuprofen taken. Woke 2 hrs later at ~2AM on 12/29/21 with pruritic papules of the posterior scalp, serous yellow discharge from excoriation sites at the posterior scalp, and diffuse anterior and posterior subcutaneous edema. Symptoms of dysphagia had also been occurring throughout the day. Admitted to hospital @9AM. Welts coalescing and flattening, more clearly diffuse urticaria. Discharged on steroids, antibiotics 12/30/21 after improvement in edema, urticaria. Readmitted to hospital 1/1/22 after nausea and vomiting overnight; I was unable to keep steroids, antihistamines down. Worsening esophageal symptoms continuing to worsen, feeling like esophageal spasms, worse when lying flat for a few hours and waking me up in considerable discomfort. EGD performed at hospital 1/2/22 showed no visible signs of pill esophagitis, esophageal ulcers, or strictures related to Eosinophilic Esophagitis history.


VAERS ID: 2002076 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-11
Onset:2021-12-28
   Days after vaccination:320
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 000000 / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cough, Sneezing
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Taking Fish Oil 1000 MG Capsule 1 capsule Orally before bed, Taking Metoprolol Succinate ER 100 MG Tablet Extended Release 24 Hour 1 tablet Orally Once a day, Taking Cialis 20 MG Tablet 1 tablet as needed Orally every 24 hrs, Taking Gabapen
Current Illness:
Preexisting Conditions: Barretts esophagus - last endoscopy 3/21, Eczema, Obesity, Htn, Due for colonoscopy in 2022. HTN
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: nonproductive cough, sneezing. starting 12/28/21


VAERS ID: 2002212 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-09-28
Onset:2021-12-28
   Days after vaccination:91
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / UNK RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Dysphonia, Pain, Pyrexia, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omepraviol 40mg once daily
Current Illness: No
Preexisting Conditions: Heart Murmur
Allergies: No
Diagnostic Lab Data: COVID test and listern to lungs and observation and blood pressure. Normal temperature at time of visit. Fever presented after 02:00 PM daily.
CDC Split Type:

Write-up: 12/28/ 2021 fever, body aches and body pain and fever , running nose and congestion. 12/30/2021Cough presented and continued with the running nose and fever. 12/30/2021 Went to get tested for COVID and was diagnosed. Fever presented after 02:00 PM daily. Voice is still changed, slight cough and some congestion.


VAERS ID: 2002675 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-27
Onset:2021-12-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 060H21A / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthritis reactive, Feeling hot, Joint effusion, Pain
SMQs:, Haemodynamic oedema, effusions and fluid overload (narrow), Conjunctival disorders (narrow), Ocular infections (broad), Arthritis (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine, Qvar, Albuterol, Hydroxyzine, Metoprolol, spironolactone
Current Illness: none
Preexisting Conditions: Essential hypertension, prediabetes, obesity, asthma
Allergies: None
Diagnostic Lab Data: pending and ordered today: Xray, rheumatoid panel
CDC Split Type:

Write-up: left knee effusion without trauma or prior history of knee issue. warmth, some pain. ? reactive arthritis. started 1 day following vaccine.


VAERS ID: 2004211 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-10-30
Onset:2021-12-28
   Days after vaccination:59
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Diabetes mellitus inadequate control, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), 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), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: baby aspirin, atorvastatin, Centrum Silver MVI, Genvoya, glimepiride, Januvia, losartan, metformin ER, Prezista
Current Illness:
Preexisting Conditions: HIV (compliant with HAART therapy), non-insulin-dependent diabetes mellitus, hypertension, hyperlipidemia
Allergies: dapsone
Diagnostic Lab Data: COVID status positive 12/28/21.
CDC Split Type:

Write-up: Patient received Moderna COVID vaccine on 2/27/21 (lot # 002A21A), 3/27/21 (lot # 026B21A), and 10/30/21 (lot # 014F21A). On 12/28/21, patient tested positive for COVID. On 12/29/21, patient admitted to our facility med/surg unit for acute hypoxemic respiratory failure and pneumonia due to COVID-19 and uncontrolled diabetes type 2. Patient was provided with remdesivir for 4 days. On 1/2/22, patient decided to leave the hospital AMA (against medical advice) after a thorough discussion of risks of leaving the hospital. He declined oxygen therapy at discharge. He was sent a prescription to complete his course of Dexamethasone in an attempt to improve his tenuous respiratory status (the risks of worsening respiratory decompensation are greater at this time to his life than elevated glucose that may result from steroid use).


VAERS ID: 2004224 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-19
Onset:2021-12-28
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183-H / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asymptomatic COVID-19, Cholangiogram, Cholecystectomy, Cholelithiasis, Laparoscopic surgery, Obstructive pancreatitis, SARS-CoV-2 test positive
SMQs:, Gallbladder related disorders (narrow), Biliary tract disorders (narrow), Gallstone related disorders (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Norco PRN pain, Zofran PRN nausea
Current Illness:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: COVID status positive 12/28/21.
CDC Split Type:

Write-up: Patient received Pfizer COVID vaccine on 4/28/21 and 5/19/21. On 12/28/21, patient admitted with cholelithiasis and gallstone pancreatitis to undergo laparoscopic cholecystectomy and cholangiogram. Patient was found to be COVID positive upon admission, but asymptomatic from respiratory point of view throughout the hospitalization. Patient was discharged home on 12/30/21 after recovering from surgery.


VAERS ID: 2004266 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 331308A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angina pectoris, Anxiety, Chest discomfort, Cognitive disorder, Dizziness, Dyspnoea, Fatigue, Pain, Sleep disorder
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None, forgone visit to ER as I am not sure when to go or how severe it should become before seeking any help.
CDC Split Type:

Write-up: Initially I felt fine. I went home from the shot and took a nap. Upon getting up I had severe anxiety and mild dizziness. As both faded away when I went out to do grocery shopping that night, I began to feel a heaviness in my heart with a constant pain best described as an ache. A week later I still have this ache and shortness of breath to the point where I have been unable to sleep and very much considered going to the ER but hesitated as I don''t know how much they would just brush off my condition. The pain in my heart isn''t followed by palpitations but I generally feel slower, fatigued and when I feel the pain it is enough of a distraction to make me feel like I am cognitively absent and or "Out of It." I work out every day, do not drink and or do drugs. I am what I would consider to be in excellent to superior health.


VAERS ID: 2005480 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-12-09
Onset:2021-12-28
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33130BA / 3 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Rosuvastatin 10mg Levothyroxine .088mg Metformin 1500mg Multi-vitamin Vitamin D3 Aspirin 81mg
Current Illness: No
Preexisting Conditions: Diabetes II Hyperlipidemia Hypothyroidism Osa Sleep Apnea
Allergies: None
Diagnostic Lab Data: After this booster, he wasn''t feeling well and tested positive for COVID
CDC Split Type: vsafe

Write-up: Bad Cough, Fever


VAERS ID: 2005641 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-10
Onset:2021-12-28
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1611 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram, Cerebrovascular accident, Computerised tomogram head, Magnetic resonance imaging head
SMQs:, 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)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations: PFIZER COVID-19 VACCINE 02/14/2021 - palpitation afterwards for a month but since resolved without need for any medications or
Other Medications: lo-loestrin fe
Current Illness: none
Preexisting Conditions: psoriasis
Allergies: none
Diagnostic Lab Data: CTangio/CT brain 12/28/2021 MRI brain 12/29/2021
CDC Split Type:

Write-up: Left M1 MCA stroke in 45 year old female with no hypertension/no hypercholestrolemia/no diabetes)


VAERS ID: 2005661 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 3 LA / IM

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

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

Write-up: PATIENT RECEIVED AN EXPIRED DOSE OF THE PFIZER BOOSTER VACCINE.


VAERS ID: 2005668 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 3 LA / IM

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

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

Write-up: PATIENT RECEIVED AN EXPIRED DOSE OF THE PFIZER BOOSTER VACCINE.


VAERS ID: 2005681 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 3 LA / IM

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

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

Write-up: PATIENT RECEIVED AN EXPIRED DOSE OF THE PFIZER BOOSTER VACCINE.


VAERS ID: 2005692 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 3 LA / IM

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

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

Write-up: PATIENT RECEIVED AN EXPIRED DOSE OF THE PFIZER BOOSTER VACCINE.


VAERS ID: 2005699 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 3 LA / IM

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

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

Write-up: PATIENT RECEIVED AN EXPIRED DOSE OF THE PFIZER BOOSTER VACCINE.


VAERS ID: 2005705 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 1 LA / IM

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

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

Write-up: PATIENT RECEIVED AN EXPIRED DOSE OF THE FIRST PFIZER VACCINE.


VAERS ID: 2005712 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 1 LA / IM

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

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

Write-up: PATIENT RECEIVED AN EXPIRED DOSE OF THE FIRST PFIZER VACCINE.


VAERS ID: 2005857 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 3 LA / IM

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

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

Write-up: PATIENT RECEIVED AN EXPIRED DOSE OF THE PFIZER BOOSTER VACCINE.


VAERS ID: 2005861 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 3 LA / IM

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

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

Write-up: PATIENT RECEIVED AN EXPIRED DOSE OF THE PFIZER BOOSTER VACCINE.


VAERS ID: 2005865 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 3 LA / IM

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

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

Write-up: PATIENT RECEIVED AN EXPIRED DOSE OF THE PFIZER BOOSTER VACCINE.


VAERS ID: 2005873 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-12-17
Onset:2021-12-28
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 RA / IM

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

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

Write-up: PATIENT EXPERIENCED HIVES AND WAS SEEN AT AN URGENT TREATMENT CLINIC. PRESCRIBED STEROID ORAL AND TOPICAL. PT FOLLOWED UP WITH PCP WHO ALSO PRESCRIBED FURTHER STERIODS


VAERS ID: 2005909 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Chest pain, Electrocardiogram, Pleurisy
SMQs:, Systemic lupus erythematosus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Levaquin
Diagnostic Lab Data: Chest X-ray, EKG, and blood work. Jan 1 2022.
CDC Split Type:

Write-up: After getting the booster shot I started having pain in my chest couple hours after shot. Gradually getting worse each day. Ending up in the ER at local hospital. Diagnosis was pleurisy. I''ve not been sick or do I take any medications. I do not smoke and in very good shape.


VAERS ID: 2005920 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059H21A / 3 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Headache, Lethargy, Sinus pain, Toothache
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: age 44. 03/29/21 Moderna 038A21A. 04/26/21 Moderna 038A21A
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Booster shot 8 months after 2nd COVID shot. All 3 have been moderna. Extreme fatigue, moderate headache that comes and goes, extreme lethargy, sinus/tooth pain. No fever. No cough.


VAERS ID: 2005931 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-12-27
Onset:2021-12-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8757 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Lymphadenopathy, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: none
Preexisting Conditions: Congenital mitral valve regurgitation
Allergies: no
Diagnostic Lab Data: None, I only took ibuprofen to help with pain and swelling.
CDC Split Type:

Write-up: I had swelling under my left arm in the underarm area, which I assumed was swollen lymph nodes. This swelling and pain lasted more than 48 hours


VAERS ID: 2005983 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chills, Dizziness, Fatigue, Headache, Migraine, Oropharyngeal pain, Pyrexia, SARS-CoV-2 test
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Gabapentin Buprohen 300 Lexapro 20mg
Current Illness:
Preexisting Conditions: Anemia Gastric Bypass
Allergies:
Diagnostic Lab Data: Covid test (PCR done and a regular)
CDC Split Type:

Write-up: Sore throat, fever, severely dizzy, severe headache (mostly migraine), chills, fatigue.


VAERS ID: 2006009 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-12-27
Onset:2021-12-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / SYR

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

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

Write-up: Moderately severe tinnitus noticed morning after shot and has not resolved.


VAERS ID: 2006020 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 20155A / 3 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Migraine
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Gabapentin; Ajovy; multivitamin; vitamin D
Current Illness: No
Preexisting Conditions: Chronic migraines
Allergies: Nickels
Diagnostic Lab Data: No
CDC Split Type: vsafe

Write-up: Within an hour of vaccine I got a terrible migraine. I have had it for about a week now. Went to urgent care, the first time I got a shot, the second time I got an IV fluid with medication.


VAERS ID: 2006226 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-18
Onset:2021-12-28
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 3 RA / -

Administered by: Public       Purchased by: ?
Symptoms: Anti-thyroid antibody, Blood thyroid stimulating hormone decreased, Exposure during pregnancy, Fatigue, Temperature intolerance, Thyroxine free decreased, Tri-iodothyronine decreased, Tri-iodothyronine free
SMQs:, Hypothyroidism (broad), Hyperthyroidism (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal Vitamin
Current Illness: None
Preexisting Conditions: Tested low normal range for THS in 2014
Allergies: None
Diagnostic Lab Data: 12/28/2021: TSH level .04 uIU/mL. 12/29/2021: TSH .04 uIU/mL, Free T4 0.6 ng/dL, T3 Total 127 ng/dL, T3 Free 2.2 pg/mL, Thyroperox Abs < 5 IntlUnit/mL.
CDC Split Type:

Write-up: Extreme fatigue and cold intolerance. One previous pregnancy (unremarkable with no complications). Expected due date: May 19, 2022. Tested thyroid. Treatment plan is to retest hormone levels in 6 weeks. 20 week ultrasound showed no fetal abnormalities.


VAERS ID: 2006250 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-12-20
Onset:2021-12-28
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blister, Insomnia, Peripheral swelling, Pruritus, Rash, Rash pruritic, Thrombosis, Urticaria, Vaccination complication
SMQs:, Cardiac failure (broad), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Suboxone
Current Illness:
Preexisting Conditions: Ehlers Danlos Syndrome, Celiac Disease
Allergies: Nubain, Versed, Morphine
Diagnostic Lab Data: No tests have been run other than observation by 4 doctors....3 ER docs and 1 Dermatologist.
CDC Split Type:

Write-up: On December 20,2021, I received the Moderna Booster shot. Then, on December 28, I noticed a rash that formed on my left neck the same side I received the shot on ?It itched , but I managed that first night. Then Wednesday, December 29th, the rash became much worse. Thursday morning at 4:45am I woke itching so bad that I could barely stand it and the hives had begun to spread to more parts of my body and in the middle of that night I was taken to the ER for the first time and was told it was chigger bites and was given 25 mg injection of Benadryl and a script for Hydroxyzine. The hives got larger and continued to spread and the itching became even worse, so I returned to ER for the 2nd time and was still told it was chiggers and was given a shot of Toradol and Neosporin to rub on my hands were I had developed large blisters of which I have pics. 24 hours later I was MUCH worse on all accounts and had almost no sleep in days because of non-stop itching and now my feet are overcome with hives and blisters and have swollen to the point that I can barely get on my shoes. I was taken to the ER for the 3rd time on New Year?s Eve and was given an injection of 50mg of Benadryl and a referral to see a Dermatologist. Unfortunately, it was now a holiday weekend and I had to wait in misery till Monday, January 3rd to see a specialist who finally said, all 3 ER doctors failed to take a History which is true. Not a single one of those docs asked about when I had my list Covid Vaccination which had only been a week earlier. Then, the Dermatologist said, ?this is NOT chigger bites but a severe reaction to the Moderna Booster and you have severe Thrombosis Uticaria. He is trying to prevent a worsening of the situation with HIGH doses of Prednisone and aspirin to thin my blood to reduce any further blood clots. Today, is January 5th and I see the Specialist again later this afternoon.


VAERS ID: 2006265 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066H21A / 3 RA / SYR

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

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

Write-up: Fever, Chills, Body Aches...


VAERS ID: 2006293 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-12-20
Onset:2021-12-28
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / SYR
FLU4: INFLUENZA (SEASONAL) (AFLURIA QUADRIVALENT) / SEQIRUS, INC. - / 1 LA / SYR
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, SARS-CoV-2 test negative, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), 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: Triamterene losartan phenytoin b-12, fish oil, turmeric, magnesium, cranberry, condjointran, glucosimen,
Current Illness: None
Preexisting Conditions: None
Allergies: penicillin
Diagnostic Lab Data: Dr. prescribed steroid, and cough medication. Completed the prescriptions, tested negative for covid 01/03/2022. Test Name 2019 RNA Virus
CDC Split Type:

Write-up: Developed a cough, and went to Dr. on 28, December 2021. Tested positive for covid


VAERS ID: 2006309 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: New York  
Vaccinated:2021-12-17
Onset:2021-12-28
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067H21A / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Escitalopram 20mg
Current Illness: None
Preexisting Conditions: Depression
Allergies: No known (may be allergic to penicillin)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Eleven days after booster shot of Moderna, hives and dermatographia began, spreading across both hips, inner thighs, up back onto neck and behind ears. Next day video consult with doctor who prescribes 40mg prednisone for four days. Symptoms begin to improve on prednisone (2 days at 40mg, 4 days at 20mg), along with Cetrizine 10mg/day and one Benadryl each night. Today, day nine, second day without prednisone, symptoms are greatly improved, though small areas or red itchy skin appear periodically and dermatographia may still occur, depending upon pressure exerted on skin and part of body.


VAERS ID: 2006317 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-20
Onset:2021-12-28
   Days after vaccination:342
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / UNK - / -

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

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

Write-up: Covid positive through family contact


VAERS ID: 2006326 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-14
Onset:2021-12-28
   Days after vaccination:258
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Anal incontinence, COVID-19, Confusional state, Hypoxia, SARS-CoV-2 test positive, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Noninfectious diarrhoea (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: dementia COPD
Allergies: unknown
Diagnostic Lab Data: 12/28/2021: SarsCOV2 positive
CDC Split Type:

Write-up: 12/28/2021: Event occurred after 2nd vaccine. 82 yo M with PMHx of dementia and COPD who presents via EMS after his grandson found him sleeping in his garage next to his car. pt was alert but confused and noted to be wheezing. He is incontinent to feces at baseline. Was hypoxic at 88% doing well on 4 L.


VAERS ID: 2006469 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-12-14
Onset:2021-12-28
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Chest pain, Dyspnoea, Electrocardiogram, X-ray
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad)

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

Write-up: PATIENT CALL 01/05/21 TO LET US KNOW SHE HAS BEEN HAVING CHEST PAIN AND SHORTNESS OF BREATH SINCE SHE HAS RECIEVED THE VACCINE ON 12/14/21. SHE WENT TO EMERGENCY ROOM 12/28/21 HAD X-RAY AND EKG. PATIENT SAYS HAS HAD ELEVATED BLOOD PRESSURE. WENT TO EMERGENCY ROOM AGAIN 01/04/21 FOR SAME REASONS. STAYED FOR 7 HOURS WAS NEVER SEEN. STILL COMPLAININ OF CHEST PAIN. PATIENT TOLD TO FOLLOW UP WITH PCP


VAERS ID: 2006541 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-12-27
Onset:2021-12-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA ? / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Fatigue, Headache, Loss of personal independence in daily activities, Malaise, Muscle spasms, Myalgia, Oedema peripheral, Pain, Peripheral swelling, Rhinorrhoea
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Dementia (broad), Dystonia (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (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: Moderna COVID-19 vaccine number two on May 5, 2021. I got quite sick for about a week after this vaccination.
Other Medications: Curamin, omega-3 fish oil, vitamin D3, vitamin C, women?s mega food multivitamins, magnesium glycinate
Current Illness: Recovering from adverse reactions to steroids and antibiotics from cataract eye surgery on November 10. Still having intermittent stomach problems. Effects of antibiotic eyedrops are definitely systemic.
Preexisting Conditions: Fibromyalgia, recovering from chronic fatigue syndrome over many years.
Allergies: Slight allergies to eggs, dairy, wheat, corn. Bigger allergies to soy, dogs, pollen, dust mites, mold, dust., alcohol. Floraquinolones, tobramycin, Steroids.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I got a flu shot simultaneous to my COVID-19 booster at the same time at pharmacy on the same day. I don?t know the name of the flu shot so I am unable to enter it Very sick on day two and three and pretty sick on day four. Extreme swelling in left arm pit and arm with a great deal of pain for four days. Runny nose for almost one week, headaches for one week, extreme fatigue for one week. A lot of muscle pain for the first few days but by the end of the week muscle spasms in upper back, chest tightness, persistent fatigue and all over body pain. Too tired to function.


VAERS ID: 2006552 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-11-01
Onset:2021-12-28
   Days after vaccination:57
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Nasal congestion, Pyrexia, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: PCR + for Covid on 1/1/2022
CDC Split Type:

Write-up: Vaccinated with Pfizer vaccines in November and December 2021. Symptoms started on 12/28 - nasal congestion, fever x few hours. Resolution of symptoms within 3 days.


VAERS ID: 2006776 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 331308A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pallor, Peripheral swelling, Pruritus, SARS-CoV-2 test negative, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft 50mg once daily
Current Illness: None
Preexisting Conditions: Autism Spectrum
Allergies: NKDA
Diagnostic Lab Data: COVID-19 PCR Test 12/28/2021 after reaction [Negative]
CDC Split Type:

Write-up: I was with my 16 year old daughter for her booster COVID-19 vaccine #3 at Pharmacy [Fax unknown]. ~5 minutes post shot she developed marked swelling/hives of palm of left hand under second digit and on thumb and then on right palm/thumb. No respiratory distress and no GI distress. I took her to PCP Dr. at 4:15pm for evaluation of worsening generalized hives/itching . I gave her 25 mg Benadryl immediately in store when reaction began which I had in my purse. Her PCP recommended Zyrtec 10mg BID and to use Benadryl for breakthrough hives. She was very pale on 1/1/2022 but afebrile and only hives. As of 1/5/2022 today she continues with intermittent waves of generalized hives on abdomen, neck, thighs, face which wax and wane and are worse at night. She seems like she is getting better slowly.


VAERS ID: 2009762 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3302580 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Diarrhoea, Dizziness, Dyskinesia, Fatigue, Insomnia, Muscle twitching, Nausea, Neurological symptom, Pain, Paraesthesia, Tinnitus
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Dyskinesia (narrow), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (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: Zyrtec
Current Illness:
Preexisting Conditions: Asthma
Allergies: Penicillin, erythromycin, sulfa, pollen, dust, cats
Diagnostic Lab Data: PCP visit Jan 3 2022 Allergist visit Dec 30 202 Going for a blood test next week
CDC Split Type:

Write-up: Serious neurological issues (shooting pains, tingling, muscle twitching, jerky movements of the leg muscles making it impossible to sleep, dizziness, tinnitus...) Diarrhea (still going after 9 days) Nausea Tiredness Dizziness


VAERS ID: 2010047 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-12-27
Onset:2021-12-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33025BD / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Sexual dysfunction (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: Lamicatal for epilepsy
Current Illness:
Preexisting Conditions: cancer survivor, epileptic, autoimmune
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: The next day my injection site swelled up like a bee sting. It was huge. My arm also felt number. Next day it was less swollen but the whole area was a huge bloch of red and hot to the touch for about 3 days. The last two days it was itchy. Now I''m fine.


VAERS ID: 2010079 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-08
Onset:2021-12-28
   Days after vaccination:234
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Diarrhoea, Dyspnoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: CKD Stage IV, diabetes , CVA
Allergies: unknown
Diagnostic Lab Data: 12/28/2021: External report of COVID positive result.
CDC Split Type:

Write-up: 12/28/2021: Event occurred after 2nd vaccine. 80-year-old female past medical history of CKD stage IV, diabetes, CVA presenting for cough, shortness of breath, diarrhea.


VAERS ID: 2010087 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3197 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site erythema, Injection site induration, Injection site mass, Injection site pain, Injection site pruritus, Injection site swelling, Injection site warmth, Interchange of vaccine products, Vaccination complication
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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: Still experiencing symptoms from the 1st and 2nd dose of Moderna.
Other Medications: Loratadine
Current Illness: None
Preexisting Conditions: Hives from second dose of Moderna
Allergies: Dust mites, pollen, cats, NSAIDs
Diagnostic Lab Data: None
CDC Split Type: vsafe

Write-up: About 12 hours after the vaccine, I started getting redness, swelling and a hard lump at the site of the vaccine. It also felt warm to the touch. About 24 hours later, it was about 2-3 inch in diameter and was very red, itchy and hot. About 48 hours later, it was still the same. I called the doc on tele doc, where I was told that I may have a strong reaction to the vaccines and I could take a steroid or use cream. Over the next few days, it decreased in swelling, redness went down and it wasn''t as hard as before. As of yesterday, the pain seems to have subsided. It appears today as a mild bruise.


VAERS ID: 2010095 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Delaware  
Vaccinated:2021-10-03
Onset:2021-12-28
   Days after vaccination:86
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Cough, Exposure to SARS-CoV-2, Oropharyngeal pain, SARS-CoV-2 test positive, Sinus congestion
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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: Losartan, Potassium 50mg, Levocetirizine 5mg., Flonase, Montelukast
Current Illness: no
Preexisting Conditions: Hypertension
Allergies: seasonal allergies
Diagnostic Lab Data: 4-COVID-19-positive
CDC Split Type: vsafe

Write-up: I had exposure to COVID on 12/5 but had no symptoms but on 12/8 I tested positive to COVID. Between 12/10-12/13 I took multiple test which were all negative but on 12/28 I developed a sore throat which turned into a cough and sinus congestion and on 1/1 I took an at home COVID test and it was positive as well, followed by 2 more additional test one of which was a PCR and all were positive as well. My symptoms are resolving current


VAERS ID: 2010167 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-25
Onset:2021-12-28
   Days after vaccination:306
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002A21A / UNK - / -

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

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

Write-up: Covid positive through contact with family member


VAERS ID: 2010187 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Computerised tomogram, Dizziness, Headache, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Labetlol and Niephine
Current Illness: None
Preexisting Conditions: Controlled blood pressure
Allergies: Some fish. All fruits. Amoxicillin, Penicillin, Morphine, Codeine, any medicine ending in Pryil, sulfa
Diagnostic Lab Data: The Emergency room did a CT scan and completed bloodwork
CDC Split Type:

Write-up: After receiving the Moderna booster, I have had a headache, dizziness and blurry vision for over a week. This is horrible.


VAERS ID: 2010192 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-02
Onset:2021-12-28
   Days after vaccination:301
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cardiomegaly, Chest X-ray abnormal, Chest pain, Dyspnoea, Pleural effusion, Pulmonary oedema, Respiratory distress, SARS-CoV-2 test positive, Syncope, Visceral congestion, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: End stage renal disease On dialysis, COPD, Diabetes
Allergies: unknown
Diagnostic Lab Data: 12/28/2021: Chest Xray- No significant change in degree of interstitial pulmonary edema with cardiomegaly, bilateral pleural effusions, central vascular congestion and curly B lines. 12/28: SarsCOV2 - positive
CDC Split Type:

Write-up: 12/28/2021: Event occurred after 2nd vaccine. Patient had a syncopal event during his hemodialysis session early today. Patient tested positive for Covid-19 in current admission. Hx of COPD, CAD, post CABG. COPD on 2 to 3 L of oxygen at home, Denies any fever, chills, nausea, vomiting or diarrhea. During evaluation of the patient, he got short of breath and was experiecing increase work of breathing through purse lips. Patient having moderate chest pain. He had an episode of vomiting. Nitro did not improved the chest pain. He was placed on a non rebreather mask and received breathing treatments which mildly improved his respiratory distress and his chest pain.


VAERS ID: 2010196 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-29
Onset:2021-12-28
   Days after vaccination:274
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B212A / UNK - / -

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

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

Write-up: Covid positive through family contact


VAERS ID: 2010206 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / UNK - / -

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

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

Write-up: Covid positive through family member. Client received booster but it had not bee 2 weeks


VAERS ID: 2010219 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-05
Onset:2021-12-28
   Days after vaccination:267
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest pain, Dyspnoea, Muscle spasms, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: He does have insulin-dependent diabetes hyperlipidemia and hypertension.
Allergies: unknown
Diagnostic Lab Data: 12/28/2021: SarsCov2- positive
CDC Split Type:

Write-up: 12/28/2021: Event occurred after 2nd vaccine. 64-year-old gentleman presents the emergency department for evaluation of shortness of breath. Patient denies any productive cough, fevers, chills, nausea vomiting. He did have some mild left-sided chest pain associated with this. Symptoms resolved. Patient also notes that he had cramping in his left calf today which is atypical for him.


VAERS ID: 2010254 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-28
Onset:2021-12-28
   Days after vaccination:275
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Dyspnoea, Lung opacity, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: HTN, thyroid dysfunction and hyperlipidemia
Allergies: unknown
Diagnostic Lab Data: 12/28/2021-SarsCOV2-positive 12/28/2021: Chest Xray -Mild patchy airspace opacities are noted bilaterally.
CDC Split Type:

Write-up: 12/28/2021: Event occurred after 2nd vaccine. 85-year-old male with past medical history of HTN, thyroid dysfunction and hyperlipidemia who comes for evaluation of dyspnea. He has a 9-day history of shortness of breath. Denies any other covid symptoms.


VAERS ID: 2010350 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-16
Onset:2021-12-28
   Days after vaccination:256
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Dyspnoea, Headache, Pyrexia, SARS-CoV-2 test positive
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), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: diabetes, HTN
Allergies:
Diagnostic Lab Data: SARS-CoV-2 (COVID-19) by NAA, Micro detected on 1/4/22
CDC Split Type:

Write-up: symptoms of covid = cough, fever, chills, headache, SOB, not hypoxic. tested positive for covid on 1/4


VAERS ID: 2010366 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33036BD / UNK - / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The individual is 14 years old and was given Pfizer Booster dose. The booster dose was only approved for 16+ as of the date it was administered.


VAERS ID: 2010368 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-27
Onset:2021-12-28
   Days after vaccination:215
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Alanine aminotransferase normal, Anion gap, Aspartate aminotransferase normal, Asthenia, Asthma, Blood albumin decreased, Blood alkaline phosphatase normal, Blood bicarbonate normal, Blood bilirubin decreased, Blood calcium normal, Blood chloride normal, Blood creatinine normal, Blood glucose increased, Blood lactate dehydrogenase normal, Blood potassium normal, Blood sodium normal, Blood urea increased, Breath sounds abnormal, C-reactive protein increased, COVID-19, Capillary nail refill test, Chest X-ray abnormal, Chest discomfort, Condition aggravated, Cough, Creatinine renal clearance decreased, Decreased activity, Diabetes mellitus inadequate control, Dry skin, Dyspnoea, Fatigue, Fibrin D dimer normal, General physical condition abnormal, Glomerular filtration rate normal, Glycosylated haemoglobin increased, Hypoxia, Inflammatory marker test, Lung infiltration, Metabolic function test abnormal, Obesity, Oedema, Pneumonia, Positive airway pressure therapy, Procalcitonin, Productive cough, Protein total normal, Respiratory distress, Rhinorrhoea, SARS-CoV-2 test positive, Serum ferritin normal, Skin warm, Wheezing
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (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), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen 1,000 mg Oral Every 6 hours PRN Albuterol Sulfate 108.5 mg Nebulization Every 4 hours PRN 108 (90 Base) MCG/ACT Aers, 2 puffs Inhalation Every 6 hours PRN Ascorbic Acid 1,000 mg Oral Daily Aspirin 81 mg Oral Every evening Ator
Current Illness:
Preexisting Conditions: Past Medical History: Diagnosis Date ? Anxiety ? Asthma ? Degenerative disc disease ? Diabetes type 2, controlled ? HTN (hypertension) ? Sleep apnea
Allergies: empagliflozin - itching celebrex - shortness of breath
Diagnostic Lab Data: DR CHEST SINGLE VIEW Resulted: 12/31/21 0915 Order Status: Completed Updated: 12/31/21 0917 Narrative: EXAMINATION: Single View Chest EXAM DATE: 12/31/2021 9:12 AM TECHNIQUE: Single view chest INDICATION: COVID 19 pneumonia, hypoxia, good diuresis COMPARISON: December 28, 2021 most recent ENCOUNTER: Subsequent FINDINGS: The heart, mediastinum, and pulmonary vasculature are normal. No lung consolidation or pleural effusions are present. No pneumothorax is presen Impression: No acute cardiopulmonary disease is present. C Reactive Protein (CRP), Blood Level (Abnormal) Collected: 12/31/21 0631 Order Status: Completed Specimen: Blood, Venous Updated: 12/31/21 0706 C-Reactive Protein 8.1 High <=5.0 mg/L Ferritin, Blood Level (Normal) Collected: 12/31/21 0631 Order Status: Completed Specimen: Blood, Venous Updated: 12/31/21 0706 Ferritin 126 11 - 307 mcg/L Lactate Dehydrogenase (LDH) (Normal) Collected: 12/31/21 0631 Order Status: Completed Specimen: Blood, Venous Updated: 12/31/21 0706 Lactate Dehydrogenase 185 100 - 220 U/L Comment: Reagent manufacturer has indicated that LDH values in patients with certain diseases (such as liver disease, skeletal muscle disease, and malignant tumors) may be affected by standard specimen storage temperatures. Comprehensive Metabolic Panel (CMP) (Abnormal) Collected: 12/31/21 0631 Order Status: Completed Specimen: Blood, Venous Updated: 12/31/21 0706 Sodium Level 138 134 - 146 mmol/L Potassium Level 5.0 3.4 - 5.0 mmol/L Chloride 101 98 - 112 mmol/L HCO3 23 21 - 29 mmol/L Anion Gap 14 9 - 18 mmol/L Glucose Level 244 High 70 - 99 mg/dL Blood Urea Nitrogen 33 High 8 - 20 mg/dL Creatinine 0.82 0.50 - 1.10 mg/dL MDRD eGFR $g60 $g=60 mL/min/1.73 m2 CG eCrCl 71 mL/min/1.73 m2 Calcium Level Total 9.5 8.6 - 10.4 mg/dL Protein Total 7.1 6.0 - 8.0 g/dL Albumin Level 3.2 Low 3.5 - 5.0 g/dL Bilirubin Total 0.2 0.2 - 1.0 mg/dL Alkaline Phosphatase 108 High 35 - 104 IU/L Alanine Aminotransferase 25 10 - 40 IU/L Aspartate Aminotransferase 16 10 - 40 IU/L D-Dimer (Normal) Collected: 12/31/21 0631 Order Status: Completed Specimen: Blood, Venous Updated: 12/31/21 0704 D-Dimer Quant <190 0 - 500 ng/mL FEU
CDC Split Type:

Write-up: Hospitalized (12.28.21 - 12.31.21); COVID-19 positive (12.28.21); Fully vaccinated -J&J x1 D/c Summary: Discharge Summary DO (Physician) BRIEF OVERVIEW: Discharge Provider: DO Primary Care Provider: DO Active Hospital Problems Diagnosis Date Noted POA ? Depression 01/10/2013 Yes ? Type 2 diabetes mellitus with hyperglycemia 11/26/2012 Yes ? HTN (hypertension) Yes ? Sleep apnea Yes ? History of degenerative disc disease Yes Resolved Hospital Problems Diagnosis Date Noted Date Resolved POA ? Acute hypoxemic respiratory failure due to COVID-19 12/29/2021 12/31/2021 Yes ? Acute asthma exacerbation 12/28/2021 12/31/2021 Yes Pre-Existing Active Problems Diagnosis Date Noted POA ? Asthma Unknown ? Anxiety Unknown Discharge Disposition: home or self care Discharge on home oxygen with 2L with activity and RA with rest Active Issues Requiring Follow-up: Acute asthma exacerbation Assessment & Plan -moderate persistent asthma: Much improved - COVID 19 negative on 12/28 and Film array + for COVID 19 on 12/28 Plan 1. DC home today on home nebulizers and MDI''s 2. Steroid taper over 9 days including Prednisone 40 daily for 3 days, 20 daily for 3 days, 10 daily for 3 days, then stop. 3. Continue antibiotics including Ceftin 500 mg PO BID x 5 days for a total of 8 days of antibiotics. Patient was on IV Rocephin the 3 days prior. Also finish a 5 day course of Azithromycin 250 mg daily. 4. Tobacco cessation which patient is highly motivated to quit. 5. Follow up with PCP in a week. * Acute hypoxemic respiratory failure due to COVID-19 Assessment & Plan - Resolved - Presented in asthma exacerbation, Covid screen negative on admission, Film array + 12/29 - 6L NC and transitioned to RA with rest and 2L with activity at discharge. - CXR 12/31 shows no further acute pulmonary disease Rocephin/Azithromycin, procalcitonin 0.07 (bacterial infection unlikely) -She does not wish to receive Remdesivir, so was not prescribed during this admission. She responded well to weight based steroids. -Compliant with proning Plan: 1. Home O2 evaluation completed today, and patient needs no oxygen at rest and only 2L with activity. Order written 2. DC home today 3. Ongoing steroid taper for asthma exacerbation. COVID pneumonia is a lot less serious culprit. 4. Continue home MDI regimen 5. Complete antibiotics as above 6. Quarantine for 10 days from start of onset of symptoms. Type 2 diabetes mellitus with hyperglycemia Assessment & Plan -A1c in June was 8.5, ow 10.5 - Improved, but suboptimal control -On piaglitazone, Trulicity, glipizide at home which she will resume at home. -As she remains on steroids at discharge home, will continue Lantus insulin at discharge including weight based which would put her at 45 units daily. She can call me over the holiday weekend if she has concerns about her blood sugars for dose titration. - follow up with PCP in 1 week. HTN (hypertension) Assessment & Plan -Well controlled on home diltiazem -DC home on Cardizem CD 120 mg PO daily. DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute asthma exacerbation Acute respiratory failure with hypoxia Asthma with acute exacerbation, unspecified asthma severity, unspecified whether persistent HOSPITAL COURSE: Very pleasant 50 y/o widowed female community dwelling patient of Dr. who was admitted on 12/28/21 for acute respiratory failure with hypoxia secondary to an acute exacerbation of her moderate persistent asthma. In addition she had a left lower lobe atypical infiltrate. Initial COVID PCR test was negative, but her film array was + for COVID 19, so she was placed in respiratory isolation. The patient politely declined Remdesivir for management of her COVID 19 infection. The patient was placed on weight based steroids for management of her COVID 19 infection and her asthma exacerbation. She improved more quickly than expected. She received 3 doses of IV Lasix to keep her on the dry side to avoid further edema. Her repeat CXR on 12/31 showed resolution of this infiltrate and was a normal study. The patient was able to transition from 6L of supplemental oxygen on admission to room air oxygen at rest with 2L required for activity. The patient''s inflammatory labs were normal. She was medically stable for discharge home from a pulmonary standpoint with a steroid taper, ongoing antibiotics converted to PO, and home oxygen at 2L with activity. She will resume all of her home MDI''s and nebulizers. It is likely that patient''s pneumonia was not truly COVID pneumonia, because it resolved so quickly. Perhaps she did well, because she received the COVID 19 vaccines x 2 doses. She did however recover quickly and was able to be discharged home in 3 days from admission. Her blood sugars were significantly elevated on admission w/ an elevated A1C indicating poor outpatient control. She was given escalating doses of Lantus insulin with basal bolus coverage. Her blood sugars improved. She will continue Lantus at discharge especially as she''ll be on a steroid taper for the next 9 days. She is asked to follow up closely with her PCP regaring ongoing use of Lantus after steroids with dosing recommendations after steroids as well. She is invited to call me with questions over the New Year''s holiday weekend. Thank you for the privilege of taking care of this very nice lady. CONSULTS / RECOMMENDATION: None Consult Orders (From admission, onward) None INPATIENT PROCEDURES: None Surgery and Procedures None Non-surgical Procedures (From admission, onward) None BP 135/82 | Pulse 93 | Temp 36.7 ?C (Temporal) | Resp 22 | Ht 1.626 m | Wt 94.9 kg | SpO2 93% | BMI 35.91 kg/m? Physical Exam Vitals and nursing note reviewed. Constitutional: General: She is not in acute distress. Appearance: She is obese. She is not toxic-appearing or diaphoretic. HENT: Nose: Rhinorrhea present. No congestion. Comments: Good nasal patency bilateral nares Mouth/Throat: Mouth: Mucous membranes are moist. Pharynx: Oropharynx is clear. No oropharyngeal exudate or posterior oropharyngeal erythema. Eyes: General: No scleral icterus. Conjunctiva/sclera: Conjunctivae normal. Pupils: Pupils are equal, round, and reactive to light. Neck: Comments: Cardiovascular: Rate and Rhythm: Normal rate. Pulmonary: Effort: Pulmonary effort is normal. No respiratory distress. Breath sounds: Normal breath sounds. No stridor. No wheezing, rhonchi or rales. Comments: Occasional cough Abdominal: General: Bowel sounds are normal. There is no distension. Palpations: Abdomen is soft. Tenderness: There is no abdominal tenderness. Musculoskeletal: General: No swelling or tenderness. Cervical back: Neck supple. Right lower leg: No edema. Left lower leg: No edema. Lymphadenopathy: Cervical: No cervical adenopathy. Skin: General: Skin is warm and dry. Capillary Refill: Capillary refill takes less than 2 seconds. Neurological: General: No focal deficit present. Mental Status: She is alert and oriented to person, place, and time. Psychiatric: Mood and Affect: Mood normal. Behavior: Behavior normal. Thought Content: Thought content normal. Judgment: Judgment normal. H&P: CHIEF COMPLAINT: Acute asthma exacerbation Assessment/Plan ASSESSMENT / PLAN: * Acute asthma exacerbation Assessment & Plan -She''s had a cough for a few days, minimally productive -Using her inhaler with increasingly inadequate response -She has moderate persistent asthma; has albuterol and lower dose Trelegy -Very tight in ED; given solumedrol, 3 duonebs -Will give duonebs 4x daily, PRN albuterol, high dose Symbicort, Solumedrol 40mg BID -CXR does have some left peribronchial infiltrate; treat for CAP with Rocephin/Azithromycin -Not Covid; check film array -Needs established with pulmonology; has dx of COPD too (smokes), but I see no PFT Type 2 diabetes mellitus with hyperglycemia Assessment & Plan -A1c in June was 8.5, repeat -On piaglitazone, Trulicity, glipizide at home -Give Lantus 10u HS with low SSI Depression Assessment & Plan -Continue home duloxetine History of degenerative disc disease Assessment & Plan -Continue home Norco 7.5 BID PRN Sleep apnea Assessment & Plan -She had the admirable presence of mind to bring her CPAP--to be used here HTN (hypertension) Assessment & Plan -Continue home diltiazem HISTORY OF PRESENT ILLNESS: Patient is a 50 y.o. female who presents today with asthma exacerbation. She has hx of moderate persistent asthma; smokes; also has hx of COPD and OSA. She doesn''t follow with pulmonology. Also has diabetes mellitus and hypertension. She''s been out of her Trelegy for a little while. She''s had more frequent exacerbations since her son/daughter in law moved in with their five young children this year. On presentation, she was tight, in distress, satting mid 80''s on room air. She made improvement with steroids and duonebs. CXR with a left sided peribronchial infiltrate. She requires admission for acute asthma exacerbation. Patient Active Problem List Diagnosis ? HTN (hypertension) ? Sleep apnea ? History of degenerative disc disease ? Asthma ? Anxiety ? Type 2 diabetes mellitus with hyperglycemia ? Depression ? Acute asthma exacerbation Review of Systems Constitutional: Positive for activity change and fatigue. Negative for fever. HENT: Negative for congestion. Eyes: Negative for visual disturbance. Respiratory: Positive for cough, wheezing, shortness of breath and chest tightness. Cardiovascular: Negative for chest pain, orthopnea and leg swelling. Gastrointestinal: Negative for nausea, vomiting, abdominal pain and diarrhea. Genitourinary: Negative for difficulty urinating and dysuria. Musculoskeletal: Negative for joint pain, muscle pain and edema. Neurological: Positive for weakness. Negative for loss of consciousness. Endo/Heme/Allergy: Negative for easy bleeding or bruising. Skin: Negative for rash and wound. Objective OBJECTIVE: BP 148/83 | Pulse 106 | Temp 36.9 ?C (Oral) | Resp 24 | Wt 95.3 kg | SpO2 90% | BMI 36.05 kg/m? Physical Exam Vitals and nursing note reviewed. Constitutional: General: She is not in acute distress. Appearance: She is well-developed. She is ill-appearing. Comments: Talking in full sentences, laughing, on duoneb via Venturi. HENT: Head: Normocephalic and atraumatic. Mouth/Throat: Mouth: Mucous membranes are moist. Eyes: General: No scleral icterus. Conjunctiva/sclera: Conjunctivae normal. Cardiovascular: Rate and Rhythm: Normal rate and regular rhythm. Pulmonary: Comments: Mild increased work of breathing. Lungs sound somewhat tight with wheezing, but I do hear air movement throughout. Good inspiratory effort. Abdominal: General: Bowel sounds are normal. Palpations: Abdomen is soft. Tenderness: There is no abdominal tenderness. Musculoskeletal: Cervical back: Neck supple. Right lower leg: No edema. Left lower leg: No edema. Skin: General: Skin is warm and dry. Neurological: General: No focal deficit present. Mental Status: She is alert and oriented to person, place, and time. Psychiatric: Mood and Affect: Mood normal.


VAERS ID: 2010415 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-12-22
Onset:2021-12-28
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

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

Write-up: No reported adverse events. Reporting the utilization of Sterile Water for Injection as diluent for Pfizer BioNTech COVID-19 vaccination recognized on 12/29/2021. It was discovered that SWFI was used for reconsitution of vaccine for the date range 12/6/2021 through 12/28/2021. These vaccines were utilized for vaccination of a total of 219 patients. There have been no reported adverse events from any vaccinated patient.


VAERS ID: 2010441 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-27
Onset:2021-12-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033H21A / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Cyanosis, Dizziness, Fatigue, Headache, Nausea, Pain, Tachycardia, Tachypnoea, Tinnitus, Vision blurred
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (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: Both vaccinations caused tachycardia at rest and fatigue that led to a fall. 19 years old during vaccinations. Vaccinations are
Other Medications: Fish oil, Vitamin D, Multivitamin, Calcium supplement and Iron PO vitamins
Current Illness: None
Preexisting Conditions: Allergies and undiagnosed digestive issues (possibly autoimmune)
Allergies: No medication allergies. Allergic to eggs, soy, wheat, diary, shellfish, BHA and BHT
Diagnostic Lab Data: Did not seek medical treatment.
CDC Split Type:

Write-up: 12/27/2021 at 9 pm (mild symptoms): headache, body aches and fatigue. 12/28/2021 at 9 am: severe abdominal pain, nausea, lightheaded, blurring vision, ringing in ears, blue lips, almost lost consciousness, tachycardia at rest (HR 150 bpm) and tachypnea (respirations $g35). Extreme fatigue and dizziness for several days after 12/28/2021.


VAERS ID: 2010762 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-05
Onset:2021-12-28
   Days after vaccination:298
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: diabetes type 2 hypertension
Allergies: penicillin
Diagnostic Lab Data: SARS-COV-2 RNA, NAAT positive on 12/30/2021
CDC Split Type:

Write-up: developed covid symptoms


VAERS ID: 2010838 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-12-27
Onset:2021-12-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH DPH OXFORD / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Headache, Oropharyngeal pain, Respiratory tract congestion, SARS-CoV-2 test
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Protoxin
Current Illness: none
Preexisting Conditions: post nasal drip
Allergies: none
Diagnostic Lab Data: 12/30/2021 covid PCR test collected at urgent Care
CDC Split Type:

Write-up: very next day, congestion and headache, sore throat


VAERS ID: 2011393 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013H21B / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain
SMQs:, Retroperitoneal fibrosis (broad)

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

Write-up: Patient complaints that she has back pain after she receives Moderna Vaccine. Then, She takes tylenol for 3 days ,and she said she feels better.


VAERS ID: 2011616 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-12-17
Onset:2021-12-28
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bell's palsy, Computerised tomogram head normal, Ear pain, Facial paralysis, Hypoaesthesia oral, Laboratory test normal, Otitis media, Scan with contrast normal, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: First week in December had a stuffy nose. Was tested for COVID-19 on 12/12/21 and was negative. Was feeling fine at time of vaccine
Preexisting Conditions: None
Allergies: Bacitracin
Diagnostic Lab Data: CT Head w/contrast
CDC Split Type:

Write-up: Start of ear pain on 12/24/21. By 12/27/21 ear pain had not gone away and swelling was noticeable. At around 8pm that evening tongue started feeling numb. By around 6 am on 12/28/21 had partial facial paralysis most noticeable by lack of smile. Immediately went to ER . Upon clear CT scan and other tests was determine to have Bell?s Palsy and middle ear infection.


VAERS ID: 2012970 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-30
Onset:2021-12-28
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH 8030 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Eye infection, Eyelid pain, Hordeolum, Swelling of eyelid
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Periorbital and eyelid disorders (narrow), Ocular infections (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: swelling on eyelid, redness, pain


VAERS ID: 2012978 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041J21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: nothing known
Preexisting Conditions: no known health conditions
Allergies: no known allergies
Diagnostic Lab Data: None known
CDC Split Type:

Write-up: The RN who was/is working in our store failed to adequately screen the date of birth for the patient. There are no symptoms, signs or other information to report.


VAERS ID: 2013947 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-22
Onset:2021-12-28
   Days after vaccination:67
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Drainage, Oropharyngeal pain, Pyrexia, SARS-CoV-2 test negative, Sinus congestion
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: High cholesterol
Allergies: None
Diagnostic Lab Data: Covid test negative on 12/31/2021
CDC Split Type:

Write-up: Sinus congestion, fever, sinus drainage, morning sore throat.


VAERS ID: 2014019 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 1 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA A32B21A / 2 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA A60H21A / 3 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose increased, Condition aggravated, Diabetes mellitus inadequate control
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, insulin, Soliqua, levothyroxine,
Current Illness:
Preexisting Conditions: Thyroid disease (hashimoto), diabetes type 2 very well controlled A1C 5.7, schograens disease.
Allergies: Blackberries, sulfa drugs, penicillin
Diagnostic Lab Data: My blood work is done every three months by my Dr. I wear a dexcom sensor which provides blood sugar levels every 5 minutes of the day since June 2021. I am a faithful user. Records are available.
CDC Split Type:

Write-up: Blood glucose is significantly higher and is very resistant even to insulin injections. Normal fasting runs 120 in the morning. Currently running 155-200 fasting 10 days post vaccine booster. After insulin it will come down to 120 but if any food or drink is consumed it spikes significantly higher than expected. Also, typically blood sugars respond to 20% more insulin after a spike from, for example, a high carb meal. After any meal currently the sugars spike and 100% increase requires 2-3 hours to bring blood sugars to 120. I have doubled my insulin dose and my blood sugar remains out of control 10 days post injection. PRIOR TO ANY COVID 19 VACCINATION I WAS WELL CONTROLLED BY SIMPLY TAKING ORAL MEDICATION. AFTER VACCINE I SM OUT OF CONTROL DIABETIC ON OVER 70U of insulin per day . 45 units of Soliqua. Worse after each dose of vaccine. I did see it getting better in the months following vaccine 2. Prior to vaccine 3 I was using 38 units per day.


VAERS ID: 2014213 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-23
Onset:2021-12-28
   Days after vaccination:280
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Asthenia, Band neutrophil count, Blood culture negative, COVID-19, COVID-19 pneumonia, Cardiomegaly, Chest X-ray abnormal, Condition aggravated, Hypotension, Hypoxia, Lung disorder, Lung opacity, Malaise, Oropharyngeal pain, Platelet count decreased, Procalcitonin increased, Prohormone brain natriuretic peptide increased, Respiratory failure, SARS-CoV-2 test positive, White blood cell count decreased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (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), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Sepsis (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet allopurinol (ZYLOPRIM) 300 MG tablet APPLE CIDER VINEGAR PO ascorbic acid (VITAMIN C) 1000 MG tablet atenolol (TENORMIN) 25 MG tablet B Complex Vitamins (VITAMIN-B COMPLEX PO) benazepril (LOTENSIN) 10 M
Current Illness:
Preexisting Conditions: Hospital OSA on CPAP Chronic diastolic heart failure Weakness Pneumonia due to COVID-19 virus Thrombocytopenia Non-Hospital Complete heart block s/p pacemaker Chronic respiratory failure with hypoxia Pericardial effusion Hyperlipidemia, unspecified Benign prostatic hyperplasia Peripheral vascular disease, unspecified Seasonal allergic rhinitis Gout Abdominal aortic aneurysm, without rupture CPAP/BiPAP dependent Nonmelanoma skin cancer Vitamin D deficiency Skin cancer RBBB plus LA hemiblock Inguinal hernia Impotence of organic origin Glucose intolerance Diverticulosis of colon Class 1 obesity with body mass index (BMI) of 34.0 to 34.9 in adult, unspecified obesity type, unspecified whether serious comorbidity present Essential hypertension Squamous cell carcinoma of arm Bifascicular block Renal artery atherosclerosis Hypoxia Cardiac pacemaker in situ Paroxysmal atrial fibrillation Hypercapnic and hypoxemic respiratory failure Bilateral pleural effusion Atrial fibrillation, persistent Atrial flutter, unspecified type Generalized weakness
Allergies: Eliquis [Apixaban] Lipitor [Atorvastatin]Joint Pain
Diagnostic Lab Data: Peripheral Blood Culture [361998082] Collected: 01/04/22 1232 Order Status: Completed Specimen: Blood, Venous Updated: 01/06/22 1601 Cult Blood Peripheral No Growth 48 hours Peripheral Blood Culture [361998083] Collected: 01/04/22 1232 Order Status: Completed Specimen: Blood, Venous Updated: 01/06/22 1601 Cult Blood Peripheral No DR CHEST 2 VIEWS FRONTAL AND LATERAL [361998084] Resulted: 01/04/22 1313 Order Status: Completed Updated: 01/04/22 1315 Narrative: EXAMINATION: Frontal and Lateral View Chest EXAM DATE: 1/4/2022 12:50 PM TECHNIQUE: Frontal and lateral views INDICATION: hypoxia with covid. COMPARISON: 12/28/2021 and 11/16/2021 ENCOUNTER: Subsequent _________________________ FINDINGS: Faint strandy and reticular opacities are seen in both lung bases raising suspicion for atelectasis or pneumonia. Heart size mildly enlarged. Pulmonary vascular markings within normal limits. No pneumothorax or pleural effusion. There are a few old healed fractures to posterolateral mid and upper right ribs. Pacemaker left chest with leads in heart. Partially visualized endovascular repair of abdominal aortic seen best on the lateral view. _________________________ Impression: 1. Mild burden of bibasilar airspace disease either atelectasis or pneumonia, slightly more conspicuous than prior exam. 2. Mild cardiomegaly without definite acute heart failure. 3. Additional findings.
CDC Split Type:

Write-up: Patient currently hospitalized. Patient is a 86 y.o. male with PMH p a fib on xarelto, HTN, HLD, OSA w. CPAP, who presents today due to hypoxia. Pt was found to be COVID-19 positive on 12/28/21 and was admitted 12/28-12/31 due to hypoxia. Pt was weaned off O2 and was discharged home with home PT. Today when OT arrived to the pt''s house, pt was found to be hypoxic with spO2 79%. Pt reports that he was feeling ok when he was discharged on 12/31, but states started to not feel well. Pt does not elaborate on why he was not feeling well, states his appetite has been normal and he has been eating and drinking a normal amount. He checks his blood pressures at home, is not sure what they normally run, but his son can bring in his log from home tonight. Pt''s son at bedside states pt has been using his walker at home and has been slightly weaker than normal and has not been able to get to the bathroom at times. Pt denies any shortness of breath, chest pain, headache, dizziness, diarrhea, constipation, LE edema, falls. Pt reports sore throat. Pt states he has been compliant with home CPAP. Upon arrival to the ED, pt saturating 88-89% on room air and was placed on 2L NC. CXR performed revealed bibasilar airspace disease. Pt also noted to be hypotensive with BP 66/39. Pt was administered total 3L IV fluid bolus with improvement BP. Labs significant for PLT 102. Pt admitted to the hospital for observation. Pt reports has 1-2 alcoholic drinks/week. Reports former cigarette smoking, about 3 cigarettes/daily for 15-20 years. Pt denies recreational drug use. Acute hypoxic respiratory insufficiency COVID-19 PNA - pt admitted 12/28-12/31/2021 due to weakness/hypotensive episode and noted hypoxia during sleeping - currently requiring 2L NC with spO2 96% - temp 37.9 on arrival - CXR shows bibasilar airspace disease - proBNP 528, no evidence of acute HF - PCT 0.10, WBC 3.52, 5 bands, doubt bacterial PNA - monitor off abx - continue decadron 6 mg daily - continuous pulse oximetry - check CRP/Ddimer - out of window for Remdesivir (based on previous documentation, symptoms started 12/23) - monitor VS/labs - encourage IS


VAERS ID: 2014283 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-22
Onset:2021-12-28
   Days after vaccination:97
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 03PC21A / 3 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Lower respiratory tract infection, SARS-CoV-2 test negative, SARS-CoV-2 test positive
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin c & d
Current Illness: n/a
Preexisting Conditions: secondary polycythemia; chiari malformation (w/ decompression surgery on 11/10/2010)
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Woman on the phone told me to fill out a report because of the symptoms i was having. I had what appeared to be a chest cold. My doctor prescribes ZPACK due to me be Fully Vaccinated and i had a negative antigen and PCR test for covid 19. After taking all prescribed medication, i then tested POSITVE on an antigen test and then Positive on a PCR test, a full week later. Symptoms now have subsided, however i tested positive on an antigen test again today 1/7/22


VAERS ID: 2014295 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-03
Onset:2021-12-28
   Days after vaccination:239
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Ageusia, Anosmia, Anticoagulant therapy, Anticoagulation drug level above therapeutic, Atrial fibrillation, Bacterial test negative, Blood creatinine increased, Blood culture negative, Blood glucose decreased, Blood sodium decreased, COVID-19, COVID-19 pneumonia, Cardiomegaly, Chest X-ray abnormal, Chest pain, Cold sweat, Cough, Diarrhoea, Dyspnoea, Dyspnoea exertional, Influenza A virus test, Influenza B virus test, Joint space narrowing, Legionella test, Lung hyperinflation, Lung opacity, Musculoskeletal chest pain, Osteoarthritis, Pain, Painful respiration, Procalcitonin increased, Respiratory syncytial virus test, SARS-CoV-2 test positive, Spinal osteoarthritis, Streptococcus test negative, Superinfection, Urine analysis normal, Viral test, Wheezing
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Taste and smell disorders (narrow), Supraventricular tachyarrhythmias (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), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Arthritis (narrow), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (narrow), Infective pneumonia (narrow), Dehydration (broad), Sepsis (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Blood Glucose Monitoring Suppl MISC, buPROPion (WELLBUTRIN XL) 150 MG 24 hr tablet, busPIRone (BUSPAR) 15 MG tablet, calcium-vitamin D (OSCAL-500) 500-200 MG-UNIT TABS per tablet, carbidopa-levodopa (SINEMET) 25-100 MG per tablet, carvedilo
Current Illness:
Preexisting Conditions: Respiratory Pulmonary nodule, left OSA (obstructive sleep apnea) Obstructive sleep apnea treated with BiPAP ASV Circulatory Cardiomyopathy, nonischemic (HCC) IVCD (intraventricular conduction defect) PVC''s (premature ventricular contractions) Persistent atrial fibrillation Biventricular ICD (implantable cardioverter-defibrillator) in place Dilated cardiomyopathy Chronic combined systolic and diastolic heart failure Essential hypertension Paroxysmal ventricular tachycardia Paroxysmal atrial fibrillation Digestive Class 3 severe obesity with serious comorbidity and body mass index (BMI) of 45.0 to 49.9 in adult, unspecified obesity type Morbid obesity Class 3 severe obesity with body mass index (BMI) of 45.0 to 49.9 in adult, unspecified obesity type, unspecified whether serious Comorbidity present Gastro-esophageal reflux disease without esophagitis Nervous Type 2 diabetes mellitus with both eyes affected by mild nonproliferative retinopathy without macular edema, with long-term current use of insulin Senile nuclear cataract, bilateral Congenital hypertrophy of retinal pigment epithelium Parkinson''s disease Genitourinary Acute renal failure superimposed on stage 3b chronic kidney disease CKD stage 3 due to type 2 diabetes mellitus Type 2 diabetes mellitus with chronic kidney disease Endocrine/Metabolic Diabetes mellitus, type 2 Hyperlipidemia Immune Monoclonal gammopathy Other Moderate episode of recurrent major depressive disorder Presbyopia of both eyes Macular drusen, bilateral
Allergies: Metformin : Diarrhea
Diagnostic Lab Data: DR RIBS 2 VIEWS RIGHT Resulted: 12/30/21 0652 Order Status: Completed Updated: 12/30/21 0654 Narrative: EXAMINATION: Ribs Right, Two Views EXAM DATE: 12/29/2021 6:41 PM TECHNIQUE: AP above diaphragm, AP below diaphragm, obliques INDICATION: Rib pain status post coughing. Covid positive. COMPARISON: Chest radiograph 12/28/2021 and 12/11/2019. ENCOUNTER: Initial FINDINGS: Chronic healed right lateral rib 2 fracture. No acute displaced rib fracture is identified. Multifocal right pulmonary opacities are unchanged. A 2.9 cm nodule projected over the left hilum is unchanged since at least 2019. Left chest cardiac implantable electronic device leads are incompletely evaluated. Right acromial clavicular and acromioclavicular joint osteoarthrosis. High riding right humeral head with narrowing of the acromiohumeral interval suggesting sequela of a chronic massive rotator cuff tear. Intra-articular body in the right superior glenohumeral joint. Degenerative changes of the spine. _________________________ Impression: 1. No acute displaced rib fracture. 2. Unchanged pulmonary opacities. DR CHEST 2 VIEWS FRONTAL AND LATERAL Resulted: 12/28/21 2018 Order Status: Completed Updated: 12/28/21 2020 Narrative: EXAMINATION: Frontal and Lateral View Chest EXAM DATE: 12/28/2021 7:25 PM TECHNIQUE: Upright AP and lateral views INDICATION: Difficulty breathing. COMPARISON: 12/11/2019 ENCOUNTER: Not applicable _________________________ FINDINGS: Stable configuration of the ICD. Moderate nonuniform bilateral pulmonary opacities consistent with COVID pneumonitis, superimposed on cardiomegaly and pulmonary hyperaeration. No significant pleural process. Peripheral Blood Culture Collected: 12/29/21 0150 Order Status: Completed Specimen: Blood, Venous Updated: 01/03/22 0301 Cult Blood Peripheral No bacteria or yeast isolated Peripheral Blood Culture Collected: 12/29/21 0157 Order Status: Completed Specimen: Blood, Venous Updated: 01/03/22 0301 Cult Blood Peripheral No bacteria or yeast isolated Streptococcus Pneumoniae Antigen, Urine (Normal) Collected: 12/30/21 1514 Order Status: Completed Specimen: Urine, Voided Updated: 12/30/21 1711 STREPTOCOCCUS PNEUMONIAE ANTIGEN Negative Negative, Invalid Legionella Antigen, Urine (Normal) Collected: 12/30/21 1514 Order Status: Completed Specimen: Urine, clean catch Updated: 12/30/21 1710 Legionella Ag Urine Negative Negative COVID-19, Influenza A/B, RSV PCR (Abnormal) Collected: 12/28/21 1844 Order Status: Completed Specimen: Swabbed Collection from Nasopharynx Updated: 12/28/21 2012 COVID-19 PCR Detected Abnormal Not Detected Comment: COVID-19 (SARS-CoV-2) test is positive. Clinical correlation with patient history and other diagnostic information is necessary to determine infection status. This test has received Emergency Use Authorization (EUA) by the FDA, but performance has not been evaluated for asymptomatic patients. Testing was performed using a nucleic acid amplification method. The specimen source may have been changed from the original order per patient situation or symptoms. Covid 19 Result Comment See Comment Comment: COVID-19 results reported as "detected" means COVID-19 positive. Positive patients should self-isolate for 10 days or 24 hours after fever resolves and other symptoms are improving, whichever is longer: - Stay home except to get medical care and wear a facemask if you must leave - Separate yourself from other people in your home, known as home isolation - Cover your coughs and sneezes - Wash your hands often - Clean high-touch surfaces everyday - Avoid sharing household items Influenza A PCR Not Detected Not Detected Influenza B PCR Not Detected Not Detected RSV PCR Not Detected Not Detected
CDC Split Type:

Write-up: Patient discharged after 3 days hospitalization. Patient is a 61 y.o. male presented with shortness of breath on exertion along with cold sweats, cough, right-sided chest pain, worsened when taking a deep breaths. Patient also had diarrhea, loss of taste and smell. He was vaccinated against with Pfizer but did not receive booster dose. Workup in the emergency department significant for sodium 127 and creatinine 2.42 (previous 1.7). X-ray showing COVID pneumonia and patient had wheezing. Patient was admitted for acute kidney injury, COVID pneumonia. AKI resolved with IV fluids. Due to elevated procalcitonin, patient was started on IV ceftriaxone and oral doxycycline and was transitioned to oral Ceftin and Doxy for total 5 days of treatment. Due to AKI, lisinopril, Lasix and Aldactone were held. Due to history of low EF, Lasix was resumed at discharge after AKI is resolved. Patient was advised to monitor blood pressure and blood sugar levels closely at home and follow up with PCP. Due to low blood sugars, Lantus dose was decreased. Patient is on warfarin for A. Fib and was supratherapeutic with INR. Patient was advised to hold warfarin and check INR at home and follow up with anticoagulation clinic for further recommendations regarding warfarin dosing. Patient was discharged to Home without services in stable condition.


VAERS ID: 2014340 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 330308D / 2 LA / IM

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

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

Write-up: PFIZER vaccine that was stored in pharmacy refrigerator given outside of 31 day expiration. Vaccine received at hospital on 11/19/2021. Expiration date on vial 02/2022. NDC# 59267100001


VAERS ID: 2014358 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 330308D / 3 RA / IM

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

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

Write-up: PFIZER vaccine that was stored in pharmacy refrigerator given outside of 31 day expiration. Vaccine received at hospital on 11/19/2021. Expiration date on vial 02/2022. NDC# 59267100001


VAERS ID: 2014360 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 330308D / 3 RA / IM

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

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

Write-up: PFIZER vaccine that was stored in pharmacy refrigerator given outside of 31 day expiration. Vaccine received at hospital on 11/19/2021. Expiration date on vial 02/2022. NDC# 59267100001


VAERS ID: 2014362 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 330308D / 3 RA / IM

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

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

Write-up: PFIZER vaccine that was stored in pharmacy refrigerator given outside of 31 day expiration. Vaccine received at hospital on 11/19/2021. Expiration date on vial 02/2022. NDC# 59267100001


VAERS ID: 2014363 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 330308D / 2 RA / IM

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

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

Write-up: PFIZER vaccine that was stored in pharmacy refrigerator given outside of 31 day expiration. Vaccine received at hospital on 11/19/2021. Expiration date on vial 02/2022. NDC# 59267100001


VAERS ID: 2014368 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 330308D / 3 RA / IM

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

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

Write-up: PFIZER vaccine that was stored in pharmacy refrigerator given outside of 31 day expiration. Vaccine received at hospital on 11/19/2021. Expiration date on vial 02/2022. NDC# 59267100001


VAERS ID: 2014387 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 330308D / 2 - / IM

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

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

Write-up: PFIZER vaccine that was stored in pharmacy refrigerator given outside of 31 day expiration. Vaccine received at hospital on 11/19/2021. Expiration date on vial 02/2022. NDC# 5926710000


VAERS ID: 2014391 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 330308D / 2 - / IM

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

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

Write-up: PFIZER vaccine that was stored in pharmacy refrigerator given outside of 31 day expiration. Vaccine received at hospital on 11/19/2021. Expiration date on vial 02/2022.


VAERS ID: 2014403 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 330308D / 2 RA / IM

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

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

Write-up: PFIZER vaccine that was stored in refrigerator given outside of 31 day expiration. Vaccine received on 11/19/2021. Expiration date on vial 02/2022. NDC# 59267100001.


VAERS ID: 2014404 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 330308D / 2 RA / IM

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

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

Write-up: PFIZER vaccine that was stored in pharmacy refrigerator given outside of 31 day expiration. Vaccine received at hospital on 11/19/2021. Expiration date on vial 02/2022. NDC# 5926710000


VAERS ID: 2014406 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 330308D / 3 RA / IM

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

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

Write-up: PFIZER vaccine that was stored in pharmacy refrigerator given outside of 31 day expiration. Vaccine received at hospital on 11/19/2021. Expiration date on vial 02/2022. NDC# 5926710000


VAERS ID: 2014410 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 330308D / 3 RA / IM

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

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

Write-up: PFIZER vaccine that was stored in pharmacy refrigerator given outside of 31 day expiration. Vaccine received at hospital on 11/19/2021. Expiration date on vial 02/2022. NDC# 59267100001.


VAERS ID: 2014411 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 330308D / 3 RA / IM

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

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

Write-up: PFIZER vaccine that was stored in pharmacy refrigerator given outside of 31 day expiration. Vaccine received at hospital on 11/19/2021. Expiration date on vial 02/2022. NDC# 59267100001


VAERS ID: 2014438 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: New York  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD7218 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Back pain, Blood pressure increased, Dyspnoea, Electrocardiogram, Eye pain, Fatigue, Gait disturbance, Headache, Heart rate increased, Heart rate irregular, Nausea, Paraesthesia, Paraesthesia oral, Swelling face, Tremor, Vision blurred
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Hypertension (narrow), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: EGGLESS FLU SHOTS - ARM PAIN, BODY ACHES, FATIQUE OVER YEARS GIVEN
Other Medications: nebivolol 5 mg, eliquis 2,5mg, armour thyroid 15 & 30 mg, ser sertraline 12.5mg
Current Illness: N/A
Preexisting Conditions: LONG-HAUL COVID PATIENT
Allergies: penicillin, codine, iodine, cefuroxime axetil, sotalol, mexile mexiletine, medrol pack, dairy, gluten
Diagnostic Lab Data: AT ER ON HEART MONITOR AND CHECKING OF VITALS OVER 5 HOURS, EKG AFTER 4 HOURS WAS GOOD, GIVEN BENEDRYL AND PEPCID
CDC Split Type:

Write-up: IRREGULAR RAPID HEARTBEAT, DIFFICULTY BREATHING/SHORTNESS OF BREATH, BLOOD PRESSURE SHOT UP, SWELLING & TINGLING OF FACE, MOUTH INSIDE & OUT LIPS, OUTER EARS, LEGS, DIFFICULTY WALKING, HAND TREMORS, SEVERE HEADACHE AND PAIN BEHIND EYES, NAUSA, SEVERE FATIGUE, UPPER BACK PAIN, BLURRY VISION


VAERS ID: 2014638 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3198 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Heart rate increased, Heavy menstrual bleeding, Lymph node pain, Lymphadenopathy, Pain, Palpitations
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cetirizine, Esomeprazole, Magnesium, Vitamin B2, Vitamin B1, Vitamin B12, Multivitamin
Current Illness: None
Preexisting Conditions: Allergic rhinitis, eczema, acid reflux, migraine
Allergies: Sulfa antibiotics, Shellfish, Flax, Gluten
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Rapid heart rate for about 1.5-2 hours starting about 4 hours after booster vaccination and several episodes of palpitations the following day - resolved without seeking medical care. Very tender and swollen lymph node left underarm from 12/29/21 till 1/2/22 - some ongoing aching but mostly resolved. Heavy vaginal bleeding began 12/29/21 around 10-11am, about 2 weeks after last menstrual bleeding - has gradually reduced from 12/29/21 to present 1/7/22 with light bleeding ongoing. Notably had Mirena IUD placed 9/22/21 but cycle had seemed like it was starting to normalize before this.


VAERS ID: 2014648 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: New York  
Vaccinated:2021-12-27
Onset:2021-12-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 060H21A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Fatigue, Feeling abnormal, Headache, Loss of consciousness, Nausea
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 2nd dose of Moderna 04/29/2021 (fatigue, nausea, "brain fog" lasting 7 days)
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Pennicillin, Dairy
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt. states that after receiving the 3rd dose of Moderna 12/27/2021, started experiencing symptoms that night of loose stool, passing out x1, fatigue, nausea, "brain fog", and headache (Lasting x10 days). No noted Primary visit/communications. Symptoms have subsided.


VAERS ID: 2014780 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-14
Onset:2021-12-28
   Days after vaccination:228
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Device related infection, Hypoxia, Pyrexia, SARS-CoV-2 test positive
SMQs:, Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: HTN, ESRD on HD, Recurrent pleural effusions, COPD, HF, Anemia, Depression
Allergies: Hydralazine, Iodine contrast, ampicillin, azithromycin, ciprofloxacin, clindamycin, doxycycline, erythromycin, metronidazole, heparin, enoxaparin, nitrofurantoin, oxycodone, metoclopramide, tetracycline, tramadol, Oats.
Diagnostic Lab Data: COVID-19 PCR + 1/4/22
CDC Split Type:

Write-up: Pt was sent to hospital on 12/28/21 due to fever. She was found to have infected permcath. While undergoing treatment, on 1/3/22, the patient became hypoxic. COVID-19 testing was performed, which was positive. Pt was symptomatic and required treatment.


VAERS ID: 2014811 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-02
Onset:2021-12-28
   Days after vaccination:117
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal discomfort, Chills, Headache, Malaise, Nausea, Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: one-day history of fevers rigors and not feeling well. She noted nausea vomiting and headache started around 11:00 a.m. the day before admission and she was unable to keep down solids or liquids. She developed abdominal discomfort as well as generalized body aches. She continued to feel unwell the day of admission subsequently came into the emergency department.


VAERS ID: 2014815 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-06
Onset:2021-12-28
   Days after vaccination:297
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Cough, Decreased appetite, Dyspnoea, Nausea, Pain, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: to be evaluated for cough, shortness of breath, subjective fevers, and chills. Patient uncertain when symptoms started, but thinks its over the past two days. She endorses nausea, vomiting (no blood) and diffuse body aches. She reports poor appetite as well.


VAERS ID: 2014821 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-06
Onset:2021-12-28
   Days after vaccination:297
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Cough, Decreased appetite, Dyspnoea, Nausea, Pain, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: to be evaluated for cough, shortness of breath, subjective fevers, and chills. Patient uncertain when symptoms started, but thinks its over the past two days. She endorses nausea, vomiting (no blood) and diffuse body aches. She reports poor appetite as well.


VAERS ID: 2014837 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-22
Onset:2021-12-28
   Days after vaccination:250
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Chills, Decreased appetite, Dyspnoea, Mobility decreased
SMQs:, Anaphylactic reaction (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: worsening generalized weakness that has limited her ability to move about her home. Over the past few days she has had poor appetite and has been able to eat, she additionally endorses intermittent shortness of breath diffuse chills.


VAERS ID: 2014889 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-27
Onset:2021-12-28
   Days after vaccination:276
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cytomegalovirus infection, Proctalgia
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (narrow), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cytomegalovirus 1/11/2021 full, who presents with rectal pain. He has COVID-19 since Tuesday December 28, 2021, and received an infusion of monoclonal antibodies on Sunday January 2, 2022.


VAERS ID: 2014891 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-27
Onset:2021-12-28
   Days after vaccination:276
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cytomegalovirus infection, Proctalgia
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (narrow), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: cytomegalovirus 1/11/2021 full, who presents with rectal pain. He has COVID since Tuesday December 28, 2021, and received an infusion of monoclonal antibodies on Sunday January 2, 2022.


VAERS ID: 2017531 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Washington  
Vaccinated:0000-00-00
Onset:2021-12-28
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855194 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Headache, Myalgia, Pain in extremity, Paraesthesia, Pruritus
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), 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? 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: USJNJFOC20220102705

Write-up: CHEST PAIN; ITCHY (FEELS NEED TO SCRATCH BODY); HEAVINESS IN THE CHEST; NUMBNESS AND TINGLING IN THE ARMS AND LEGS; SORE ARM; HEADACHE; MUSCLE ACHES; This spontaneous report received from a patient concerned a female 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 ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1855194, and expiry: UNKNOWN) dose was not reported, administered on 28-DEC-2021 for prophylactic vaccination. No concomitant medications were reported. On 28-DEC-2021, the patient experienced sore arm, headache, and muscle aches. On 31-DEC-2021, the patient experienced chest pain, itchy (feels need to scratch body), heaviness in the chest, and numbness and tingling in the arms and legs. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from sore arm, headache, and muscle aches, and had not recovered from numbness and tingling in the arms and legs, chest pain, itchy (feels need to scratch body), and heaviness in the chest. This report was non-serious. This report was associated with product complaint number.


VAERS ID: 2017544 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-12-28
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: SARS-CoV-2 test, Suspected COVID-19, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Blood pressure high; Non-smoker
Preexisting Conditions: Comments: The patient had no known drug allergies.
Allergies:
Diagnostic Lab Data: Test Date: 20220102; Test Name: COVID-19 virus test; Result Unstructured Data: Negative
CDC Split Type: USJNJFOC20220104490

Write-up: SUSPECTED CLINICAL VACCINATION FAILURE; SUSPECTED COVID-19 INFECTION; This spontaneous report received from a patient concerned a 49 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: high blood pressure on medication, non smoker and non alcohol user and other pre-existing medical conditions included: The patient had no known drug allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 203A21A, and expiry: unknown) dose was not reported, 1 total, administered on 26-AUG-2021 for prophylactic vaccination. No concomitant medications were reported. On 28-DEC-2021, the patient experienced suspected covid-19 infection and hence suspected clinical vaccination failure. On 28-DEC-2021 at night after work, He had symptoms of cough, chills, stuffy nose and high fever. Patient reported that when he coughed his chest hurt. He visited his daughter that night to check on her and she told him she has Covid-19 virus. He was within 6 feet of his daughter for up to 20 minutes. On 02-JAN-2022, Laboratory data included: COVID-19 virus test (NR: not provided) Negative. During the report he mentioned symptom of headache as well. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from suspected covid-19 infection, and the outcome of suspected clinical vaccination failure was not reported. This report was serious (Other Medically Important Condition). This report was associated with a product quality complaint.; Sender''s Comments: V0- 20220104490-Covid-19 vaccine ad26.CoV-2.s- Suspected clinical vaccination failure. This event is considered not related. The event 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 than the drug. Specifically: SPECIAL SITUATIONS


VAERS ID: 2017588 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:0000-00-00
Onset:2021-12-28
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 264B21A / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Anemia; Vitamin B12 deficiency; Comments: The patient had no known allergies.
Allergies:
Diagnostic Lab Data: Test Date: 20220104; Test Name: COVID-19 PCR test; Result Unstructured Data: Positive
CDC Split Type: USJNJFOC20220107787

Write-up: CONFIRMED CLINICAL VACCINATION FAILURE; CONFIRMED COVID-19 INFECTION; This spontaneous report received from a patient concerned a 41 year old female. The patient''s height, and weight were not reported. The patient''s past medical history included: anemia, and low b12, and other pre-existing medical conditions included: The patient had no known allergies. The patient received covid-19 vaccine ad26.cov2.s(dose series 1) (suspension for injection, route of admin not reported, batch number: 264B21A expiry: unknown) dose was not reported, 1 total, administered on 13-SEP-2021 on right arm for prophylactic vaccination. No concomitant medications were reported. On 28-DEC-2021, the patient experienced loss of taste and smell, sore throat, headache, cough, and stuff nose (confirmed covid-19 infection) and also had confirmed clinical vaccination failure for which patient tested Covid-19 positive . On 04-JAN-2022, Laboratory data included: COVID-19 PCR (polymerase case reaction) test (NR: not provided) Positive. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from confirmed covid-19 infection, and the outcome of confirmed clinical vaccination failure was not reported. This report was serious (Other Medically Important Condition). This report was associated with product quality complaint: 90000210342.; Sender''s Comments: V0-20220107787-Covid-19 vaccine ad26.cov2.s-Confirmed Clinical Vaccination failure. This event is considered not related. The event 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 than the drug. Specifically: SPECIAL SITUATIONS


VAERS ID: 2017713 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-01-29
Onset:2021-12-28
   Days after vaccination:333
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20211228; Test Name: COVID-19 test; Test Result: Positive; Result Unstructured Data: Positive.
CDC Split Type: USMODERNATX, INC.MOD20214

Write-up: Tested positive for COVID-19; This spontaneous case was reported by a pharmacist and describes the occurrence of SARS-COV-2 TEST POSITIVE in a 36-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 014M20A and 032L20A) for COVID-19 vaccination. No Medical History information was reported. On 29-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 26-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 28-Dec-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced SARS-COV-2 TEST POSITIVE (Tested positive for COVID-. At the time of the report, SARS-COV-2 TEST POSITIVE outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available) on 28-Dec-2021, SARS-CoV-2 test positive. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were reported. No treatment information was reported. Company comment: This is a spontaneous case concerning a 36-year-old, male patient with no reported medical history, who experienced the unexpected, non serious, AESI event of SARS-CoV-2 test positive. The patient received first and second dose of mRNA-1273 vaccine with appropriate dosage interval of 28 days. The event SARS-CoV-2 test positive occurred 305 days after the second dose of mRNA-1273 vaccine administration. No reported treatment medication. The outcome of the event was unknown. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report. This case was linked to MOD-2021-433545 (Patient Link).


VAERS ID: 2017723 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-12-22
Onset:2021-12-28
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / OT

Administered by: Unknown       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? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: GABAPENTIN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20214

Write-up: Seizure; This spontaneous case was reported by a consumer and describes the occurrence of SEIZURE (Seizure) in a 25-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Co-suspect product included non-company product INFLUENZA VACCINE (FLU VACCINE VII) for an unknown indication. Concomitant products included GABAPENTIN for an unknown indication. On 22-Dec-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form and dose of INFLUENZA VACCINE (FLU VACCINE VII) (unknown route) 1 dosage form. On 28-Dec-2021, the patient experienced SEIZURE (Seizure) (seriousness criteria hospitalization and medically significant). At the time of the report, SEIZURE (Seizure) had not resolved. Since past Tuesday, patient suffered a seizure, and has been in the hospital ever since then. So far, the doctors have not been able to figure out what the problem was. No Treatment information was provided. Company comment: This spontaneous case concerns a 25-year-old female patient with no medical history and co-administration of Influenza vaccine, who experienced the unexpected serious (hospitalization and medically significant) event of Seizure after mRNA- 1273 vaccine. The event occurred approximately 6 days after the booster dose of mRNA- 1273 vaccine and led to hospitalization. Very limited information is available regarding course of hospitalization, diagnostic work-up and treatment received. Co-administration of Influenza Vaccine remains a confounder. The benefit-risk relationship of mRNA- 1273 vaccine is not affected by this report.; Sender''s Comments: This spontaneous case concerns a 25-year-old female patient with no medical history and co-administration of Influenza vaccine, who experienced the unexpected serious (hospitalization and medically significant) event of Seizure after mRNA- 1273 vaccine. The event occurred approximately 6 days after the booster dose of mRNA- 1273 vaccine and led to hospitalization. Very limited information is available regarding course of hospitalization, diagnostic work-up and treatment received. Co-administration of Influenza Vaccine remains a confounder. The benefit-risk relationship of mRNA- 1273 vaccine is not affected by this report.


VAERS ID: 2017738 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature, Chills, Cold sweat, Dyspnoea, Fatigue, Feeling abnormal, Headache, Heart rate, Heart rate increased, Myalgia, Nausea, Peripheral swelling, Pyrexia, Vaccination site pruritus, Vaccination site warmth, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20211228; Test Name: Body temperature; Result Unstructured Data: Body temperature increased 101.2.; Test Date: 20211228; Test Name: Heart rate; Result Unstructured Data: Heart rate increased 111.
CDC Split Type: USMODERNATX, INC.MOD20214

Write-up: heart rate of 111; Her arm was also warm,; Her arm was also swollen; Her arm was also itching; vomiting; fatigue/tired; like I was going to pass out; shortness of breath/she continues to feel a little short of breath; cold sweats; nausea; headache/Her headache is in the back of her head and up behind her eyes.; like when you are first getting covid; chills; fever 101.2; body aches; This spontaneous case was reported by a nurse and describes the occurrence of FEELING ABNORMAL (like I was going to pass out), DYSPNOEA (shortness of breath/she continues to feel a little short of breath), COLD SWEAT (cold sweats), FEELING ABNORMAL (like when you are first getting covid) and HEART RATE INCREASED (heart rate of 111) in a 69-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 034F21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Previously administered products included for COVID-19 vaccination: PFIZER BIONTECH COVID-19 VACCINE (First dose) on 02-Apr-2021 and PFIZER BIONTECH COVID-19 VACCINE (Second dose) on 26-Apr-2021. Past adverse reactions to the above products included No adverse event with PFIZER BIONTECH COVID-19 VACCINE and PFIZER BIONTECH COVID-19 VACCINE. On 28-Dec-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 28-Dec-2021, the patient experienced FEELING ABNORMAL (like when you are first getting covid), CHILLS (chills), PYREXIA (fever 101.2) and MYALGIA (body aches). On 29-Dec-2021, the patient experienced FEELING ABNORMAL (like I was going to pass out), DYSPNOEA (shortness of breath/she continues to feel a little short of breath), COLD SWEAT (cold sweats), HEART RATE INCREASED (heart rate of 111), VACCINATION SITE WARMTH (Her arm was also warm,), PERIPHERAL SWELLING (Her arm was also swollen), VACCINATION SITE PRURITUS (Her arm was also itching), VOMITING (vomiting), FATIGUE (fatigue/tired), NAUSEA (nausea) and HEADACHE (headache/Her headache is in the back of her head and up behind her eyes.). The patient was treated with NAPROXEN for Migraine, at an unspecified dose and frequency; DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL [DIPHENHYDRAMINE HYDROCHLORIDE]) for Migraine, at an unspecified dose and frequency and SUMATRIPTAN for Migraine, at an unspecified dose and frequency. On 28-Dec-2021, FEELING ABNORMAL (like when you are first getting covid) had resolved. On 30-Dec-2021, FEELING ABNORMAL (like I was going to pass out), COLD SWEAT (cold sweats), HEART RATE INCREASED (heart rate of 111), VACCINATION SITE WARMTH (Her arm was also warm,), PERIPHERAL SWELLING (Her arm was also swollen), VACCINATION SITE PRURITUS (Her arm was also itching), VOMITING (vomiting), CHILLS (chills), PYREXIA (fever 101.2), MYALGIA (body aches), NAUSEA (nausea) and HEADACHE (headache/Her headache is in the back of her head and up behind her eyes.) had resolved. At the time of the report, DYSPNOEA (shortness of breath/she continues to feel a little short of breath) and FATIGUE (fatigue/tired) had not resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 28-Dec-2021, Body temperature: 101.2 (High) Body temperature increased 101.2.. On 28-Dec-2021, Heart rate: 111 Heart rate increased 111.. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medications details were not reported by the reporter.


VAERS ID: 2017923 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Virginia  
Vaccinated:2021-04-28
Onset:2021-12-28
   Days after vaccination:244
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Lip swelling, Mechanical urticaria, Pruritus, Swelling of eyelid, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20224

Write-up: dermographism, when any pressure is apply on their body it turns red.; broke out with hives all over their body; lip swelling; eyelid swelling; very itchy; This spontaneous prospective pregnancy case was reported by a consumer and describes the occurrence of URTICARIA (broke out with hives all over their body), LIP SWELLING (lip swelling), SWELLING OF EYELID (eyelid swelling), PRURITUS (very itchy) and MECHANICAL URTICARIA (dermographism, when any pressure is apply on their body it turns red.) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 070H21A, 049C21A and 025B21A) for COVID-19 vaccination. No Medical History information was reported. On 28-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 26-May-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 18-Dec-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. Last menstrual period and estimated date of delivery were not provided. On 28-Dec-2021, the patient experienced URTICARIA (broke out with hives all over their body), LIP SWELLING (lip swelling), SWELLING OF EYELID (eyelid swelling) and PRURITUS (very itchy). On an unknown date, the patient experienced MECHANICAL URTICARIA (dermographism, when any pressure is apply on their body it turns red.). The patient was treated with CORTISONE on 31-Dec-2021 for Adverse event, at an unspecified dose and frequency; PREDNISONE on 31-Dec-2021 for Adverse event, at an unspecified dose and frequency and BETAHISTINE HYDROCHLORIDE (VERTEX [BETAHISTINE HYDROCHLORIDE]) for Antihistamine therapy, at an unspecified dose and frequency. At the time of the report, URTICARIA (broke out with hives all over their body) and PRURITUS (very itchy) had not resolved, LIP SWELLING (lip swelling) and SWELLING OF EYELID (eyelid swelling) had resolved and MECHANICAL URTICARIA (dermographism, when any pressure is apply on their body it turns red.) outcome was unknown. No Concomitant medications were reported. Patient stated that she experienced hives every day and very itchy, which come and go throughout the day, spread on the stomach and appeared in various parts of the body at different times. Patient stated that she have been taking Vertex, an antihistaminic and also visited urgent care on Friday 31-Dec-2021 where she got a cortisone shot and a prednisone course for 5 days. Patient also stated that she do not take any medication regularly and she was pregnant back when she received the first two shots of vaccine


VAERS ID: 2018745 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-04-27
Onset:2021-12-28
   Days after vaccination:245
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Drug ineffective, Suspected COVID-19
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure high
Allergies:
Diagnostic Lab Data: Test Date: 2021; Test Name: Blood test; Result Unstructured Data: Test Result:Unknown result
CDC Split Type: USPFIZER INC202101871798

Write-up: she found out she has covid about 2 hours ago; she found out she has covid about 2 hours ago; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP) from medical information team and product quality group. The reporter is the patient. A 64-year-old female patient received bnt162b2 (BNT162B2), administration date 27Apr2021 (Batch/Lot number: unknown) at the age of 64 years as dose 2, single and administration date 05Apr2021 (Batch/Lot number: unknown) as dose 1, single for covid-19 immunisation (consumer provided lot number "ER8734" and expiration date "Jul2021", unspecified to which dose). Relevant medical history included: "high blood pressure" (unspecified if ongoing). The patient took concomitant medications for for high blood pressure. The following information was reported: DRUG INEFFECTIVE (medically significant), SUSPECTED COVID-19 (medically significant) all with onset 28Dec2021, outcome "unknown" and all described as "she found out she has covid about 2 hours ago". The patient stated she had both doses of the Pfizer covid 19 vaccine on 5Apr2021 and 27Apr2021. She found out she has covid about 2 hours ago before the report (28Dec2021). The patient underwent the following laboratory tests and procedures: blood test: (2021) unknown result. When probed regarding the name of test, the patient stated, "I don''t know my doctor did it. I had the blood test." The lot number for bnt162b2 was not provided and will be requested during follow up.


VAERS ID: 2018759 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3198 / UNK RA / -

Administered by: Private       Purchased by: ?
Symptoms: Immunisation, Product administration error, Vaccination site haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101872800

Write-up: booster shot; when the needle put out there is lot of blood; when the needle put out there is lot of blood/vaccine on her right arm but the problem is the needle a lot of blood coming out; there is bleeding issue; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP). The reporter is the parent. A 17 year-old female patient received bnt162b2 (BNT162B2), administered in arm right, administration date 28Dec2021 17:00 (Lot number: FL3198) at the age of 17 years as dose number unknown (booster), single for covid-19 immunisation. The patient had no relevant medical history. There were no concomitant medications. Vaccination history included: Covid-19 vaccine (DOSE X; MANUFACTURER UNKNOWN), for COVID-19 immunization. The following information was reported: IMMUNISATION (non-serious) with onset 28Dec2021 17:00, outcome "unknown", described as "booster shot"; PRODUCT ADMINISTRATION ERROR (non-serious) with onset 28Dec2021 17:00, outcome "unknown", described as "when the needle put out there is lot of blood"; VACCINATION SITE HAEMORRHAGE (non-serious) with onset 28Dec2021 17:00, outcome "unknown", described as "when the needle put out there is lot of blood/vaccine on her right arm but the problem is the needle a lot of blood coming out; there is bleeding issue". Additional information: It was reported that the patient went walking to that hospital that afternoon around the 12 o''clock had a Pfizer vaccine shot afternoon at 5 O''clock and basically it was given on her right arm and when the needle put out there was lot of blood and basically it was slowing on. The problem was the needle, a lot of blood was coming out and the nurse had to wipe it twice and so her concern was that whether the vaccine given inside was availed. There was bleeding issue. The reporter wanted to know whether that was the cause that compromise the booster and if the needle went inside the muscle or if that could cause the bleeding issue. No follow-up attempts are possible. No further information is expected.


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