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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 134 out of 10,493

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VAERS ID: 2018801 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-02-16
Onset:2021-12-28
   Days after vaccination:315
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 2 LA / -

Administered by: Work       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:
Allergies:
Diagnostic Lab Data: Test Date: 20211228; Test Name: Rapid Test; Test Result: Positive; Comments: Nasal Swab.
CDC Split Type: USPFIZER INC202101877878

Write-up: Breakthrough case / covid test result=Positive; Breakthrough case / covid test result=Positive; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP) from product quality group. The reporter is the patient. An 30 year-old female patient (not pregnant) received bnt162b2 (BNT162B2), administered in arm left, administration date 16Feb2021 (Lot number: EL3247) at the age of 29 years as dose 2, single, and administration date 26Jan2021 (Lot number: El3247) as dose 1, single for covid-19 immunisation. The patient''s relevant medical history and concomitant medications were not reported. The following information was reported VACCINATION FAILURE (medically significant), COVID-19 (medically significant) all with onset 28Dec2021, outcome recovering. The patient underwent the following laboratory tests and procedures sars-cov-2 test (28Dec2021) positive, Nasal Swab. Therapeutic measures were not taken as a result of vaccination failure, covid-19. No, covid prior vaccination. No known allergies. No follow-up attempts are needed. No further information is expected.


VAERS ID: 2018831 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: California  
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 33130BA / 3 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Headache, Immunisation, Lymph node pain, Myalgia, Nausea, Pain in extremity, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Drug intolerance (known allergies: Intolerant of opioids.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101882336

Write-up: Fever; Nausea; Slight headache; Chills; Sore arm; Extremely painful lymph node under left arm; Muscle ache/muscle pain; Joint ache/joint pain; dose number=3; This is a spontaneous report from a contactable reporter (consumer or other non-HCP). The reporter is the patient. A 64-year-old female patient (not pregnant) received bnt162b2 (BNT162B2), administered in arm left, administration date 28Dec2021 at 15:00 (Batch/Lot number: 33130BA) at the age of 64 Year(s) as dose 3 (booster), single for COVID-19 immunisation. Relevant medical history included: "Drug intolerance" (unspecified if ongoing), notes: known allergies: Intolerant of opioids. The patient did not receive concomitant medications. Past drug history included: Aspirin, reaction(s): "Drug intolerance", notes: known allergies: Intolerant of aspirin. Vaccination history included: Bnt162b2 (DOSE 1, SINGLE; Lot Number: EN6206; Administration time: 10:00 Administration Location: Left Arm), administration date: 18Mar2021, when the patient was 63 year(s) old, for COVID-19 immunisation, reaction(s): "No adverse event" and Bnt162b2 (DOSE 2, SINGLE; Lot Number: ER8734; Administration time: 10:00 Administration Location: Left Arm), administration date: 08Apr2021, when the patient was 63 year(s) old, for COVID-19 immunisation, reaction(s): "No adverse event". The following information was reported: IMMUNISATION (non-serious) with onset 28Dec2021 at 15:00, outcome "unknown", described as "dose number=3"; PYREXIA (non-serious) with onset 29Dec2021 at 06:00, outcome "recovered" (29Dec2021), described as "Fever"; NAUSEA (non-serious) with onset 29Dec2021 at 06:00, outcome "recovered" (29Dec2021), described as "Nausea"; HEADACHE (non-serious) with onset 29Dec2021 at 06:00, outcome "recovered" (29Dec2021), described as "Slight headache"; CHILLS (non-serious) with onset 29Dec2021 at 06:00, outcome "recovered" (29Dec2021), described as "Chills"; PAIN IN EXTREMITY (non-serious) with onset 29Dec2021 at 06:00, outcome "recovered" (29Dec2021), described as "Sore arm"; LYMPH NODE PAIN (non-serious) with onset 29Dec2021 at 06:00, outcome "recovering", described as "Extremely painful lymph node under left arm"; MYALGIA (non-serious) with onset 29Dec2021 at 06:00, outcome "recovering", described as "Muscle ache/muscle pain"; ARTHRALGIA (non-serious) with onset 29Dec2021 at 06:00, outcome "recovering", described as "Joint ache/joint pain". Relevant laboratory tests and procedures are available in the appropriate section. Therapeutic measures were not taken as a result of pyrexia, nausea, headache, chills, pain in extremity, lymph node pain, myalgia and arthralgia. Additional information: Prior to vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the prior to the COVID-19 vaccine. Since the vaccination, the patient had not been tested for COVID-19. The events did not result in doctor or other healthcare professional office/clinic visit and emergency room/department or urgent care.


VAERS ID: 2019194 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-01
Onset:2021-12-28
   Days after vaccination:271
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 2 LA / OT

Administered by: Work       Purchased by: ?
Symptoms: COVID-19, Polymerase chain reaction, 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: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: none
Allergies:
Diagnostic Lab Data: Test Date: 20211231; Test Name: PCR; Test Result: Positive ; Comments: Nasal Swab
CDC Split Type: USPFIZER INC202200009257

Write-up: Contracted Covid-19. Fever and flu like symptoms for 6 days.; Contracted Covid-19. Fever and flu like symptoms for 6 days.; This is a spontaneous report received from a contactable reporter (Consumer or other non HCP). The reporter is the patient. A 46 year-old female patient (not pregnant) received bnt162b2 (BNT162B2), intramuscular, administered in arm left, administration date 01Apr2021 (Lot number: EN6199) at the age of 46 years as dose 2, single and intramuscular, administered in arm left, administration date 11Mar2021 (Lot number: EL3248) as dose 1, single for covid-19 immunisation. The patient had no relevant medical history and no known allergies. The patient did not receive any other vaccine in four weeks. There were no concomitant medications (did not receive other medications in two weeks).The patient had no Covid prior vaccination and tested covid post vaccination. The following information was reported: VACCINATION FAILURE (medically significant), COVID-19 (medically significant) all with onset 28Dec2021, outcome "recovering" and all described as "Contracted Covid-19. Fever and flu like symptoms for 6 days.". The patient underwent the following laboratory tests and procedures: polymerase chain reaction: (31Dec2021) positive, notes: Nasal Swab. Therapeutic measures were not taken as a result of vaccination failure, covid-19.


VAERS ID: 2019345 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-10
Onset:2021-12-28
   Days after vaccination:232
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest discomfort, Chills, Cough, Fatigue, 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: chills, fatigue, cough, chest tightness + COVID test


VAERS ID: 2019348 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-22
Onset:2021-12-28
   Days after vaccination:220
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Dyspnoea, Pyrexia, Respiratory tract congestion, 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills, fever, congestion, cough, shortness of breath and positive COVID-19 test.


VAERS ID: 2019351 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-22
Onset:2021-12-28
   Days after vaccination:220
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest pain, Myalgia, Oropharyngeal pain, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: sore throat, chest pain, myalgias + COVID test


VAERS ID: 2019353 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-08-26
Onset:2021-12-28
   Days after vaccination:124
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (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? 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: short of breath + COVID test


VAERS ID: 2019425 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-11-15
Onset:2021-12-28
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Bell's palsy, Facial paralysis, Magnetic resonance imaging
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, Montelukast, Bupropion, QVAR inhaler, Albuterol inhaler (PRN)
Current Illness: None.
Preexisting Conditions: Asthma, hypothyroidism
Allergies: Latex. Nickel
Diagnostic Lab Data: MRI 12/29/2021
CDC Split Type:

Write-up: Bell''s Palsy with onset starting 12/28/2021. Left side of my face is paralyzed. Treatment so far has included a 7 day course of Prednisone and a 7 day course of Valacyclovir. No improvement, so far.


VAERS ID: 2019497 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Georgia  
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 041J21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Depressed mood, Feeling abnormal, Feeling of body temperature change, Headache, Influenza like illness, Injection site pain, Myalgia, Paranasal sinus discomfort, Pyrexia, Respiratory tract congestion, Rhinorrhoea, Wheezing
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Hives
Other Medications: Multi-vitamin
Current Illness: None
Preexisting Conditions:
Allergies: Sulfa
Diagnostic Lab Data: None?reported to the pharmacy
CDC Split Type:

Write-up: By 7pm i had a fever. I went to bed early. Felt hot and cold through the night. By the next morning, I was wheezing, feeling very fluish and VERY depressed. I maintained the fever for the next 1.5 days. It went away but came back several times over the next several days. Feeling bad overall with muscular aches all over, wheezing, congestion, headache with sinus pressure, Injection site still painful. 11 days out I still have mild depression (which I had with covid itself back in Feb of 2021 (also reported to my doctor who stated it didn?t meet the exemption status regardless of severity.)) Still have a runny nose and intermittent wheezing.


VAERS ID: 2019602 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-12-27
Onset:2021-12-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood urea, Chest pain, Oesophagitis
SMQs:, Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Constant chest pain going on 2 weeks now. Has not resolved. Visit with my PCP diagnosed with esophagitis. Started on pantoprazole 40mg bid with no improvement after 13 days. Now I need to see specialists.


VAERS ID: 2019952 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-01-16
Onset:2021-12-28
   Days after vaccination:346
Submitted: 0000-00-00
Entered: 2022-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030M20A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 077C21B / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Cough, Fatigue, Influenza virus test negative, Oropharyngeal pain, Pain, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concerta, levothyroxine
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Positive covid test 12/29/21. Negative influenza A and B and strep tests 12/29/21.
CDC Split Type:

Write-up: Symptom of sore throat started 12/28/21 and continued until 12/31/21. Accompanied by fever, cough, aches, fatigue, loss of smell and taste on 21/30/21 for about 18 hours. Still currently feeling fatigues and coughing.


VAERS ID: 2020488 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Florida  
Vaccinated:0000-00-00
Onset:2021-12-28
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Hypersomnia, SARS-CoV-2 test, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20211228; Test Name: COVID-19 antigen test; Result Unstructured Data: Negative; Test Date: 20211230; Test Name: COVID-19 PCR test; Result Unstructured Data: Positive; Test Date: 20211230; Test Name: COVID-19 antigen test; Result Unstructured Data: Negative; Test Date: 20211231; Test Name: COVID-19 antigen test; Result Unstructured Data: Negative; Test Date: 20220101; Test Name: COVID-19 antigen test; Result Unstructured Data: Positive.
CDC Split Type: USJNJFOC20220108126

Write-up: CONFIRMED CLINICAL VACCINATION FAILURE; CONFIRMED COVID-19 INFECTION; SLEPT A LOT; This spontaneous report received from a patient via a company representative concerned a 47 year old white, not hispanic or latino male. 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: 043A21A, and expiry: UNKNOWN) dose was not reported(dose number in series: 1), 1 total administered on 06-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On 28-DEC-2021, the patient experienced symptoms of slept a lot, headache, sore throat, congestion with runny nose, sneezing (dose number in series: 1) and performed rapid home test binax Laboratory data included: COVID-19 antigen test (NR: not provided) negative. On 30-DEC-2021, the patient experienced confirmed covid-19 infection, and confirmed clinical vaccination failure. Laboratory data included: COVID-19 PCR( polymerase chain reaction) test (NR: not provided) positive, patient performed rapid home test binax , COVID-19 antigen test (NR: not provided) negative. On 31-DEC-2021, Laboratory data included: COVID-19 antigen test (NR: not provided) negative. On 01-JAN-2022, Laboratory data included: COVID-19 antigen test (NR: not provided) positive. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the confirmed covid-19 infection, slept a lot and confirmed clinical vaccination failure was not reported. This report was serious (Other Medically Important Condition). This report was associated with a product quality complaint:90000210285.; Sender''s Comments: V0: 20220108126-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: 2020727 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-12-17
Onset:2021-12-28
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213D21A / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Back pain, Gait inability, Mobility decreased, Tinnitus
SMQs:, Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hearing impairment (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Sore back and hip, unable to walk or lay down, ringing in the ears.


VAERS ID: 2020768 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-12-27
Onset:2021-12-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012H21B / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Trazadone levothyroxine multivitamins Allegra melatonin
Current Illness: NON-COVID Viral upper respiratory tract infection, secondary bacterial sinus infection
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: sever swelling of the right axillary lymph node lasting 7 days, fatigue and body aches lasting 48 hours


VAERS ID: 2020870 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Extra dose administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: booster given prior to CDC guidance, patient tolerated vaccine fine, no adverse events noted


VAERS ID: 2020879 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Extra dose administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Vaccine given prior to CDC guidelines, no adverse events noted


VAERS ID: 2020964 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: New York  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33130BA / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Axillary pain, Back pain, Condition aggravated, Dysstasia, Fatigue, Fibromyalgia, Lymphadenopathy, Migraine, Mobility decreased, Musculoskeletal chest pain, Neck pain, Pain, Pain in extremity, Sitting disability
SMQs:, Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ropinerole, Lisinopril -HCT, Duloxetine HCL, Levothyroxine, Rosuvastatin, Calcium, Magnesium, D3, Zinc, CoQ10, Curcumin.
Current Illness:
Preexisting Conditions: Fibromyalgia, Cervical Stenosis, Lumbar/Sciatica, Hypertension, Hypothyroid, Type 2 Diabetes (controlled by diet).
Allergies: None
Diagnostic Lab Data: None. No tests for fibromyalgia problems.
CDC Split Type:

Write-up: Started as a Fibromyalgia event with feeling aggravating pain throughout body, unable to sit or stand. Which then sends me to bed. But the pain increased to more intense than I would normally feel. I felt this pain from head to toes. Especially, upper back and neck with migraine-type headache, my lower back and hips, my knees radiated to ankles, felt the pain on top of my feet, also my rib cage, arms, hands and fingers. Needed to take a full Hydrochodone 7.5-325 but pain persisted on and off throughout night and next day. Still feeling increased amount of fatigue. Also experienced pain in left arm pit and found several enlarged lymphnodes.


VAERS ID: 2021048 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose normal, Confusional state, Discomfort, Dysarthria, Eye movement disorder, Full blood count abnormal, Grimacing, Hyperhidrosis, Metabolic function test, Pallor, Palpitations, Syncope, Unresponsive to stimuli, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Haematopoietic leukopenia (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Dyskinesia (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: CBC , CMP IN THE HOSPITAL.ELEVATED CBC, PLAN TO REPEAT IN FEW WEEKS
CDC Split Type:

Write-up: I was called to attend an emergency that happened during COVID Clinic. The medical assistant reported 10year old boy was there for his routine first COVID vaccine. 5 minutes after the COVID shot, he was sweating and appeared to be in discomfort. The Nurse practitioner was called who mentioned that pt was initially responding to verbal command but later he had decreased responsiveness. Help was called immediately. By the time I arrived, he was sitting on the chair and was looking to the side with up rolling of his eyes. No involuntary movements of his limbs. I immediately laid him down on the floor. He appeared very pale and was diaphoretic. Pt did not response to voice commands. Sternal rub was done couple of times for tactile stimulation, patient had minimal response/grimacing. I asked help to get his vitals Oxygen saturation, Blood pressure, Blood glucose and for Oxygen. EMS was called. His heart sounds were muffled on examination and the NP did not appreciate any pulse in the groin. Epipen was given by NP. Within 60 seconds, his heart rate was pounding, he started responding to pain, his speech was slurred was confused. Patient?s Oxygen saturation was maintained throughout at 98%, pulse 62 and blood pressure was 90/65. Blood sugar was 90mg/dl. Upon reevaluation, pt. started responding to the questions in a slow manner, he still appeared sweaty and pale. Paramedics arrived and we provided details about the patient. He was referred to a local Hospital for further evaluation. After 4 hours, I Spoke with the attending at the Hospital who mentioned pt was doing well. However, prior to discharge he got diaphoretic and was readmitted at Emergency Department for observation. IV fluids were given. CBC showed elevation of WBC. Normal CMP. Discharged home with diagnosis of syncope and advised to follow up with PCP. Parents were asking whether patient can receive the second dose of Pfizer vaccine. Based on the experience below, please suggest if its okay to give second Pfizer vaccine and please advice on precautions we need to take. I appreciate your input and help. Thank you.


VAERS ID: 2021185 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-07
Onset:2021-12-28
   Days after vaccination:143
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 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? 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: Vaccinated 8/26/2021, 3/9/2021, 2/16/2021. Hospitalized with COVID 1/7/22


VAERS ID: 2021258 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-08-17
Onset:2021-12-28
   Days after vaccination:133
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: metoprolol
Current Illness: none
Preexisting Conditions: hypertension, hypertriglyceridemia, obesity, psoriasis, bph, osa
Allergies: lisinopril phenobarbital amlodipine
Diagnostic Lab Data: SARS-COV-2 RNA, NAAT positive on 12/29/2021
CDC Split Type:

Write-up: developed covid symptoms 12/28/21


VAERS ID: 2021262 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: New York  
Vaccinated:2021-12-20
Onset:2021-12-28
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8757 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abscess drainage, Breast abscess, Breast mass
SMQs:

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

Write-up: 5-7 days after receiving vaccination a lump appeared on right breast, was treated with antibiotics; abscess was drained.


VAERS ID: 2021280 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-16
Onset:2021-12-28
   Days after vaccination:256
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B21A / 2 LA / IM

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

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

Write-up: developed covid symptoms 12/29/2021


VAERS ID: 2021435 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-10-04
Onset:2021-12-28
   Days after vaccination:85
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN 6200 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135819 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Exposure to SARS-CoV-2, Fatigue, Headache, Nausea, Night sweats, Pain, Pyrexia, Throat irritation
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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:
Current Illness: none
Preexisting Conditions: mild COPD
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: covid symptoms started on 12/28.2021, fever, body aches, night sweats, hacking cough, ticklish throat, headache causing nausea, fatigue ending 8 days later. wife tested positive for covid, twice, so I didn''t bother.


VAERS ID: 2021789 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33130BA / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Headache, Migraine, Nausea, Pain in extremity, Palpitations, Restlessness, Sleep disorder
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Akathisia (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: It felt like my heart was in a vice grip, chest pain starting middle of the night day I received the vaccine. Restless, unable to sleep. Sat upright in a recliner most of the night. It felt like my heart was racing, chest pain, headache and arm ached. I continued to experience migraines and nausea for almost a week post vaccination. Peaking the Sunday following.


VAERS ID: 2022033 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Joint swelling, Skin discolouration, Vaccine positive rechallenge
SMQs:, Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Birth control pills
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: I visited a NP for an unrelated issue about 5 days after the initial swelling started. My ankles were still slightly swollen and she wasn?t sure why though we did joke that it was the vaccine at the time. I don?t know if she made note of it.
CDC Split Type:

Write-up: Painful, swollen and purplish ankles, which I never have any other time, but the same thing happened after my second shot in April 2021. The swelling started 10 days after my second shot and again 13 days after my booster.


VAERS ID: 2024731 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-01
Onset:2021-12-28
   Days after vaccination:271
Submitted: 0000-00-00
Entered: 2022-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 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 house hold contact. Client did receive booster but not within 2 weeks of getting sick


VAERS ID: 2024785 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-12-27
Onset:2021-12-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

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

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

Write-up: Hives on stomach and back


VAERS ID: 2024846 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-12-16
Onset:2021-12-28
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2022-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angioedema, Arthralgia, Blood test, Chest X-ray, Dizziness, Dyspnoea, Flushing, Headache, Hypersensitivity, Painful respiration, Rash, Urine analysis, Urticaria chronic
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan.
Current Illness: None.
Preexisting Conditions: Hypertension.
Allergies: Advair, Shellfish.
Diagnostic Lab Data: Chest X-Ray, blood and urine samples are currently being analyzed.
CDC Split Type:

Write-up: Woke up ~12 days later with chronic hives, rash, face flushing, joint paint, angiodema, head aches, dizziness, and trouble/pain when breathing. Went to ER twice on the basis that it was an allergic reaction. Was given prednisone, benadryl, and then eventually epinephrine. All helped a little bit for a short while, but after a day, symptoms returned. Doctor has recently put me back on prednisone (80 mg), with symptoms persisting.


VAERS ID: 2024990 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-06-07
Onset:2021-12-28
   Days after vaccination:204
Submitted: 0000-00-00
Entered: 2022-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 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 house hold contact


VAERS ID: 2025003 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-10
Onset:2021-12-28
   Days after vaccination:262
Submitted: 0000-00-00
Entered: 2022-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 064H21A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Pain in extremity, SARS-CoV-2 test positive
SMQs:, Tendinopathies and ligament disorders (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: Vit D ,Vit C , multi-vitamin, melatonin, aspirin
Current Illness: No
Preexisting Conditions: Diastolic dysfunction low grade
Allergies: Sulfa
Diagnostic Lab Data: Positive COVID test on Dec 30th.
CDC Split Type:

Write-up: No side affects with Janssen. Moderna booster just sore arm a couple days


VAERS ID: 2025040 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-12-27
Onset:2021-12-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3197 / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Allergy test, Asthenia, Colonoscopy, Cough, Fatigue, Oesophagogastroduodenoscopy
SMQs:, Anaphylactic reaction (broad), Guillain-Barre 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: Prozac Adderall Nexium Vitamin C Vitamin D Probiotics
Current Illness: No
Preexisting Conditions: No
Allergies: Phenergen
Diagnostic Lab Data: Allergy tests, and began getting allergy shots in July 2021. Esophagogastroduodenoscopy and Colonoscopy on 11/19/21. No issues detected.
CDC Split Type:

Write-up: 1ST DOSE - 04/21/21 - PFIZER LOT# ER8731 2ND DOSE - 05/12/21 - PFIZER LOT# EW0170 3RD DOSE - 12/27/21 - PFIZER LOT# FL3197 I have had a cough every day since 05/13/21 after my 2nd dose of the Pfizer vaccine, and I have been feeling rundown and worn out with no energy every day since then.


VAERS ID: 2025138 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213D21A / 1 LA / -

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

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

Write-up: Unbeknownst to vaccinator, according to client had had one dose of Pfizer. Attempted to reach client but unable to leave message.


VAERS ID: 2025278 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: New York  
Vaccinated:2021-12-13
Onset:2021-12-28
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2022-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Erythema, Mechanical urticaria, Pain in extremity, Pruritus, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin C, Vitamin D, multi vitamin, Olive leaf, Zinc
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: NA - Follow up appt with Allergist is TBD.
CDC Split Type:

Write-up: 1st Vax 4/1/21 - general arm soreness less than 24 hours. 2nd Vax 4/27 - general arm soreness, chills for 24 hours. Booster Shot 12/13 minimal arm soreness less than 24 hours. All 3 shots were Moderna. Wife tested positive for COVID 19 on 12/21. I had no symptoms and tested negative 3 times. On/around 12/28 I started to get very itchy for no reason. Dr. recommended I a get a PCR. PCR taken and came back negative on 12/31. Since 12/28, random bouts of red skin (in lines) hives (raised) and very itchy skin happen several times per day. More profound at night and last 20-30 minutes before subsiding. The rash seems to bounce around my body randomly appearing on my neck, back, arms, groin, privates, ankles, forehead, shoulders etc. There is no pattern to where they show up. The back of my ears every night get very warm & red. Showers make skin appear red, but do not make it itchy on its own. When I dry with a towel, the skin gets redder and becomes more itchy. I have not introduced anything new to my diet and we have used the same detergent/soaps for years. I saw the Dr. again on 1/11 and he noticed dermographism & skin got redder after light scratching/touching. Referred me to allergist. During 1st 2 weeks I tried Benedryl, it did not help. As of 1/10, I took a 24 hour Zyrtec and itchiness subsided. I will pause the use of Zyrtec after a couple days to see if itchiness/rash is resolved or if it comes back without the use of Zyrtec.


VAERS ID: 2025286 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-10-01
Onset:2021-12-28
   Days after vaccination:88
Submitted: 0000-00-00
Entered: 2022-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 2 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Delivery, Exposure during pregnancy, SARS-CoV-2 test positive
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Normal pregnancy conditions and outcomes (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received Pfizer vaccines on 12/23, 1/18, 10/1/21 COVID-19 positive by PCR on 12/28/21 admitted to hospital on 1/8/22 for labor and delivery, delivered female infant on 1/8/22


VAERS ID: 2025428 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breast swelling, Breast tenderness, Lymphadenopathy, Pain in extremity
SMQs:, Angioedema (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: UNKNOWN
Current Illness: NONE
Preexisting Conditions: UNKNOWN
Allergies: UNKNOWN
Diagnostic Lab Data: NONE AT THIS TIME
CDC Split Type:

Write-up: MOTHER REPORTS DAUGHTER COMPLAINED OF PAIN UNDER HER ARM FOR A COUPLE DAYS. MOTHER THOUGHT IT WAS JSUT EHR ARM BUT WHEN SHE LOOKED AT HER LEFT UNDERARM, THE CHILDS UNDERARM/ARMPIT AREA WAS SIGNIFICANTLY SWOLLEN. THE MOTHER ALSO NOTICED THE CHILDS LEFT BREAST WAS SWOLLEN AS WELL AND WAS NOTICABLY LARGER THAN HER OTHER BREAST. 2 WEEKS HAVE PAST AND THE CHILDS ARM HAS IMPROVED HOWEVER THE BREAST STILL IS SWOLLEN AND TENDER. WRITER ADVISED THE MOTHER CALL THE CHILDS PROVIDER BEFORE SCHEDULING A 2ND DOSE. MOTHER AGREED TO CALL.


VAERS ID: 2025451 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-12-22
Onset:2021-12-28
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2022-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 1 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / 2 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood pressure fluctuation, COVID-19, COVID-19 pneumonia, Cardiac telemetry, Cystitis, Electrocardiogram QT prolonged, Full blood count abnormal, Hypotension, Hypoxia, Lethargy, Lymphopenia, Mental impairment, Pyuria, SARS-CoV-2 test positive, Urinary tract infection, Urine analysis abnormal
SMQs:, Torsade de pointes/QT prolongation (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Conduction defects (narrow), Torsade de pointes, shock-associated conditions (narrow), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (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, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet atorvastatin (LIPITOR) 10 MG tablet bisacodyl (DULCOLAX) 10 MG suppository carbamide peroxide (DEBROX) 6.5 % otic solution chlorhexidine (PERIDEX) 0.12 % solution cholecalciferol (VITAMIN D3) 50 MCG (20
Current Illness:
Preexisting Conditions: Pneumonia due to COVID-19 virus Rectal prolapse s/p Delormes procedure 1/28/19 BY Dr. Pt with recurrent rectal prolapse now s/p lap. ventral rectopexy with mesh on 1/13/21 by Dr. Restlessness and agitation Profound intellectual disabilities Autistic disorder
Allergies: Codeine Environmental Tomato
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized 12/28/2021; COVID 19 positive 12/28/2021; fully vaccinated plus booster BRIEF OVERVIEW: Discharge Provider:, MD Primary Care Provider at Discharge: MD (Inactive) None Admission Date: 12/28/2021 Discharge Date: 1/10/2022 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute cystitis without hematuria Pneumonia due to COVID-19 virus COVID-19 HOSPITAL COURSE : a 66-year-old woman with severe developmental delay, autistic disorder who resides at a residential facility, is nonverbal presented with hypoxia with onset of symptoms unclear. Upon emergency department arrival blood pressure was labile, hypoxic requiring 2 L nasal cannula oxygen support. Complete blood count showed lymphopenia and COVID testing positive. Urinalysis showed pyuria and was given 1 g of IV Rocephin empirically presumed urinary tract infection at emergency department. On admission, patient started on Decadron and continued 2 L nasal cannula oxygen support. During the 1st 24 hours of stay patient had had episodes of hypotension and responded well with IV fluid bolus. Also she was significantly lethargic that all her psych meds had been held. With her EKG showing prolonged QTC. Patient was placed on telemetry. After 48 hours of stay, patient''s mentation significantly improved, she continued to saturate well at 2 L nasal cannula support. She was initiated with remdesivir with planned completion of 5 doses. Repeat QTC check had shown improvement that Seroquel dosing initiated with lower dose as well as her Depakote. Continued Clonazepam and Topamax at her home dose. Patient did well with all these medication dosing changes. She was the continued on a tapering dose of dexamethasone. Patient continued improvement that she has been weaned off oxygen. PTOT evaluation did and recommended skilled nursing facility. With patient stable and safe discharge plans completed she was discharged to SAR stable on 1/10/21.


VAERS ID: 2025893 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-27
Onset:2021-12-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspnoea, Muscular weakness, Nausea, Sensory loss
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Similar symptoms, though less severe, after 2nd dose of Moderna
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe nausea, difficulty breathing, muscle weakness, loss of sensation in hands and feet for 5-6 hours


VAERS ID: 2025927 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-05-14
Onset:2021-12-28
   Days after vaccination:228
Submitted: 0000-00-00
Entered: 2022-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Nausea, Polymerase chain reaction, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: HTN, alcohol use
Preexisting Conditions: HTN, alcohol use
Allergies:
Diagnostic Lab Data: cycle threshold: 22.4
CDC Split Type:

Write-up: N/V 2/2 COVID-19 requiring hospitalization


VAERS ID: 2026093 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-12-17
Onset:2021-12-28
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2022-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3548 / 3 LA / SYR

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

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

Write-up: Allergy, rashes


VAERS ID: 2026114 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-11-29
Onset:2021-12-28
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2022-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / UNK LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / UNK LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Erythema, Lymphadenopathy, Oropharyngeal pain, Peripheral swelling, Pruritus, Pyrexia, SARS-CoV-2 test positive, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations:
Other Medications: atomoxitine, vitamin D
Current Illness: N/A
Preexisting Conditions:
Allergies: nickel.
Diagnostic Lab Data: covid test 1/6/2022 got results of positive on 1/7/2022
CDC Split Type:

Write-up: tested positive with covid. first symptoms on 12/28/21 most likely effected date 12/23/21. tested on 1/06/22 results of positive received 1/07/22. symptoms lasted until 1/09/22. sore throat left side first couple days with fever starting next day. lasted a few days then fever went away and sore throat was almost gone for about 16 hours. lymph node on right side of throat swelled up and fever returned even worse. fever lasted few days. after lymph node swole. throat got sore on right side as well. once fever was gone for 2 days I got hives on legs on butt area some in other areas, both palms got very red swollen and itchy lasted about 16 hours. felt better for about 12 hours then left side lymph nodes in neck started swelling and hives returned very quickly. hives lasted about 12 hours then very quickly went away all at once. lymph node in neck right side no longer is swollen and slight swelling on left side as of 1/11/2022


VAERS ID: 2026238 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-12-05
Onset:2021-12-28
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2022-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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


VAERS ID: 2027295 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-13
Onset:2021-12-28
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2022-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Skin warm, Tenderness, 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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Booster Moderna 12/13 - On 12/28 I started experiencing Spontaneous Urticaria all over my body. Heat and touch seem to be the biggest activators.


VAERS ID: 2027113 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-01-11
Onset:2021-12-28
   Days after vaccination:351
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Drug ineffective, SARS-CoV-2 test
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:
Allergies:
Diagnostic Lab Data: Test Date: 20211228; Test Name: COVID-19; Test Result: Positive ; Result Unstructured Data: Positive
CDC Split Type: USMODERNATX, INC.MOD20214

Write-up: COVID-19; Lack of efficacy; This spontaneous case was reported by a pharmacist and describes the occurrence of COVID-19 (COVID-19) and DRUG INEFFECTIVE (Lack of efficacy) in a 37-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 08FEB2021 and 026L20A) for COVID-19 vaccination. No Medical History information was reported. On 11-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 08-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 28-Dec-2021, the patient experienced COVID-19 (COVID-19) and DRUG INEFFECTIVE (Lack of efficacy). At the time of the report, COVID-19 (COVID-19) and DRUG INEFFECTIVE (Lack of efficacy) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 28-Dec-2021, SARS-CoV-2 test: positive (Positive) Positive. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medications were reported. No treatment medications were reported. COMPANY COMMENT: This is a spontaneous case concerning a 37-year-old female patient with no clinical history who experienced the unexpected events of COVID-19 (AESI) and DRUG INEFFECTIVE The events occurred 324 days after 2nd dose of mRNA-1273. The rechallenge was not applicable since only information about 2nd dose was disclosed The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report. This case was linked to MOD-2021-432829 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 29-Dec-2021: follow-up received and contains non-significant information; Sender''s Comments: COMPANY COMMENT: This is a spontaneous case concerning a 37-year-old female patient with no clinical history who experienced the unexpected events of COVID-19 (AESI) and DRUG INEFFECTIVE The events occurred 324 days after 2nd dose of mRNA-1273. The rechallenge was not applicable since only information about 2nd dose was disclosed The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.


VAERS ID: 2027158 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-24
Onset:2021-12-28
   Days after vaccination:218
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Accidental overdose, Anxiety, Illness, Nucleic acid test
SMQs:, Drug abuse and dependence (broad), Medication errors (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Grass allergy
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19
Allergies:
Diagnostic Lab Data: Test Date: 20201111; Test Name: Nucleic acid amplification testing; Test Result: Positive ; Result Unstructured Data: tested positive
CDC Split Type: USMODERNATX, INC.MOD20214

Write-up: I was feeling ill that evening; I was feeling ill that evening, and am worried; Was injected with an immunocompromised dosage of the Moderna shot instead of my intended regular booster.; This spontaneous case was reported by a consumer and describes the occurrence of ILLNESS (I was feeling ill that evening), ANXIETY (I was feeling ill that evening, and am worried) and ACCIDENTAL OVERDOSE (Was injected with an immunocompromised dosage of the Moderna shot instead of my intended regular booster.) in a 21-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 041J21A, 038C21A and 026C21A) for COVID-19 vaccination. The patient''s past medical history included COVID-19 on 11-Nov-2020. Concurrent medical conditions included Grass allergy. On 24-May-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 21-Jun-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 28-Dec-2021 at 10:00 AM, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 28-Dec-2021, the patient experienced ILLNESS (I was feeling ill that evening), ANXIETY (I was feeling ill that evening, and am worried) and ACCIDENTAL OVERDOSE (Was injected with an immunocompromised dosage of the Moderna shot instead of my intended regular booster.). On 28-Dec-2021, ACCIDENTAL OVERDOSE (Was injected with an immunocompromised dosage of the Moderna shot instead of my intended regular booster.) had resolved. At the time of the report, ILLNESS (I was feeling ill that evening) and ANXIETY (I was feeling ill that evening, and am worried) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 11-Nov-2020, Nucleic acid test: positive (Positive) tested positive. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Treatment and concomitant medications were not provided. Patient have had COVID and received 2 full doses of the Moderna vaccine, and now have received the incorrect vaccine. The patient height was 180 cm.


VAERS ID: 2027309 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-01-21
Onset:2021-12-28
   Days after vaccination:341
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Anticoagulant therapy, COVID-19, COVID-19 pneumonia, Electrocardiogram ST-T segment abnormal, Pulmonary embolism, SARS-CoV-2 test negative, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (narrow), Other ischaemic heart disease (broad), 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: atenolol, atorvastatin, losartan, metformin xr
Current Illness:
Preexisting Conditions: type 2 diabetes, hypertension and hyperlipidemia, and distant history of provoked DVT (due to plane travel per patient)
Allergies: NKDA
Diagnostic Lab Data: COVID status positive at home 12/28/21. COVID status positive at admission 1/7/22.
CDC Split Type:

Write-up: Patient received Pfizer COVID vaccine on 12/31/20 and 1/21/21. On 12/28/21, patient tested positive for COVID at home. On 1/7/22, patient admitted to our inpatient facility with acute respiratory failure with hypoxia likely due to both COVID-19 pneumonia and acute pulmonary emboli bilaterally with mild right heart strain. COVID PCR status upon admission on 1/7/22 was negative, but given recent positive test and progression of illness strongly suspect this is residual inflammation/pneumonia from COVID-19. Patient discharged home with oxygen and anticoagulation on 1/11/22.


VAERS ID: 2027403 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-27
Onset:2021-12-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Pain, SARS-CoV-2 antibody test, Suspected COVID-19, Throat irritation
SMQs:, 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? 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 Name: Covid-19 antibody test; Result Unstructured Data: Test Result:Positive
CDC Split Type: USPFIZER INC202101877885

Write-up: suspected covid-19; next day I had a little bit of body ache, and then today a little bit more; also a little bit of a scratchy throat; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP) from medical information team. The reporter is the patient. A female patient received bnt162b2 (BNT162B2), administration date 27Dec2021 (Batch/Lot number: unknown) as dose number unknown, single for covid-19 immunisation. The patient''s relevant medical history and concomitant medications were not reported. The following information was reported: DRUG INEFFECTIVE (medically significant), SARS-COV-2 ANTIBODY TEST POSITIVE (medically significant), outcome "unknown" and all described as "I took an antibody test and it came out positive"; PAIN (non-serious) with onset 28Dec2021, outcome "unknown", described as "next day I had a little bit of body ache, and then today a little bit more"; THROAT IRRITATION (non-serious) with onset 28Dec2021, outcome "unknown", described as "also a little bit of a scratchy throat". The patient underwent the following laboratory tests and procedures: sars-cov-2 test: positive. Additional information: onset latency for the events was 01 day. The lot number for bnt162b2 was not provided and will be requested during follow up.


VAERS ID: 2027574 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-02-22
Onset:2021-12-28
   Days after vaccination:309
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood test, COVID-19, Maternal exposure during pregnancy, SARS-CoV-2 test, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (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: FERROUS SULFATE; IRON; PRENATAL [FOLIC ACID;IRON]
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None, Comment: Patient History: No
Allergies:
Diagnostic Lab Data: Test Name: Blood work; Result Unstructured Data: Test Result:Unknown results; Test Date: 20211228; Test Name: COVID; Test Result: Positive
CDC Split Type: USPFIZER INC202200004974

Write-up: I am pregnant; I got vaccinated back in February; I just got COVID; I am tested positive; I got vaccinated back in February; I just got COVID; I am tested positive; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP) from product quality group. The reporter is the patient. A 34 year-old female patient (pregnant) received bnt162b2 (BNT162B2), administered in arm left, administration date 22Feb2021 (Lot number: EL3247) at the age of 33 years as dose 2, single and administered in arm left, administration date 01Feb2021 (Lot number: EL3247) as dose 1, single for covid-19 immunisation. The patient had no relevant medical history. Concomitant medication(s) included: FERROUS SULFATE; IRON; PRENATAL [FOLIC ACID;IRON]. The following information was reported: VACCINATION FAILURE (medically significant), COVID-19 (medically significant) all with onset 28Dec2021, outcome "unknown" and all described as "I got vaccinated back in February; I just got COVID; I am tested positive"; MATERNAL EXPOSURE DURING PREGNANCY (non-serious), outcome "unknown", described as "I am pregnant". The patient underwent the following laboratory tests and procedures: blood test: (unspecified date) unknown results; sars-cov-2 test: (28Dec2021) positive. Therapeutic measures were taken as a result of vaccination failure, covid-19. with Tylenol. Patient takes one pill 500 milligrams. Patient took 3 pills in the past two days and that was it. No follow-up attempts are needed. No further information is expected.


VAERS ID: 2027895 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33025BD / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Chest pain, Cough, Myalgia, Neck pain, Pain, Pain in extremity, Rhinorrhoea
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: I have been experiencing neck and back pain, I am currently in physical therapy and seeing an orthopedic surgeon. I also have been having chest pains that radiates to the left arm and causes muscle pains, runny nose and coughing.


VAERS ID: 2028446 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: New York  
Vaccinated:2021-12-16
Onset:2021-12-28
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058H21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye swelling, Lip swelling, Mechanical urticaria, Peripheral swelling, Pharyngeal swelling, Pruritus, Swollen tongue, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dermographia, hives, swelling of feet, hands, lips, eyes, tongue and throat. Ordered to take 2 zyrtec and 2 pepcid a day. Prescribed a 5 day 40mg per day dose of Prednisone. Prescribed an epi pen due to throat, lip and tongue swelling. Swelling subsided with the prednisone treatment after 8 days. Hives, itchiness and dermographia continue to persist but are being managed by the zyrtec and pepcid. Breakthrough hives, itchiness and dermographia continue to persist, even with medication


VAERS ID: 2028666 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-01-11
Onset:2021-12-28
   Days after vaccination:351
Submitted: 0000-00-00
Entered: 2022-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Decreased appetite, Diarrhoea, Fatigue, Headache, Myalgia, Pain, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prilosec Pepcid
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: At home Test- positive (12/31/2021) Covid test- potive (12/31/2021)
CDC Split Type: vsafe

Write-up: 24 hours after receiving the vaccine I had muscle aches, body aches, and a headache that lasted for a day. When I caught covid it started with a severe headache. The next day I had congestion and diarrhea. I had body aches, a fever, fatigue and lost of appetite. That lasted for about 5 days then I was able to go to work after that. I took OTC Aspirin, Ibuprofen, Tylenol, and Zofran. On and off I still get congestion that comes and goes.


VAERS ID: 2030983 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-01
Onset:2021-12-28
   Days after vaccination:271
Submitted: 0000-00-00
Entered: 2022-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test
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 PCR TEST; Test Result: Positive ; Result Unstructured Data: PCR positive
CDC Split Type: USMODERNATX, INC.MOD20224

Write-up: Positive PCR test 6 months after 2nd dose/ Tested positive for COVID disease 7 days ago; This spontaneous case was reported by a consumer and describes the occurrence of COVID-19 (Positive PCR test 6 months after 2nd dose/ Tested positive for COVID disease 7 days ago) in a 75-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. In April 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. In May 2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 28-Dec-2021, the patient experienced COVID-19 (Positive PCR test 6 months after 2nd dose/ Tested positive for COVID disease 7 days ago). At the time of the report, COVID-19 (Positive PCR test 6 months after 2nd dose/ Tested positive for COVID disease 7 days ago) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 28-Dec-2021, SARS-CoV-2 test: positive (Positive) PCR positive. No concomitant drug details were reported. No treatment details were reported. Patient stated that he never lost sense of taste or smell. Patient had mild COVID symptoms such as cough and being lethergic Patient received the booster dose on 03-Jan-2022 i.e. 7 days after testing positive for COVID-19. Company comment :This is a spontaneous case concerning a 75-year-old, male patient with no medical history reported who was diagnosed with COVID-19 7 months after receiving the second dose of mRNA1273. Patient refers having mild symptoms. He confirmed receiving the booster dose on 03JAN2022 without any associated AEs. The benefit-risk relationship of mRNA-1273 in not affected by this report.; Sender''s Comments: This is a spontaneous case concerning a 75-year-old, male patient with no medical history reported who was diagnosed with COVID-19 7 months after receiving the second dose of mRNA1273. Patient refers having mild symptoms. He confirmed receiving the booster dose on 03JAN2022 without any associated AEs. The benefit-risk relationship of mRNA-1273 in not affected by this report.


VAERS ID: 2031379 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032F21A / N/A RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none reported by patient
Current Illness: none reported by patient
Preexisting Conditions: none reported by patient
Allergies: none reported by patient
Diagnostic Lab Data: No test required and no adverse outcomes
CDC Split Type:

Write-up: Patient attested that he received his second dose of Moderna Vaccine more than six months ago and requested a booster dose of Monderna on 12/28/2021. The Moderna booster was administered to patient per his request. It was then verified in the computer system, that his last vaccine was given on 8/7/21. This discovery indicated that the booster was given prior to current CDC guidelines.


VAERS ID: 2031392 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-12
Onset:2021-12-28
   Days after vaccination:350
Submitted: 0000-00-00
Entered: 2022-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19
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


VAERS ID: 2031399 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-18
Onset:2021-12-28
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2022-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / UNK RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / UNK RA / IM

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


VAERS ID: 2031415 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-14
Onset:2021-12-28
   Days after vaccination:105
Submitted: 0000-00-00
Entered: 2022-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 04C21A / UNK UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / UNK UN / IM

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


VAERS ID: 2031584 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Illinois  
Vaccinated:2020-12-19
Onset:2021-12-28
   Days after vaccination:374
Submitted: 0000-00-00
Entered: 2022-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Plaquenil, meloxicam, Tamsulosin, duloxetine
Current Illness: none
Preexisting Conditions: Sjogren''s disease
Allergies: None
Diagnostic Lab Data: Went to a COVID test site with cold symptoms. Positive COVID result 12/28/2021
CDC Split Type:

Write-up: Cold symptoms tested positive with home test


VAERS ID: 2031906 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Blood test abnormal, Chest X-ray abnormal, Cough, Haemoptysis, Pneumonia, Sleep disorder
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: heart disease, high blood pressure
Allergies:
Diagnostic Lab Data: Chest xrays and blood tests confirmed pneumonia.
CDC Split Type:

Write-up: started coughing 4 hours after vaccination, within 48 hours couldn''t lie down or sleep due to chronic cough, coughing up blood, went to Urgent Care Dec 31 & diagnosed with pneumonia, infection in lungs. Taken by ambulance to hospital. Hospitalized for 8 days, discharged on oxygen. Cough continues, still coughing up blood


VAERS ID: 2032584 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-04-13
Onset:2021-12-28
   Days after vaccination:259
Submitted: 0000-00-00
Entered: 2022-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Polymerase chain reaction
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: hydrocortisone
Current Illness: Addison''s disease
Preexisting Conditions: Addison''s disease
Allergies: PCN
Diagnostic Lab Data: 12/28 Cycle Threshold: 22.9
CDC Split Type:

Write-up: COVID-19 infection leading to hospitalization


VAERS ID: 2032611 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-03-23
Onset:2021-12-28
   Days after vaccination:280
Submitted: 0000-00-00
Entered: 2022-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Polymerase chain reaction
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: prednisone 10 mg as needed
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 12/29 cycle threshold: 25.3
CDC Split Type:

Write-up: Hospitalization due to COVID-19 infection


VAERS ID: 2032622 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-03-13
Onset:2021-12-28
   Days after vaccination:290
Submitted: 0000-00-00
Entered: 2022-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Polymerase chain reaction
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: venetoclax & Calquence
Current Illness: CLL
Preexisting Conditions: CLL
Allergies:
Diagnostic Lab Data: 12/28 cycle threshold: 25.7
CDC Split Type:

Write-up: Hospitalization due to COVID-19 infection


VAERS ID: 2034153 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-12-17
Onset:2021-12-28
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2022-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Bladder pain, Dysphagia, Myalgia, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: This spontaneous case was reported by a consumer and describes the occurrence of DYSPHAGIA (He couldn''t swallow anything), BLADDER PAIN (His bladder was hurting), URTICARIA (Developed hives all over his body/ hives started on his scalp, thighs and just went everywhere/ hives were getting worse) and MYALGIA (Muscles also started hurting) in a 35-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 030H21B) for COVID-19 vaccination. No Medical History information was reported. On 17-Dec-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 28-Dec-2021, the patient experienced DYSPHAGIA (He couldn''t swallow anything), URTICARIA (Developed hives all over his body/ hives started on his scalp, thighs and just went everywhere/ hives were getting worse) and MYALGIA (Muscles also started hurting). On 01-Jan-2022, the patient experienced BLADDER PAIN (His bladder was hurting). The patient was treated with DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL [DIPHENHYDRAMINE HYDROCHLORIDE]) on 29-Dec-2021 for Adverse event, at an unspecified dose and frequency; DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL [DIPHENHYDRAMINE HYDROCHLORIDE]) on 29-Dec-2021 for Adverse event, at an unspecified dose and frequency and LEVOCETIRIZINE DIHYDROCHLORIDE (XYZAL) on 01-Jan-2022 for Adverse event, at an unspecified dose and frequency. At the time of the report, DYSPHAGIA (He couldn''t swallow anything), BLADDER PAIN (His bladder was hurting) and MYALGIA (Muscles also started hurting) outcome was unknown and URTICARIA (Developed hives all over his body/ hives started on his scalp, thighs and just went everywhere/ hives were getting worse) was resolving. No concomitant medications were provided. Treatment medications also included Steroid injection in his butt. On 29-DEC-2021 the patient went to Urgent Care. He conveyed that the hives were getting worse and his bladder was hurting so he went to the Emergency on 01-JAN-2022. The patient stated that Xyzal helped him more and the hives are improving.


VAERS ID: 2035311 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-12-12
Onset:2021-12-28
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2022-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Fatigue, Pain, 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? 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: Covid-19 test
CDC Split Type: vsafe

Write-up: I had fever of 102. I had body ache, chills, and a mild cough. I also have fatigue. These lasted for about 4 days. On Dec 28th, I tested positive for Covid-19.


VAERS ID: 2035639 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-27
Onset:2021-12-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3313089 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Breast pain, Chills, Condition aggravated, Discomfort, Dyspnoea, Fatigue, Feeling abnormal, Injection site erythema, Malaise, Pain in extremity, Palpitations, Pyrexia, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (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), Cardiomyopathy (broad), Lipodystrophy (broad), Tendinopathies and ligament 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: only sore arm at Pfizer 1, with Pfizer 2 fever body aches headache and extreme fatigue yet resolve after 48 hours.
Other Medications: synthroid 75 mcg daily metoprolol xr 50mg daily vitamin D
Current Illness: none
Preexisting Conditions: hypothyroid hypertension
Allergies: Tetanus allergy
Diagnostic Lab Data: None, only visualization, monitoring and Tylenol then RX for Keflex.
CDC Split Type:

Write-up: I received my Pfizer booster at 1245 in the afternoon. I felt tired that night with sore left arm. At 0500 on the following day 12/28/2021 I had chills and pain at arm, under left arm and down left arm. I showered and went to work; it was too late to call off. As the day of work progressed, I ran fever 100.8, I took Tylenol. Arm started to have a reddened area below the injection point. I am an ER nurse and a doctor said what''s wrong with you. I said I had my booster and felt a bit rough. I then said can you look at my arm. I showed my arm and they said hmmm, we need to keep an eye. I believe this is either cellulitis or a reaction. I put ice pack at arm site and continued to work taking Motrin 400 mg every 4 hours. Upon getting home I showered, went to bed with 102.1 temperature, redness was increasing I marked it with a pen. Went to work the next day after doing a covid test to ensure the experience I was having was vaccine versus covid related. I tested negative for covid every other day. I was experiencing shortness of breath and heart palpitations; I was uncomfortable. I went to work because we are so short staffed, and I told my manager I was unwell. I again had the doctors see my arm and they said its worsening so let''s start you on Keflex. I received an RX for Keflex and started to take. The reason we were feeling unlikely cellulitis is that the redness that wrapped around my arm was below injection site. Overall, these were my symptoms after booster: Fever, headache, body aches, chills, redness at injection arm as well as underarm and under left breast, shortness of breath and heart palpitations. I did not feel resolve till 12/31/2021. My arm still is not perfect, but it has very much so resolved.


VAERS ID: 2035762 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-28
Onset:2021-12-28
   Days after vaccination:91
Submitted: 0000-00-00
Entered: 2022-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0165 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Headache, Oropharyngeal pain, Pyrexia, Rash, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: Covid-19 test.
CDC Split Type: vsafe

Write-up: I had sore throat, fever, headache, mild cough and rash. These lasted for about 2 weeks. On Dec 30th, I tested positive for Covid-19.


VAERS ID: 2037659 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: New York  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal distension, Abdominal pain upper, Arthralgia, Chills, Fatigue, Immunisation, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: AMLODIPINE; BENAZEP; ALLOPURINOL; ACETYLSALICYLIC ACID
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Clot blood (4 years prior the patient had a blood clot in small intestine); COVID-19 (Prior to vaccination, was the patient diagnosed with COVID-19: Yes)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202200055225

Write-up: Body aches/ full body sourness; Soar joints; Swollen stomach; Pain in the stomach; Fatigue; Chills; Fever; Dose received: 3; This is a spontaneous report from a contactable reporter (consumer or other non-hcp). The reporter is the patient. A 55-year-old male patient received bnt162b2 (BNT162B2), administered in arm right, administration date 28Dec2021 at 14:00 (Lot number: unknown) at the age of 55 years as dose 3 (booster), single for COVID-19 immunisation. Relevant medical history included: "Clot blood" start date: an unknown date in 2018 (unspecified if ongoing), notes: 4 years prior the patient had a blood clot in small intestine and "COVID-19" (unspecified if ongoing), notes: Prior to vaccination, was the patient diagnosed with COVID-19: Yes. Concomitant medications included: AMLODIPINE; BENAZEP; ALLOPURINOL and 81 MG ASPIRIN. Vaccination history included: Bnt162b2 (DOSE 1, SINGLE; Lot number: unknown; Anatomical location: right arm; Administration time: 12:00), administration date: 01Apr2021, when the patient was 54 years old, for COVID-19 immunisation and Bnt162b2 (DOSE 2, SINGLE; Lot number: unknown; Anatomical location: left arm; Administration time: 12:00), administration date: 23Apr2021, when the patient was 54 years old, for COVID-19 immunisation. The following information was reported: IMMUNISATION (non-serious) with onset 28Dec2021 at 14:00, outcome "unknown", described as "Dose received: 3"; CHILLS (non-serious) with onset 29Dec2021, outcome "not recovered", described as "Chills"; PYREXIA (non-serious) with onset 29Dec2021, outcome "not recovered", described as "Fever"; PAIN (non-serious) with onset an unknown date in Jan2022, outcome "not recovered", described as "Body aches/ full body sourness"; ARTHRALGIA (non-serious) with onset an unknown date in Jan2022, outcome "not recovered", described as "Soar joints"; ABDOMINAL DISTENSION (non-serious) with onset an unknown date in Jan2022, outcome "not recovered", described as "Swollen stomach"; ABDOMINAL PAIN UPPER (non-serious) with onset an unknown date in Jan2022, outcome "not recovered", described as "Pain in the stomach"; FATIGUE (non-serious) with onset an unknown date in Jan2022, outcome "not recovered", described as "Fatigue". The events "Chills", "Fever", "Body aches/ full body sourness", "Soar joints", "Swollen stomach", "Pain in the stomach" and "Fatigue" were evaluated at the physician office visit. Therapeutic measures were not taken as a result of chills, pyrexia, pain, arthralgia, abdominal distension, abdominal pain upper and fatigue. Additional information: The patient had no known allergies. The patient did not receive other vaccines within four weeks prior to COVID vaccine. First 2 days the patient had chills, fever. It was reported that 1 "through" 2 weeks later and present the patient had body aches, sour joints, swollen stomach, pain in the stomach, fatigue, full body soreness. Since the vaccination, the patient had not been tested for COVID-19. The lot number for BNT162b2 was not provided and will be requested during follow up.


VAERS ID: 2037763 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-19
Onset:2021-12-28
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2022-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Asthenia, Blood creatinine increased, Blood urea increased, Laboratory test abnormal, Pruritus, SARS-CoV-2 antibody test, SARS-CoV-2 test negative, SARS-CoV-2 test positive, Urine output decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), 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), Guillain-Barre syndrome (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (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, 18 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amLODIPine 10 mg Tablet Directions: 1 tablet oral daily (Active) aspirin (Aspirin Low Dose) 81 mg tablet,delayed release Directions: 1 tablet oral daily (Active) chlorthalidone 25 mg Tablet Directions: 1 tablet oral daily (Active) cho
Current Illness:
Preexisting Conditions: HTN diabetes anemia hypothyroidism . Significant Surg Hx As Listed Addt''l Surgical History Uterine fibroidectomy C-section. Smoking Status Former Smoker
Allergies: NKDA
Diagnostic Lab Data: 12/28/2021 - SARS-COV-2 ANtigen (-) 12/31/2022 - SARS-Cov-2 IgM 0.02, IgG 0.02 01/03/2022 - SARS-CoV-2 PCR (-) 01/11/2022 (SARS-CoV-2 PCR (++)+
CDC Split Type:

Write-up: 77-year-old female with a PMH significant for HTN, diabetes, anemia, hypothyroidism who was sent to the ER due to abnormal labs. Reportedly pt has been experiencing weakness for about 2 weeks, with decreased urine output and itching on her upper torso reason for which she went to PCP who after performing labs notified her creatinine is 4.5. At home, she is on chlorthalidone, lisinopril and metformin which she has been taking. In the ER, initial VS temp 97.8? F, BP 68/45, HR 85, RR 16 with 97% on RA, she received a total 1L IVF with lasted BP 102/49-HR 79. Labs revealed AKI BUN 59/creatinine 4.5


VAERS ID: 2037780 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-12-27
Onset:2021-12-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012H21B / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pruritus, Rash, Sleep disorder, 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: Typhoid vaccine, age 32, caused loss of consciousness, vomiting, other neurological symptoms. Treated in ER and eventually trace
Other Medications: Iron supplement (OTC), Vitamin D3 (OTC)
Current Illness: none
Preexisting Conditions: none
Allergies: phenol hypersensitivity
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Poison ivy-like rash on lower leg (calf) appeared within 17hrs. It was intensely itchy but temporary relief was gained using Benadryl cream. This rash has turned into a large welt 7cm x 9cm. It''s lost most of its color now and only itches occasionally in the evening. 10 days later (Jan 5) I began experiencing spontaneous urticaria (hives) on lower legs which appear every evening and resolve by morning. This has continued for the past 10 days. The hives are intensely itchy and disrupt sleep, but temporary relief is gained using oral Benadryl.


VAERS ID: 2037870 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-22
Onset:2021-12-28
   Days after vaccination:220
Submitted: 0000-00-00
Entered: 2022-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Cough, Dyspnoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: + COVID test
CDC Split Type:

Write-up: cough, short of breath, cheat pain


VAERS ID: 2037889 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-28
Onset:2021-12-28
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2022-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3198 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Discomfort, Swollen tongue, Tongue erythema
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Escitalopram, 10mg/day Fish oil, 1200mg/day Vitamin D3, 5000 IU/day Magnesium, 250mg/day
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Redness and swelling of the back of the tongue - discomfort for two days, and gone in about a week. No difficulty breathing.


VAERS ID: 2037947 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-12-16
Onset:2021-12-28
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2022-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Depression, Tinnitus
SMQs:, Depression (excl suicide and self injury) (narrow), Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Doctor visits, multiple, confirming tinnitus including 12/31/21, 1/3/22, 1/6/22 and 1/13/22. Prescribed Methylprednisone, Dexamethasolone
CDC Split Type:

Write-up: Loud Tinnitus right ear, induced by booster shot. Doctor states he?s received a spike in Tinnitus cases resulting from vaccines. This is a huge issue as failure to treat early and recognize cause can result in a permanent dehabilitating condition. It has been 2 and a half weeks and no reduction in high level tinnitus screech in right ear. Significant depression first 2 weeks, 2nd course of steroids being taken.


VAERS ID: 2037999 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: New York  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F216 / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Angioedema, Blood test, Hypersensitivity, Lip swelling, Peripheral swelling, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), 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: Metformin 500 mg for pcos (have been taking since age 16 to regulate period )
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin Pineapples
Diagnostic Lab Data: Went to primary doctor 12/29/21, allergist 1/4/22 and 1/11/22. See allergist weekly now to monitor symptoms. Next apt 1/19/22. Went to urgent care 1/14/22 because swelling had gotten worse and wanted to ensure airway was clear. Have had blood work done
CDC Split Type:

Write-up: This was booster shot. Within four hours eyes started itching lip swelled tongue was itchy. Then noticed hands swelling and itching as well as feet. Initially took Benadryl went to doctor next day. Have now been having allergic reaction with angiodema for over two weeks. Swelling comes back as soon as antihistamine course of drugs my allergist has me on wears off.


VAERS ID: 2038058 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-12-23
Onset:2021-12-28
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2022-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Sleep disorder, 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: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: I am experiencing terrible ringing in my ears. I realize this is not as serious as COVID, but I didn''t have it before this 3rd booster dose and it''s especially hard to sleep.


VAERS ID: 2038071 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067H21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Hypersensitivity, Hypoaesthesia, Paraesthesia, Throat clearing, Throat irritation
SMQs:, Angioedema (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: BENADRYL ALLERGY 25 MG
Current Illness: NONE KNOWN
Preexisting Conditions: NONE REPORTED
Allergies: NONE KNOWN
Diagnostic Lab Data: SAO2 98%
CDC Split Type:

Write-up: PT RETURNED TO A CLINIC URGENT CARE AREA APPROX. 1.5 HOURS AFTER RECEIVING 3RD MODERNA VACCINE, COMPLAINING OF LEFT-SIDE FACIAL AND BODY NUMBNESS AND TINGLING, WITH ASSOCIATED THROAT IRRITATION THAT MAKES HER REPEATEDLY CLEAR HER THROAT, AS WELL AS DIZZINESS. DIAGNOSED WITH ALLERGIC REACTION WITHOUT ANAPHYLAXIS; GIVEN 50 MG BENADRYL AND RX 25 MG BENADRYL TID X 3 DAYS AND RX 40 MG PREDNISONE X 3 DAYS.


VAERS ID: 2038193 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-12-22
Onset:2021-12-28
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2022-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 2 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013H21B / 3 LA / SYR

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

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

Write-up: Burning itchy rash along with small hives plus long thin raised welts that look like scratches that appear mainly in the evening which last for 15 to 20 minutes on random parts of my chest back and both arms. This will appear in random areas throughout the day. Symptoms began in Oct 2021 but we?re very mild. After my booster 12/22/2021 it?s been happening everyday.


VAERS ID: 2038360 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-12-23
Onset:2021-12-28
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2022-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1620 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Soreness after shingrex
Other Medications: Otezla; glucosamine; turmeric; nac; nmn; krill oil;astaxanthan; multivitamin; Vitamin D3&K2;zinc; areds2; lions mane
Current Illness: None
Preexisting Conditions: Psoriasis
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Urticaria


VAERS ID: 2038466 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-12-01
Onset:2021-12-28
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2022-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Thyroiditis subacute
SMQs:, Hypothyroidism (broad), Hyperthyroidism (broad)

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

Write-up: subacute thyroiditis


VAERS ID: 2038496 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-27
Onset:2021-12-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33036BD / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Pyrexia, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (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: Metaprolol 25 mg
Current Illness:
Preexisting Conditions: Hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tachycardia (120 bpm) for 5 hours within 24 hours of vaccination following chills and fever. Brief episode of tachycardia ( few minutes) the following day. In both cases, heart rate returned to normal without treatment.


VAERS ID: 2038506 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-21
Onset:2021-12-28
   Days after vaccination:251
Submitted: 0000-00-00
Entered: 2022-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016BZ1A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023CZ1A / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Had Covid 12/28
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: I called my on gyn to report this in December and will be reporting January as well. I will see if they want to run any tests.
CDC Split Type:

Write-up: I was in menopause for over a year. I just now am getting my period again. The first period was end of Dec 2021 and coincided with me also having Covid & now I have it again in January. I have no other on/gym or other health issues.


VAERS ID: 2038509 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-12-27
Onset:2021-12-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Chest X-ray abnormal, Cough, Fatigue, Gastrointestinal pain, Headache, Hypotension, Illness, Pneumonia, Urinary tract infection
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: sick from second shingrix vaccine nothing like this reaction to booster
Other Medications: vitamin c multi -vitamin Prescription Vitamin D
Current Illness: nothing excellent health
Preexisting Conditions: none
Allergies: non known
Diagnostic Lab Data: chest xray to see pneumonia - i had a comparison on record from a physical last summer. Examination by doctor at er and my medical doctor- blood pressure lower than normal I was put on several different medications plus steroids cough syrup
CDC Split Type:

Write-up: cough, tired, headache, stomach problems, within two days of seeing my family doctor with the cough I developed pneumonia, sickness, severe stomach pain - urinary track infection ,having trouble drinking water and I usually drink a gallon of water a day, can not go to the restroom bowels are painful fever,


VAERS ID: 2039272 (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: 2022-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0311121A / 3 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Computerised tomogram, Dizziness, Headache, Hypoaesthesia, Vision blurred
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Dizziness/feeling faint
Other Medications: Labetlol and Nifedipine
Current Illness: None
Preexisting Conditions: High blood pressure *Controlled *
Allergies: All fruits, amoxicillin, Penicillin, Morphine, sulfa any pryil medicines
Diagnostic Lab Data: CT scans and Bloodwork on 01/06/22
CDC Split Type: NA

Write-up: I experienced a severe headache for 11 days. Headache, dizziness, blurred vision and my face went numb. I had went to an urgent care also the ER for treatment.


VAERS ID: 2039441 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-12-27
Onset:2021-12-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211D21A / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Injected limb mobility decreased, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Methotrexate Folic Acid Citalopram Imitrex (as needed - haven''t taken in about 4 months) Lorazepam (as needed)
Current Illness: Psoriasis (which is what the Methotrexate and Folic Acid are for)
Preexisting Conditions: Psoriasis
Allergies: None
Diagnostic Lab Data: 1/17/2022 - office visit to the clinic - doctor indicated it was a reaction from receiving the shot. Prescribed anti inflammatory medication to see if that gives some relieft.
CDC Split Type:

Write-up: Woke up the next morning with pain in my left shoulder. Pain continued and increased since then. Unable to raise arm, or move shoulder area without severe pain, and mobility is limited.


VAERS ID: 2039494 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-12-18
Onset:2021-12-28
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2022-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067H21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Anti-transglutaminase antibody negative, Antinuclear antibody negative, Arthralgia, Blood immunoglobulin A normal, Blood immunoglobulin G, Blood thyroid stimulating hormone normal, Borrelia test negative, C-reactive protein increased, Complement factor C3, Complement factor C4, Epstein-Barr virus test negative, Erythema, Mononucleosis heterophile test negative, Peripheral swelling, Pruritus, Rash, Rash erythematous, Rash pruritic, Red blood cell sedimentation rate normal, Streptococcus test, Streptococcus test negative
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Asthma
Allergies:
Diagnostic Lab Data: All labs drawn 1/6/2022 ESR - 10 C reactive protein - <3.0 Immunoglobulin A - 125 TSH - 2.18 heterophile antibody - negative Lyme ab igg - negative lyme ab igm - negative EBV panel - negative ANA screen w/ reflex - negative complement C4 - 24 ttiga antibody - <1.2 T. transglutamin igG - <1.2 complement c3 - 122 antistrep O titer - 68 Anti dnase B titer - 220
CDC Split Type:

Write-up: 18 year old presents w/ mother for ongoing rash -Pt. received Moderna COVID booster on 12/18, mom believes rash is related to booster -Onset of rash began on the back of the scalp x10 days ago and moved to the back of the neck w/ itchy red bumps, sxs have since resolved, photos provided -Rash is currently on posterior of lower Rt. arm and Rt. hand -Pt. notes when applying pressure to an area it turns into a rash -Reports hands and fingers have been swollen w/ increased redness and itchiness -C/O of wrist and ankle pain - no joint swelling or pain - abd pain - no cough - no resp symptoms -Currently using benadryl and zyrtec for treatment -Denies any insect bites -Denies any other sxs - no new meds


VAERS ID: 2039570 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-12-15
Onset:2021-12-28
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2022-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 070H21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, Trulicity, Losartan, Vitamin D
Current Illness: None
Preexisting Conditions: Diabetes type 2, PCOS
Allergies: No know allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: On Decemeber 28th, severe itching and hives started on hands and feet. This continued for days and then started in other parts of the body: armpits, neck, scalp, forearms, backs of arms, backs of legs. Itching is severe, random, and worsens if scratched and worsens at night. I have no allergies, contact or seasonal. Used hydrocortisone, no relief. Used steroid cream, Clobetesol - no relief. Used Benedryl - no relief. Tried numerous lotions and anti itch, no relief. Found others on the internet with same issues and was suggested to try Zyrtec. The itching only stopped after using Zyrtec. If Zyrtec is discontinued, itching comes back. I continue to take Zyrtec every 24 hours.


VAERS ID: 2039922 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-12-18
Onset:2021-12-28
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2022-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / N/A LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hives started 12/28 in the evening started. When fist occurs they were wide spread on torso, arms, legs, check and buttocks. Started on Prednisone on 12/29 for 3 days with 10mg Zyrtec and Prilosec. Hives calmed after 3 days of the Predniso
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin, Vicodin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hives to Booster only, not to any previous vaccine. Prednisone and Zyrtec. Hives calmed but still persisting.


VAERS ID: 2039973 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 069H21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Erythema, Flushing, Periorbital swelling, Rash
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu shot at age 22
Other Medications: Dupixent Losartan Clairitn
Current Illness: polyps in the Ethmoid sinus
Preexisting Conditions: asthma
Allergies: peanut olive oil coconut avocado Psuedofed hydrocodone Red dye #40
Diagnostic Lab Data:
CDC Split Type:

Write-up: signs: Dyspnea, Red flush , puffy eyes, rash used: Epinephrine, triamcinolone and lidocaine , and PO bendaryl 50 mg monitored for 2 hours and released when stabilized to family


VAERS ID: 2042115 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-12-27
Onset:2021-12-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: 24 hours after the vaccine, I experience severe hip pain, down through my knees. The pain has gotten better, but is still there.


VAERS ID: 2041973 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-12-28
Submitted: 0000-00-00
Entered: 2022-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Chest discomfort, Depressed mood, Dizziness, Headache, Influenza, Influenza virus test, Nausea, Pain, Pyrexia, SARS-CoV-2 test, Vaccination failure
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19 (mild, 4 weeks of infection); Disorder circulatory system; Iron deficiency; Iron supplementation; Comments: Patient had No known allergies
Allergies:
Diagnostic Lab Data: Test Date: 20211224; Test Name: SARS-CoV-2 PCR test; Result Unstructured Data: Negative; Test Date: 20211224; Test Name: SARS-CoV-2 rapid POC test; Result Unstructured Data: Negative; Test Date: 20211228; Test Name: SARS-CoV-2 rapid POC test; Result Unstructured Data: Positive; Test Date: 20211228; Test Name: Influenza virus test; Result Unstructured Data: Positive; Comments: tested positive for flu A and B; Test Date: 20220101; Test Name: SARS-CoV-2 rapid POC test; Result Unstructured Data: Negative
CDC Split Type: USJNJFOC20220124040

Write-up: BODY ACHE; FELT DOWN; CHEST PRESSURE; DIZZINESS; FEVER; HEADACHE; NAUSEA; SUSPECTED CLINICAL VACCINATION FAILURE; SUSPECTED COVID-19 INFECTION; FLU A AND B; This spontaneous report received from a patient concerned a 44-year-old female. Initial information was processed along with the additional information received on 14-JAN-2022. The patient''s height, and weight were not reported. The patient''s past medical history included iron deficiency, iron infusion, Covid 19 infection, and circulation problems. Patient had No known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 206A21A, expiry: Unknown) dose was not reported, 1 total administered on 13-JUL-2021 at left arm for prophylactic vaccination. No concomitant medications were reported. On an unknown date, the patient had side effects from the vaccine which were fever, headache, nausea, body ache, felt down. On 24-DEC-2021, Patient had tested negative with PCR (polymerase chain reaction) and antigen test. On 28-DEC-2021, she tested positive for COVID-19 with rapid test and had suspected clinical vaccination failure. On 28-DEC-2021, She also tested positive for flu A and B. 01-JAN-2022, She tested negative again on with rapid test. She also stated someone touched her phone at the airport. She felt chest pressure, little cough, and dizziness. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from suspected covid-19 infection on 01-JAN-2022, and flu a and b, body ache, felt down, dizziness, fever, headache, and nausea, and the outcome of suspected clinical vaccination failure and chest pressure was not reported. This report was serious (Other Medically Important Condition). This report was associated with product quality complaint: 90000211586.; Sender''s Comments: V0: 20220124040 -Covid-19 vaccine ad26.cov2.s- Suspected clinical vaccination failure. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS


VAERS ID: 2042002 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-12-28
Onset:2021-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029H21B / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Anosmia, Asthenia, Hypersomnia, Illness, Malaise, Nausea, Pyrexia, SARS-CoV-2 test, Vaccination site erythema, Vaccination site warmth
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: Covid-19 test; Test Result: Negative ; Result Unstructured Data: Went it to get the covid-19 test again and it was negative; Test Name: Covid-19 test; Test Result: Negative; Result Unstructured Data: Negative; Test Date: 202112; Test Name: Covid-19 test; Test Result: Negative; Result Unstructured Data: A negative test prior to the 1st dose of Moderna vaccine.
CDC Split Type: USMODERNATX, INC.MOD20224

Write-up: was not feeling well/did not feel good; was sleeping 18-20 hours a day; was still very sick/is seriously ill, has serious illness; Had no taste; No smell; Had no energy; Fever/patient ran fever on/off/ran high fever; Nauseous; her arm turned hot that evening/it was hot to the touch; arm was red hot; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE WARMTH (her arm turned hot that evening/it was hot to the touch), MALAISE (was not feeling well/did not feel good), HYPERSOMNIA (was sleeping 18-20 hours a day), ILLNESS (was still very sick/is seriously ill, has serious illness) and AGEUSIA (Had no taste) in a 19-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 029H21B) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 28-Dec-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 28-Dec-2021, the patient experienced VACCINATION SITE WARMTH (her arm turned hot that evening/it was hot to the touch) and VACCINATION SITE ERYTHEMA (arm was red hot). On an unknown date, the patient experienced MALAISE (was not feeling well/did not feel good), HYPERSOMNIA (was sleeping 18-20 hours a day), ILLNESS (was still very sick/is seriously ill, has serious illness), AGEUSIA (Had no taste), ANOSMIA (No smell), ASTHENIA (Had no energy), PYREXIA (Fever/patient ran fever on/off/ran high fever) and NAUSEA (Nauseous). At the time of the report, VACCINATION SITE WARMTH (her arm turned hot that evening/it was hot to the touch), MALAISE (was not feeling well/did not feel good), HYPERSOMNIA (was sleeping 18-20 hours a day), AGEUSIA (Had no taste), ANOSMIA (No smell), ASTHENIA (Had no energy), VACCINATION SITE ERYTHEMA (arm was red hot) and NAUSEA (Nauseous) outcome was unknown and ILLNESS (was still very sick/is seriously ill, has serious illness) and PYREXIA (Fever/patient ran fever on/off/ran high fever) had not resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In December 2021, SARS-CoV-2 test: negative (Negative) A negative test prior to the 1st dose of Moderna vaccine. On an unknown date, SARS-CoV-2 test: negative (Negative) Went it to get the covid-19 test again and it was negative and negative (Negative) Negative. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No Concomitant product use was reported. The reporter was calling on behalf of their daughter who was the patient and stated that after the patient received the 1st dose of the Moderna vaccine, their arm turned hot that evening, arm was red hot, it was hot to the touch, started with a fever and was not feeling well. The reporter stated that the patient had a negative test prior to the 1st dose of Moderna vaccine as the patient was exposed to someone on 22-Dec-2021. The reporter stated that the patient did not feel good, went it to get the covid-19 test again and it was negative. The daughter went to the urgent care as she was still very sick, and the urgent care told the patient to go to the hospital to get a swab test. The patient ran fever on/off, had no taste, no smell, nauseous, had no energy and was sleeping 18-20 hours a day which stated was not like patient. The patient went for a 4th test as the patient had all the symptoms of Covid-19 and the test was also negative on the 4th try. The reporter stated that the patient was seriously ill and was going back to work or else patient could lose their job. The reporter stated that this had lasted 9 days, and all the patient''s symptoms coincide with the Covid virus, was seriously ill, had serious illness and ran high fever. No treatment information was provided. Company comment:This is a case concerning a 19-year-old female patient with no medical history provided, who experienced the unexpected AESI events of Hypersomnia, Ageusia, Anosmia and other nonserious events. These events occurred on unknown date after patient received the first dose of mRNA-1273. There is no medical assessment or treatment has been informed and outcome was reported as unknown. Reportedly, SARS-CoV-2 test was negative which was done on unknown date prior to vaccination and on unknown date after the vaccination. The benefit-risk relationship of mRNA-1273 Vaccine is not affected by this report. Sender''s Comments: This is a case concerning a 19-year-old female patient with no medical history provided, who experienced the unexpected AESI events of Hypersomnia, Ageusia, Anosmia and other nonserious events. These events occurred on unknown date after patient received the first dose of mRNA-1273. There is no medical assessment or treatment has been informed and outcome was reported as unknown. Reportedly, SARS-CoV-2 test was negative which was done on unknown date prior to vaccination and on unknown date after the vaccination. The benefit-risk relationship of mRNA-1273 Vaccine is not affected by this report.


VAERS ID: 2042585 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:2021-12-28
Submitted: 0000-00-00
Entered: 2022-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 1 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ADDERALL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19 (Prior to vaccination, was the patient diagnosed with COVID-19?:Yes)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202200056003

Write-up: I got rashes dime size; Quarter size red rashes all throughout my body. Especially my stomach and legs.; This is a spontaneous report from a contactable reporter (Consumer or other non HCP). The reporter is the patient. A 33-year-old male patient received bnt162b2 (COVID-19 VACCINE - MANUFACTURER UNKNOWN), administered in left arm, administration time at 16:00 (Lot number: unknown) at the age of 33 years as dose 1, single for COVID-19 immunisation. Relevant medical history included: "COVID-19" (unspecified if ongoing), notes: Prior to vaccination, was the patient diagnosed with COVID-19?:Yes. Concomitant medication included: ADDERALL. The following information was reported: RASH (non-serious) with onset 28Dec2021 at 16:00, outcome "recovered", described as "I got rashes dime size"; RASH ERYTHEMATOUS (non-serious) with onset 28Dec2021 at 16:00, outcome "recovered", described as "Quarter size red rashes all throughout my body. Especially my stomach and legs". Therapeutic measures were taken as a result of rash and rash erythematous. Additional Information: The patient had no known allergies. The patient did not receive any other vaccines within four weeks prior to the COVID vaccine. Prior to vaccination, the patient was diagnosed with COVID-19. Since the vaccination, the patient had not been tested for COVID-19. The events did not result in doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care. The patient drank a lot of Benadryl as treatment for rash and rash erythematous. The lot number for BNT162b2 was not provided and will be requested during follow up.


VAERS ID: 2042970 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-03-19
Onset:2021-12-28
   Days after vaccination:284
Submitted: 0000-00-00
Entered: 2022-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Mental status changes, SARS-CoV-2 test positive
SMQs:, Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 12/28/21 SARS-CoV-2 (COVID-19) detected
CDC Split Type:

Write-up: 12/28/21 presents to EC ED for "altered mental status". PMHx of "hypertension dementia"


VAERS ID: 2043049 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-06
Onset:2021-12-28
   Days after vaccination:266
Submitted: 0000-00-00
Entered: 2022-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Fatigue, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (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? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 12/31/21 SARS-CoV-2 (COVID-19) by NAA detected 12/28/21 SARS-CoV-2 (COVID-19) by NAA detected
CDC Split Type:

Write-up: 12/28/21 presents to EC ED for "shortness of breath and fatigue". PMHx of "bed-bound/wheelchair bound, Dementia, CVA, GERD, chronic atrial fibrillation, essential HTN, PE, chronic lower back pain, and prostate CA"


VAERS ID: 2043058 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-12
Onset:2021-12-28
   Days after vaccination:291
Submitted: 0000-00-00
Entered: 2022-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (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? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 12/28/21 SARS-CoV-2 (COVID-19) by NAA detected
CDC Split Type:

Write-up: 12/28/21 presents to EC ED for "Shortness of breath". PMHx of "pulmonary fibrosis currently enrolled in Hospice"


VAERS ID: 2043073 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-14
Onset:2021-12-28
   Days after vaccination:197
Submitted: 0000-00-00
Entered: 2022-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Nausea, SARS-CoV-2 test positive, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 12/28/21 SARS-CoV-2 (COVID-19) by NAA detected
CDC Split Type:

Write-up: 12/28/21 presents to ED for "acute onset n/v for 1 day". PMHx of "HTN, DM 2, HLD, breast cancer, hiatal hernia, frequent falls, SDH, SAH


VAERS ID: 2043100 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-06
Onset:2021-12-28
   Days after vaccination:266
Submitted: 0000-00-00
Entered: 2022-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 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? 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: 12/28/21 SARS-CoV-2 (COVID-19) by NAA detected
CDC Split Type:

Write-up: 12/28/21 presents to Diagnostic Radiology for "elective kidney biopsy, ordered by his transplant surgeon". PMHx of "HTN, CAD, AV replacement, DVT, ESRD s/p renal transplant x 2"


VAERS ID: 2043169 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-10-05
Onset:2021-12-28
   Days after vaccination:84
Submitted: 0000-00-00
Entered: 2022-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acquired diaphragmatic eventration, Asthenia, Blood creatinine increased, Blood gases, Blood pH decreased, Blood sodium decreased, COVID-19, Chest X-ray abnormal, Dizziness, Dyspnoea, Exposure to SARS-CoV-2, Fatigue, Hypoxia, Laboratory test, Lung infiltration, Malaise, Myalgia, Pneumonia, Pyrexia, SARS-CoV-2 test positive, Tachypnoea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Lactic acidosis (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: 70 y.o. male with history of oxygen and steroid-dependent COPD, type 2 diabetes mellitus, morbid obesity, recurrent DVT on anticoagulation with Coumadin, obstructive sleep apnea
Allergies: Feldene [piroxicam], Montelukast, and Vicodin [hydrocodone-acetaminophen]
Diagnostic Lab Data: COVID POSITIVE 1/3/2022
CDC Split Type:

Write-up: 70 y.o. male with history of oxygen and steroid-dependent COPD, type 2 diabetes mellitus, morbid obesity, recurrent DVT on anticoagulation with Coumadin, obstructive sleep apnea, who presented to the emergency room with complaints of worsening weakness and shortness of breath over the past few days. Patient says that he developed symptoms of COVID-19 around December 28 th or 29 th, with symptoms of weakness, fatigue, myalgias, fevers. He tested positive for COVID-19 around 1/3/2022. He thinks he may have caught it from a restaurant as his wife and daughter also tested positive. He continue to monitor his pulse oximetry at home and he noticed that he was developing worsening shortness of breath. So he decided to come to the emergency room today. He has had mild lightheadedness and dizziness. In the EC, vital signs showed tachypnea and hypoxia. He was initiated on supplemental oxygen. Labs showed a sodium of 133, creatinine 1.31. Venous blood gas showed a pH of 7.29. Chest x-ray showed new left lower lobe infiltrate. Also showed a right lung infiltrate and elevation of the right hemidiaphragm (patient has history of right pneumonectomy vs lobectomy). He was given IV Zithromax and IV ceftriaxone for community-acquired pneumonia. He was also initiated on supplemental oxygen. PROGRESS NOTE 1/17/2022 70 y.o. male with history of oxygen and steroid-dependent COPD, type 2 diabetes mellitus, morbid obesity, recurrent DVT on anticoagulation with Coumadin, obstructive sleep apnea, who presented to the emergency room with complaints of worsening weakness and shortness of breath over the past few days. Patient says that he developed symptoms of COVID-19 around December 28 th or 29 th, with symptoms of weakness, fatigue, myalgias, fevers. He tested positive for COVID-19 around 1/3/2022. He thinks he may have caught it from a restaurant as his wife and daughter also tested positive. He continue to monitor his pulse oximetry at home and he noticed that he was developing worsening shortness of breath. So he decided to come to the emergency room today. He has had mild lightheadedness and dizziness. In the EC, vital signs showed tachypnea and hypoxia. He was initiated on supplemental oxygen. Labs showed a sodium of 133, creatinine 1.31. Venous blood gas showed a pH of 7.29. Chest x-ray showed new left lower lobe infiltrate. Also showed a right lung infiltrate and elevation of the right hemidiaphragm (patient has history of right pneumonectomy vs lobectomy). He was given IV Zithromax and IV ceftriaxone for community-acquired pneumonia. He was also initiated on supplemental oxygen.


VAERS ID: 2043188 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-12-27
Onset:2021-12-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8757 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram, Chest pain, Echocardiogram abnormal, Electrocardiogram abnormal, Laboratory test, Nodal rhythm, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Disorders of sinus node function (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin, Atorvastatin, Metoprolol tartrate, levothyroxine, mirtazapine, pantoprazole
Current Illness: None.
Preexisting Conditions: CAD, Tongue cancer 2016, hypothyroidism, GERD, HTN
Allergies: None.
Diagnostic Lab Data: Echo, labs, EKG, CTA
CDC Split Type:

Write-up: Pt developed chest pain the next morning which continued intermittently for 2 weeks and became severe on 1/10/22 which lead to hospitalization. Pt was found to be in a tachycardic junctional rhythm and treated with adenosine.


VAERS ID: 2043254 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-13
Onset:2021-12-28
   Days after vaccination:168
Submitted: 0000-00-00
Entered: 2022-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, Hypertension, Oropharyngeal pain, Pain, Rhinorrhoea, SARS-CoV-2 test positive, Sneezing
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypertension (narrow), Hypersensitivity (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: flu
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: HTN, type 2 diabetic, chronic back pains
Allergies: blood pressure medicine, antibiotics
Diagnostic Lab Data: Covid-19 test
CDC Split Type: vsafe

Write-up: I had sore throat and running nose. Then, I my blood pressure was really high. Then, I had no energy and very weak. I had a lot of mucus and congestive. I had body aches as well. I was also coughing and sneezing. These symptoms are still ongoing since Dec 28th, so about 3 weeks now. On Dec 30th, I was tested positive for Covid-19. I went on Jan 12th for another Covid-19 test, negative results for that one. I do have an appointment on Jan 21th, to see my doctor about this.


VAERS ID: 2043406 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-12-27
Onset:2021-12-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / UNK UN / SC

Administered by: Private       Purchased by: ?
Symptoms: Amnesia, Feeling abnormal, Headache, Lethargy, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 2nd Pfizer shot
Other Medications: Low dose Aspirin, Benefiber, Clozaril, Diltiazem HCL, Fish Oil, Klonopin, Lithium Carbonate, Metformin, Nexium, Tegretol, Trazodone, Vitamin B-12, Vitamin D3
Current Illness: None
Preexisting Conditions: Bipolar Disorder, PTSD
Allergies: NKA
Diagnostic Lab Data: Patient was given the Pfizer vaccination Booster, but also had adverse results from the second Pfizer shot. Patient stated her brain fog was significant, she could not remember anything. Patient stated her symptoms started the night of the booster. Patient received her vaccine at the local County Health Department.
CDC Split Type:

Write-up: Patient experienced fever, headache, lethargy, significant brain fog - all of these lasted 2-3 days


VAERS ID: 2043441 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-12-26
Onset:2021-12-28
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2022-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: geodon, zyprexa, gabapentin, modafinil, depakote
Current Illness:
Preexisting Conditions: bipolar disoder, ADHD
Allergies: sulfa, keflex, mupirocin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: erythema at injection site, swelling, itching, swollen lymph nodes in R axilla


VAERS ID: 2043587 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-21
Onset:2021-12-28
   Days after vaccination:282
Submitted: 0000-00-00
Entered: 2022-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Anxiety, Atrial fibrillation, COVID-19, Cough, Diarrhoea, Feeling abnormal, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Supraventricular tachyarrhythmias (narrow), Dementia (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 16 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 325 MG PO Tab take 2 Tabs by mouth every 4 hours as needed for FOR MODERATE PAIN. Unknown Unknown time alum & mag hydroxide-simeth (MYLANTA, MAALOX) 200-200-20 MG/5ML PO Suspension take 30 mL by mouth every 6
Current Illness: ? Anemia ? Anxiety disorder ? Atrial fibrillation NEW ONSET 8/19/21 ? Carotid atherosclerosis ? Dementia ? Dizziness CHRONIC SINCE MVA 10/2018 ? DVT (deep venous thrombosis) 08/22/2021 left soleal vein ? Gastritis ? Gastrointestinal ulcer ? GERD (gastroesophageal reflux disease) ? Hearing loss ? Heart murmur ? Hx of meningioma of the brain ? Hypertension ? Hypothyroid ? Panic attacks ? TIA (transient ischemic attack) ? Unspecified visual loss
Preexisting Conditions: ? Anemia ? Anxiety disorder ? Atrial fibrillation NEW ONSET 8/19/21 ? Carotid atherosclerosis ? Dementia ? Dizziness CHRONIC SINCE MVA 10/2018 ? DVT (deep venous thrombosis) 08/22/2021 left soleal vein ? Gastritis ? Gastrointestinal ulcer ? GERD (gastroesophageal reflux disease) ? Hearing loss ? Heart murmur ? Hx of meningioma of the brain ? Hypertension ? Hypothyroid ? Panic attacks ? TIA (transient ischemic attack) ? Unspecified visual loss
Allergies: Azithromycin Hives ? Erythromycin GI Distress
Diagnostic Lab Data: 1/3/2022 2:23 PM - Background, Lab User. Component Value Ref Range & Units Status Specimen Submitted Nasopharyngeal Final SARS-CoV-2 (COVID-19) Detected Abnormal Not detected Final Methodology Final Nucleic Acid Amplification (NAA)/Polymerase Chain Reaction (RT-PCR). This SARS-CoV-2 test is for in vitro diagnostic use under the FDA Emergency Use Authorization (EUA) by laboratories certified to perform high complexity testing. This test has not been FDA cleared or approved.
CDC Split Type:

Write-up: patient admitted to in patient psych unit. tested + while staying there. Patient doesn''t feel good. She was running temperature yesterday 100.3 and c/o diarrhea. She has been coughing. She had diarrhea. She slept well last night. Staff reports anxiety. She is received Ativan yesterday evening.


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