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From the 9/10/2021 release of VAERS data:

Found 686,636 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 137 out of 6,867

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VAERS ID: 1578177 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-02-18
Onset:2021-08-14
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Sofia Antigen COVID-19 test with a positive result.
CDC Split Type:

Write-up: Patient received the Pfizer COVID-19 vaccine on 1/28/21 and 2/18/21, so was fully vaccinated when he tested positive on 8/14/21.


VAERS ID: 1578216 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-01-13
Onset:2021-08-14
   Days after vaccination:213
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 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? 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: COVID-19 PCR test with a positive result.
CDC Split Type:

Write-up: Patient received the Pfizer COVID-19 vaccine on 12/23/20 and 1/13/21, so was fully vaccinated when she tested positive for COVID-19 on 8/14/21.


VAERS ID: 1578231 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-28
Onset:2021-08-14
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / SYR

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

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

Write-up: First pregnancy, Est. Due Date April 11th At time of injection, patient felt rush in lower abdomen/uterus Pregnancy symptoms diminished over the next few days after injection Miscarriage began on August 14, confirmed by physician on 8/16/21. Pregnancy loss


VAERS ID: 1578236 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-13
Onset:2021-08-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye pruritus, Glossodynia, Injection site erythema, Injection site pruritus, Lacrimation increased, Oral mucosal blistering, Pain in extremity, Pruritus, Sneezing, Stomatitis, Swollen tongue
SMQs:, Severe cutaneous adverse reactions (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), Lacrimal disorders (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: Zyrtec Flonase lo-estrogen valtrex
Current Illness:
Preexisting Conditions:
Allergies: Penicillin erythromycin kelflex
Diagnostic Lab Data: No medical attention
CDC Split Type:

Write-up: I had my injection Friday 8/13 at 10:45. The next morning I woke up at 7:00 am my arm was very sore. I had blisters in the roof of my mouth. Extreme allergy symptoms itchy watery eyes sneezing and itchy skin and face .The next morning Sunday I woke up at 8:30 am my arm was still very sore but had a large red spot where I received the injection. The sores in my mouth we still present but a little worse. Same allergy symptoms.Monday my injection spot was gone but very itchy. Same allergy symptoms. The blisters in my mouth were now popped and just sores . My tongue is slightly swollen but very sore . No open sores or blisters on my tongue. Started salt water rinse in mouth. My allergy symptoms went away Monday afternoon.Tuesday mouth sores still present and tongue sore and now sore throat. Still using salt water rinse. No allergy symptoms and my arm no longer sore or itchy.


VAERS ID: 1578249 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-08-13
Onset:2021-08-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Arthralgia, Asthenia, Dyspnoea, Headache, Neck pain, Pain in extremity, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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: VIville Dot patch, Baby Aspirin 81mg, Pepcid AC, losartan 25mg, multi vitamin, Vitamin D 5000 iu, Zinc 50mg
Current Illness: Long Haul Covid new onset hypertension
Preexisting Conditions: Long Haul Covid, original COVID dx 2/20/2021
Allergies: Cat scan IV contrast dye, Keflex, Vicodin, mango
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Fever 102 for 24 hours, severe neck and shoulder pain, headache, increased shortness of breath, arm pain and weakness, stomach ache.


VAERS ID: 1578272 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium


VAERS ID: 1578277 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-12
Onset:2021-08-14
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Cholelithiasis, Computerised tomogram thorax abnormal, Cough, Dyspnoea, Fatigue, Hypoacusis, Lung opacity, Malaise, Nephrolithiasis, Pyrexia, Renal cyst, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Gallbladder related disorders (narrow), Gallstone related disorders (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hearing impairment (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin 325 mg oral delayed release tablet, 325 mg/ 1 tab(s), Oral, Daily Flomax 0.4 mg oral capsule, 0.4 mg/ 1 cap(s), Oral, Daily metoprolol succinate 25 mg oral tablet, extended release, See Instructions omeprazole 20 mg oral delayed
Current Illness: Unknown
Preexisting Conditions: coronary Artery disease
Allergies: No Known Medication Allergies
Diagnostic Lab Data: Covid PCR Positive 8/14, 8/15/21 CT Chest (8/14/21): Groundglass infiltrates in the lung fields bilaterally more prominent on the left than the right. No evidence of pulmonary embolism or aortic dissection. Cholelithiasis. Right renal stone and prominent left renal cysts.
CDC Split Type:

Write-up: Requiring hospitalization for positive covid infection. 87-year-old male history of coronary artery disease with coronary stent placement who presents with complaint of cough and shortness of breath. She recently took a home test and tested positive for Covid. Patient notes cough, shortness of breath. Patient also notes malaise and fatigue. Patient severely hard of hearing this history difficult to obtain. Currently denies any pain. No chest pain or palpitations. No headache or acute visual change. No abdominal pain nausea and vomiting. Reactive fever, no chills or rigors. Patient has no other concerns. Patient notes she was double vaccinated in February. Patient to be admitted for further evaluation.


VAERS ID: 1578291 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Did not have an adverse event. But both guardian and kid gave false date of birth, and the shot was given to the kid who hasn''t turned 12 yet.


VAERS ID: 1578329 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-08-08
Onset:2021-08-14
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 1 LA / IM

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

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

Write-up: 2 inch diameter circular erythema and edema at injection point that began 14 Aug 2021


VAERS ID: 1578333 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-03
Onset:2021-08-14
   Days after vaccination:164
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Chest pain, Cough, Dyspnoea, Rhinorrhoea, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol HFA (VENTOLIN HFA) 90 mcg/actuation inhaler amLODIPine (NORVASC) 5 mg tablet amLODIPine (NORVASC) 5 mg tablet atorvastatin (LIPITOR) 40 mg tablet atorvastatin (LIPITOR) 40 mg tablet ATROVENT HFA 17 mcg/actuation inhaler baclofen (
Current Illness:
Preexisting Conditions: Nervous Cervical radiculopathy Osteoarthritis of spine with radiculopathy, cervical region Fibromyalgia Polyneuropathy Right hip pain Osteoarthritis of spine with radiculopathy, lumbar region Chronic pain syndrome Lumbosacral spondylosis with radiculopathy Migraine Respiratory Dependence on supplemental oxygen Seasonal allergic rhinitis Moderate persistent asthma without complication Circulatory Chronic pulmonary embolism (CMS/HCC) Essential hypertension Pulmonary arterial hypertension (CMS/HCC) Chronic pulmonary heart disease (CMS/HCC) Digestive Chronic GERD Musculoskeletal Osteoporosis Avascular necrosis of bone of left hip (CMS/HCC) Plantar fasciitis of right foot Endocrine/Metabolic Hypothyroidism Mixed hyperlipidemia Other Depression with anxiety Preoperative clearance
Allergies: Pollen ExtractsOther (document details in comments)
Diagnostic Lab Data: Chest x-ray COVID-19 PCR
CDC Split Type:

Write-up: Cough Rhinorrhea Chest pain Shortness of breath


VAERS ID: 1578353 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-29
Onset:2021-08-14
   Days after vaccination:197
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Moderna on 1/29 and 2/23. Positive on 8/14 admitted on 8/14-current


VAERS ID: 1578358 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2020-12-28
Onset:2021-08-14
   Days after vaccination:229
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Pfizer on 12/28 and 1/18. Positive on 8/14 admitted on 8/14-current


VAERS ID: 1578454 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-13
Onset:2021-08-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: extreme body aches, fever, chills and migraine.


VAERS ID: 1578462 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-14
Onset:2021-08-14
   Days after vaccination:122
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026B21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, Decreased appetite, Illness, Malaise, Presyncope, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Contains critical data CORONAVIRUS (COVID 19) PCR Status: Final result 0 Result Notes 1 Follow-up Encounter 8/16/21 0945 CORONAVIRUS SARS COV 2 PCR POSITIVE
CDC Split Type:

Write-up: Suspected Coronavirus (Covid-19) Pt has been sick for a few days. He states that he was going to get tested for COVID today but had a near syncopal episode while getting ready this morning. Pt states that he has not been eating due to not feeling well. ? Weakness ? Fever 9 Weeks To 74 Years ? Cough HPI 71-year-old male presents for evaluation of fever and nonproductive cough. Patient reports that symptoms started 2 days ago. He states that he has been feeling progressively weak over the past 48 hours and was going to follow-up with his doctor today but had a near syncopal episode while getting ready. He states that he did not have any associated chest pain or shortness of breath. He denies any abdominal pain.


VAERS ID: 1578547 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-01-20
Onset:2021-08-14
   Days after vaccination:206
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 2 - / IM

Administered by: Work       Purchased by: ?
Symptoms: COVID-19, Illness, Maternal exposure before pregnancy, 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluoxetine, Vit D, Multi vit
Current Illness: No
Preexisting Conditions: Currently Preg (post vaccine)
Allergies: cephalosporin
Diagnostic Lab Data: Covid PCR
CDC Split Type:

Write-up: 12/23/20 Covid Moderna 1/20/21 Covid Moderna 8/14/21 ill 8/16/21 + Covid PCR 8/25 RTW


VAERS ID: 1578616 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-12
Onset:2021-08-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (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: I am currently breastfeeding
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaginal bleeding


VAERS ID: 1578617 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Malaise, 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: unknown which vaccine, felt dizzy as child
Other Medications: UNKNOWN
Current Illness: Antiphospholipid syndrome (APS)
Preexisting Conditions: Antiphospholipid syndrome (APS)
Allergies: PENICILLIN, BACTRIM, ONION, GARLIC
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Pt was nervous about getting vaccinated. Before administering the shot, the pt was told that she had to wait 30 mins after the injection to make sure she doesn''t have any reactions to the vaccine. 20 mins after the vaccination, the pharmacy technician told the pharmacist that the pt did not look well while waiting with her husband. The pharmacist then spoke with the patient and husband. The pt was seated and said she had an itchy red hive on her left forearm ( the same arm of the vaccination). She said she had benadryl and would take them if she needed to. The pharmacist observed the 2 inch hive, asked the pt to check for more hives on her body and if she had any other symptoms. Pt did not. Pt sat for 25 minutes more. The hive was fading away at that time (45 mins post vaccination). The pt was told to go to another facility with emergency services if MD clears her for further doses. MD was informed on the next business day (2 days later). The MD office left a voicemail stating for the next dose the pt needs to go to a facility capable of treating anaphylaxis on site.


VAERS ID: 1578650 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-08-07
Onset:2021-08-14
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site paraesthesia, Pain in extremity, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Arm pain, tingling from where the shot was give to the finger of the hand.


VAERS ID: 1578651 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 RA / IM

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

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

Write-up: This client presented and stated he needed his 2nd dose Pfizer. He was rushed and harried and the staff gave him his dose prior to checking the immunization registry. After the dose was given, it was found that the person received a Janssen vaccine on 7/10/2021.


VAERS ID: 1578736 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-13
Onset:2021-08-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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

Write-up: pt called on tuesday 08/17/2021 reporting that she had redness all around the injection side and reported that it is itching


VAERS ID: 1579210 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-13
Onset:2021-08-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK UN / IM

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

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

Write-up: myocarditis necessitating hospital admission


VAERS ID: 1579603 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, No adverse event
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: METHIMAZOLE 5MG 1 TABLET BY MOUTH DAILY
Current Illness: HYPERTHYROIDISM
Preexisting Conditions: HYPERTHYROIDISM
Allergies: NO KNOWN ALLERGIES
Diagnostic Lab Data: no tests
CDC Split Type:

Write-up: Not an adverse event an administration error. On 08/14/21 Patient came into the pharmacy for her second Pfizer COVID-19 vaccination, she thought that you got the 2nd shot 14 days after the first shot and did not look at her appointment on her card that specified 08/21/21 for her 2nd shot appointment. The pharmacist who gave her the shot did not realize that the patient was early for her COVID-19 vaccine and gave her the shot on day 14 instead of day 21. We were made aware of the issue by a family member who came to the pharmacy on 08/17/21 to get his second covid shot but was informed he was too early for the vaccine until saturday and he stated we gave patient her shot on saturday 8/14 and they got their 1st shots on the same day. We contacted patient and informed her that she got the shot early. We also contacted Pfizer to see if the patient would need to be revaccinated and the guidance from them was to not revaccinate. Patient stated that she has had to adverse effects from the early shot


VAERS ID: 1579604 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-08-01
Onset:2021-08-14
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chest discomfort, Chest pain, Computerised tomogram, Dyspnoea, Electroencephalogram, Scan with contrast, X-ray
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ibuprophen
Current Illness: None
Preexisting Conditions: Corornary artery disease hypertension.angina.fibromylagia
Allergies: Sulfa compazine
Diagnostic Lab Data: Xray catscan with contrast.eeg bloodwork cardiac.meds given toradol and zofran
CDC Split Type:

Write-up: 6 hours after receiving 1st dose i developed pressure and pain in my chest.i had trouble taking in a breath.very uncomfortable.spent 12 hours in the er.was told i had a reaction to the vaccine.


VAERS ID: 1579605 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Tachycardia, Tremor, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Patient reports feeling dizzy, cloudy vision, tachycardia and shaking. Vitals are taken B/P 169/97, P 85, R12. Water is given to her. Doctor is notify and transferred in ambulance.


VAERS ID: 1579739 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-09
Onset:2021-08-14
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

Write-up: 5 days after second vaccination, I am experiencing allergic reactions on my face such as redness, itching, burning and hives/welts. They occur daily and has been occurring for currently 3 days. 1st vaccine I had arm soreness, redness and swelling at injection site.


VAERS ID: 1580106 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Arizona  
Vaccinated:0000-00-00
Onset:2021-08-14
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chills, Feeling abnormal, Gait disturbance, Headache, Hypokinesia, Malaise, Pain
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210830309

Write-up: FEELING UNWELL/SOUNDED UNWELL; INTENSE HEADACHE; TROUBLE WALKING; FELT A BIT FUNNY; CAN HARDLY GET OUT OF BED; PAIN ALL OVER THE BODY (ARMS, LEGS, BACK, FEET); GETTING REALLY HOT AND COLD (CHILLS); This spontaneous report received from a patient concerned a 54 year old female. 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, intramuscular, batch number: Unknown) dose was not reported, administered on 14-AUG-2021 10:00 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 14-AUG-2021, the patient experienced trouble walking. On 14-AUG-2021, the patient experienced felt a bit funny. On 14-AUG-2021, the patient experienced can hardly get out of bed. On 14-AUG-2021, the patient experienced pain all over the body (arms, legs, back, feet). On 14-AUG-2021, the patient experienced getting really hot and cold (chills). On 14-AUG-2021, the patient experienced intense headache. On 15-AUG-2021, the patient experienced feeling unwell/sounded unwell. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from getting really hot and cold (chills), trouble walking, can hardly get out of bed, pain all over the body (arms, legs, back, feet), and intense headache, and the outcome of felt a bit funny and feeling unwell/sounded unwell was not reported. This report was non-serious.


VAERS ID: 1580116 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:2021-08-14
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210830517

Write-up: HEADACHE WITH A PAIN SCALE OF 5/10; This spontaneous report received from a parent concerned an 18 year old 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: 206A21A, expiry: UNKNOWN) dose was not reported, administered on 13-AUG-2021 for prophylactic vaccination. No concomitant medications were reported. On 14-AUG-2021, the patient experienced headache with a pain scale of 5/10. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from headache with a pain scale of 5/10. This report was non-serious.


VAERS ID: 1580268 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-06
Onset:2021-08-14
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, Multivitamin, Vitamin C, Magnesium
Current Illness: None
Preexisting Conditions: Hypothyroidism, fibromyalgia
Allergies: Citrus allergy, hayfever
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Welt on arm for first few days. It seemed to go away and came back itchy and red after a week. It seems to have gotten slightly bigger the last day or two.


VAERS ID: 1582114 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-24
Onset:2021-08-14
   Days after vaccination:143
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 LA / 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin with minerals daily Zoloft 25mg daily
Current Illness: None documented
Preexisting Conditions: Barrett''s esophagus Anxiety Hypoglycemia Hx of adenomatous polyp of colon B12 Deficieny
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient tested positive for COVID-19 after being fully vaccinated.


VAERS ID: 1582328 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 3 LA / IM

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

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

Write-up: The pharmacy was unusually busy this day since boosters had just been approved and also flu shots were just starting to be advertised and so people were now asking for them, so it was very busy with immunizations that morning. I entered the vaccine room and was engaging in small talk with patient and his spouse. I did not verbally confirm with patient which vaccine he was to receive that day. I immunized him with the Moderna vaccine and then he and his spouse left the store. Once they left the immunization room, I was finishing (filling in my name, signature, lot numbers and expiration and so on) and I saw the pre-printed vaccine information had a volume of 0.7ml instead of 0.5ml (which is the volume for Moderna). I then knew I had given the wrong vaccine; the vaccine he was supposed to receive was the Fluzone HD for patients 65+ years old. Several hours elapsed between discovering this and contacting the couple -- I was highly upset and was worried I would start crying while on the phone with them and also I was seeking advice from my RXM on how to proceed with internal error reporting and also how to explain what had happened to them. In the meantime I checked his profile and saw that this was his third dose of the Moderna and his second dose was in March. I called the patient''s wife and left a voicemail with her requesting she call us back at her earliest convenience so we could discuss her and her husband''s visit to the pharmacy earlier that day. Several hours later she called us back and patient was in on the call for a bit too. They expressed that they were not upset and mainly wanted to get clarification on when they could get their flu shots with respect to timing relative to the Moderna. Patient is planning on coming in later in the week to receive his flu shot and update his COVID vaccine card with his third dose information.


VAERS ID: 1582405 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-08-13
Onset:2021-08-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Blood test, Chest pain, Dyspnoea, Eye colour change, Musculoskeletal chest pain, Presyncope
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Blood work was done today waiting on results
CDC Split Type:

Write-up: Yellowing of eyes, Chest pain, rib pain, back pain, shortness of breath, nearly passing out


VAERS ID: 1582426 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-15
Onset:2021-08-14
   Days after vaccination:152
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / UNK - / -

Administered by: Pharmacy       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? Yes
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:

Write-up: Has Covid 19 8/14/2021


VAERS ID: 1582435 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-13
Onset:2021-08-14
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / UNK - / -

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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt currently has covid 19


VAERS ID: 1582480 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Asthenopia, Blepharospasm, Chest pain, Fatigue, Fine motor skill dysfunction, Loss of personal independence in daily activities, Pain in extremity, Thinking abnormal
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Corneal disorders (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Nothing noticeable maybe a minor cold in weeks prior.
Preexisting Conditions: None that I know of
Allergies: None that I know of.
Diagnostic Lab Data:
CDC Split Type:

Write-up: My left eye began twitching about 2 hours after the vaccination and continued on and off for two days. This has never happened to me and was very bizarre. I couldn?t think clearly for around two days, especially the first day, and my hand dexterity was very poor on the first day. I couldn?t type well or do normal motor functions on the phone or computer. I was also extremely tired for around 1 day could barely keep my eyes open, starting a few hours after the vaccine. I also had moderate pain in my lower right stomach although that has largely subsided after 4 days. I had moderate pain in my arm that went away after 2-3 days. I also had intermittent chest pain. I never recall having any reactions to any vaccines before other than pain in the arm. This was very very different. If I had known I would have this reaction, especially with whatever was happening with my brain and chest, I definitely would not have received the vaccine.


VAERS ID: 1582496 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-08-13
Onset:2021-08-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Echocardiogram abnormal, Ejection fraction decreased, Electrocardiogram abnormal, Intensive care, Left ventricular dysfunction, Myocardial infarction, Myocarditis, Pulmonary valve incompetence, Pyrexia, SARS-CoV-2 test negative, Tricuspid valve incompetence, Troponin I increased
SMQs:, Cardiac failure (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Pulmonary hypertension (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (narrow), 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? Yes
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: none
Preexisting Conditions: Bronchiolitis Obliterans Oct 2015 due to Mycoplasma associated mucocutaneous syndrome (Stephen Johnson Syndrome Variant)
Allergies: Amoxicillin, Azithromycin
Diagnostic Lab Data: This diagnosis was made via 1. ECG with "Normal sinus rhythm. Inferior infarct , possibly acute. Anterolateral injury pattern". 2. ECHO Summary: - Mildly decreased left ventricular function with approx. 45-48% EF globally. - Normal right ventricular function - Normal venous and arterial connections - Trivial tricuspid valve insufficiency with incomplete Doppler envelope to calculate right ventricular systolic pressure - Trivial pulmonary valve insufficiency - Normal origin and course of the coronary arteries by 2D imaging and color flow Doppler - No pericardial effusion (ECHO normalized on day prior to discharge) 3. serial troponin i : initial 31.64ng/mL, peak 43.31ng/mL, discharge 7.16ng/mL. negative COVID PCR.
CDC Split Type:

Write-up: The patient was admitted to the Pediatric Intensive care Unit for acute vaccine related myocarditis. He began to have fever the evening after his vaccine with chest pain developing the following night. his chest pain progressed prompting evaluation in the ED where abnormal ECG prompted further workup. He was treated with Solumedrol, IVIG x 2, Pepcid, Tylenol, aspirin x 1, benadryl with a good response. He was monitored in the PICU for risk of arrythmia or shock but did not ever demonstrate either of these conditions. He improved and his labs and echo, ecg normalized. he was discharged home on prednisone and pepcid to follow up with cardiology the following week to discuss steroid taper pending further lab analysis.


VAERS ID: 1582535 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-08-12
Onset:2021-08-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007D21A / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

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

Write-up: Abnormal and frequent heart palpitations


VAERS ID: 1582667 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-08-12
Onset:2021-08-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test normal, Chest X-ray normal, Chest pain, Electrocardiogram normal, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: electrocardiogram, chest xray, and bloodwork; results all clear on 8/24/2021
CDC Split Type:

Write-up: Experienced chest pain (sternum area) and elevated heart beat two days after second dose was administered. By evening pain had intensified. Could not get through to primary provider so taken to hospital emergency room where he stayed for a total of 4.5 hours. Tests included electrocardiogram, chest xray, and bloodwork; results all clear. Staff administered tylenol. Chest pain went away and has not returned.


VAERS ID: 1582687 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-02
Onset:2021-08-14
   Days after vaccination:134
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 2 LA / SC

Administered by: Work       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: 8/17/21 COVID-19, Naat, positive
CDC Split Type:

Write-up: COVID Positive $g14 days post vaccine series


VAERS ID: 1582706 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-08-12
Onset:2021-08-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0165 / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Appendicitis, Condition aggravated, Ultrasound abdomen abnormal
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Patient received covid vaccine Thursday. 48 hours later (Saturday) he was experience abdominal pain that worsened throughout the night. Sunday evening he went to childrens urgent care and an ultrasound revealed he had appendicitis. Child is healthy, up to date on all vaccines and has never had issues prior.


VAERS ID: 1582748 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-13
Onset:2021-08-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059E21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, Axillary pain, Fatigue, Lymph node pain, Lymphadenopathy, Muscular weakness, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Taste and smell disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Daily: Vitamin A (700 mcg RAE), Vitamin C (56 mg), and Vitamin E (11.4 mg)
Current Illness: None.
Preexisting Conditions: None.
Allergies: Antibiotics: Cefzil, Cleocin, Penicillin, Erythromycin, and Cipro.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Swollen and painful lymph node under armpit on left side only following day that was swollen and sore for 5 days. A little less each day. Very tired and all over muscle soreness and weakness the following day after injection for about 1 1/2 days total. Slight nausea the following day after injection. No fever. *I believe I had Covid, but was not tested, in mid-March 2021. Loss of taste and smell for a week and had major muscle pain, weakness and tiredness for about 3 days.


VAERS ID: 1582769 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-08-13
Onset:2021-08-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Eye swelling, Rash pruritic
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: None reported
Current Illness: None reported
Preexisting Conditions: None reported
Allergies: NKA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient reports beginning to develop itchy rash to upper body approximately 6;00 the following evening 08/14/2021 after vaccination (33 hours). She has been taking claritin to help with itching. Denies any other new exposures in home, or medications. Nobody else at home having issues. Presents today 08/18/2021 with continued pruritic rash to upper body (chest, bilat arms, back, neck area) feels like her eyes are swollen.


VAERS ID: 1582772 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ballaside Disodium 750 mg 9 per day Atenolol 1 per day Levothroxine 1 per day Simvistatin 1 per day
Current Illness: none
Preexisting Conditions: Ulcerative colitis
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Stomach cramps--severe at times.


VAERS ID: 1582779 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-08-13
Onset:2021-08-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Paraesthesia, Paraesthesia oral
SMQs:, Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre 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: unknown
Current Illness: Unknown
Preexisting Conditions: no
Allergies: no known allergies, VARS form did not indicate any
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patient experienced tingling in lips followed by paresthesia in her legs the day after receiving her covid vaccine. The tingling and numbness was coming and going. She experienced this all weekend. She went to the ER and the MD said this was a common side effect and recommend she take motrin for 24 hours to see if it subsides.


VAERS ID: 1582782 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-13
Onset:2021-08-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Nausea, Pain in extremity, Unevaluable event
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: Pt. states that after receiving the 1st dose of Moderna 08/13/2021, started experiencing symptoms 08/16/2021 of "magnetized arm" in the left arm site of injection. "Coins" stick to the site and when removed from area nausea and sharp pain penetrates throughout the arm. Reapplying the "Coin" stops the pain, held with magnetism. No noted Primary visit.


VAERS ID: 1582788 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-03-05
Onset:2021-08-14
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031AZ1A / 2 LA / IM

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

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

Write-up: This week, August 14ish, my left arm became unusable...the muscles over my shoulder hurt if I tried to lift the arm, and the pain kept me from sleeping. Aspirin allows me to forget, but since that''s the injection arm, I thought it might be important to report. So, the pain began on Saturday...still there Sunday...seemed to disappear on Monday...now it''s back and worse: I''m planning on using a sling. The same muscles are active when I sweep the deck, etc...and this may have nothing to do with the shots BUT maybe it does.


VAERS ID: 1582825 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-06-11
Onset:2021-08-14
   Days after vaccination:64
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Public       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: Blood Pressure Medication - Name unknown
Current Illness: None
Preexisting Conditions: ? High Blood Pressure ? Former Smoker
Allergies: None
Diagnostic Lab Data: Rapid Antigen Test completed on 08/16/2021
CDC Split Type:

Write-up: Contracted COVID-19 on 08/14/2021


VAERS ID: 1582858 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-08-13
Onset:2021-08-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diplopia
SMQs:, Ocular motility 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: Plaquenil, methotrexate, folic acid, b12, iron, trazodone, Celebrex, flexeril
Current Illness: UTI
Preexisting Conditions: Lupus, sjrogens, arthritis
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Double vision looking upward. Double vision in R eye looking upward to the left


VAERS ID: 1582947 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine. Several years ago. It caused my allergies to go into overdrive shortly after injection. It lasted a couple of month
Other Medications: Tylenol Sinus Tumeric, Milk Thistle, Quercetin, Bromelain
Current Illness: Unknown virus the week before vaccination that mimicked Covid, but was not Covid. I had a Covid test during the illness which was negative.
Preexisting Conditions: none
Allergies: Codeine
Diagnostic Lab Data: none
CDC Split Type:

Write-up: After about five minutes of receiving the vaccine, I felt extremely dizzy. It hit me like a ton of bricks. I had to lie down for awhile until it passed. After that, I was alright, and able to go back home. I have been feeling great ever since.


VAERS ID: 1582993 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-08-01
Onset:2021-08-14
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Cough, Ear pruritus, Eye pruritus, Fatigue, Headache, Malaise, Nasal congestion, Pain, Rhinorrhoea, Sneezing, Throat irritation, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: VTach some epinephrine injection
Other Medications: Prilosec 20 mg twice a day Alprazolam.025 four times a day Fluoxetine 20 mg daily Levothyroxine 125 MCG daily Metoprolol sucanate 25 mg one daily Valsartan 160 mg one daily Centrum vitamin over 50 one daily Extra strength Tylenol Travaprost
Current Illness: None
Preexisting Conditions: Arthritis Leaky heart valve COPD Glaucoma
Allergies: Eggs Morphine Epinephrine Some sulfa Latex Quinine Surgical tape Piroxicam
Diagnostic Lab Data:
CDC Split Type:

Write-up: Very tired and Hive on the face first 30 hours. Then developed bad headache, itchy eyes, throat and ears, nasal congestion, body pain, tight chest, sneezing and lots of nasal drainage, bad cough. Very sick Sunday and Monday. Starting to feel a little better on Tuesday. Wednesday still a lot of nasal congestion and coughing.


VAERS ID: 1583017 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-12
Onset:2021-08-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

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

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

Write-up: Covid symptomps within 2 days, positive test for covid 4 days later.


VAERS ID: 1583067 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: DO NOT KNOW
Current Illness: DO NOT KNOW
Preexisting Conditions:
Allergies: DO NOT KNOW
Diagnostic Lab Data:
CDC Split Type:

Write-up: After vaccination, pt was sitting with father and in about 5 mins she fainted, eyes open but no consciousness. Came to but was very hot and sweaty.


VAERS ID: 1583074 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ROSUVASTATIN 5MG, FAMOTIDINE 40MG
Current Illness: NONE
Preexisting Conditions: ACID REFLUX AND HIGH CHOLESTEROL
Allergies: NONE
Diagnostic Lab Data: WE CALLED 911 AND AMBULENCE CAME AND EVALATED PATIENT AND HE WAS FINE AND THEY LEFT
CDC Split Type:

Write-up: SHORTLY AFTER PATIENT RECIEVED VACCINE, HE FELT FAINT , DIZZY AND COULDNT SEE CLEARLY. SO HE LAYED ON THE FLOOR


VAERS ID: 1583120 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Charlotte 24, Multi-vitamin, Acyclovir, Prevacid, Lamictal, Zoloft, Zyrtec, Trokendi XR, Baclofen, Vitamin D, Emgality, Maxalt, Reglan
Current Illness: Common cold-- within a week or so before vaccine
Preexisting Conditions: Migraine, seasonal allergies, herpes, anxiety
Allergies: Fluroscein, Whole wheat, white potato, vanilla bean, yellow dye
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Saturday evening, August 14, developed low grade fever and severe arm pain where shot was given, severe fatigue. Sunday, August 15, low grade fever-- 100 degrees F all day, treated with Tylenol. Severe head pain in center of head-- worse than migraine pain. Severe fatigue, nausea, body aches all over body, chills. This all lasted for about 24 hours. By Monday, 8/16, symptoms mostly gone except for arm pain.


VAERS ID: 1583121 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 80777-0273-15 / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Chills, Dehydration, Diarrhoea, Headache, Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (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: Anti rejection meds
Current Illness: None
Preexisting Conditions: Kidney transplant
Allergies: None
Diagnostic Lab Data: Blood work 08/15/2021
CDC Split Type:

Write-up: Body aches, fever, vomiting, extreme diarrhea, dehydration,chills,headache


VAERS ID: 1583151 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-10
Onset:2021-08-14
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Fatigue, SARS-CoV-2 test positive
SMQs:, Guillain-Barre 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? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lipitor 80mg, Felodipine 10mg, Sotalol 80mg, Citalopram 20mg, Losartan 50mg, Xanax 0.5mg, Hydralazine 50mg, Omeprazole 20mg, Ticagrelor 90mg, Xarelto 20mg, Metformin 500mg,
Current Illness:
Preexisting Conditions: Arthritis, Atrial Fibrillation, COPD, Depression, Diabetes mellitus, Hypertension, Sleep apnea
Allergies: NKA
Diagnostic Lab Data: SARS COV2 COVID19 PCR
CDC Split Type:

Write-up: Full vaccinated Covid-19 case. General weakness, and fatigue


VAERS ID: 1583171 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Refusal of examination, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Syncope after dose 1, assisted to stretch, allowed to rest, patient''s father refused further evaluation


VAERS ID: 1583173 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-07
Onset:2021-08-14
   Days after vaccination:99
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Chest discomfort, Dizziness, Dyspnoea, Fatigue, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Multivitamin 1 tab, Tramadol 50mg
Current Illness:
Preexisting Conditions: Hip replacement
Allergies: Hydrocodone
Diagnostic Lab Data: SARS COV2 COVID19 PCR
CDC Split Type:

Write-up: Shortness of breath, Dizziness, Chest tightness, Fatigue, General weakness and Fever. Fully vaccinated Covid-19 case


VAERS ID: 1583175 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 3 LA / IM

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

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

Write-up: I entered the immunization room and while engaging with small talk with the patient and her spouse, administered a Moderna COVID-19 shot in her left deltoid muscle. I did not verbally confirm with the patient or spouse which vaccine they were to be receiving that day. After I immunized her spouse, they left and I went to complete the back of the VAR by filling in lot number and expiration dates and noticed the pre-printed volume in the immunization information section was 0.7ml, not 0.5ml (which is what Moderna is). I realized at that point I had given the wrong vaccine and checked the VAR -- she was supposed to receive the Fluzone HD for patients 65+ years old. She had already left the store at this point. Multiple hours elapsed between me discovering this and contacting the patient -- I was distraught and did not to end up crying while on the phone while trying to tell her; also I was seeking advice from my pharmacy manager on how to proceed as far as error reporting with company policy as well as how to explain the situation to her. Once I did call her, I got her voicemail and left a message requesting a call back at her earliest convenience so we could discuss her visit to the pharmacy earlier that day. I checked her profile in our software and saw that this was her third dose of Moderna and her most recent dose was back in March. When she called back later in the day we discussed what had happened and she was very understanding and not upset; she said she and her husband had been planning to try to come in for boosters/third doses of Moderna later in the week. We made a plan for them to return later this week for flu shots and to update their vaccine cards with the third Moderna dose. (I am filing a separate VAERS for the patient''s spouse, who had the same administration error).


VAERS ID: 1583189 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-04-10
Onset:2021-08-14
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / UNK RA / SYR

Administered by: School       Purchased by: ?
Symptoms: Asthenia, Burning sensation, Contusion, Flushing, Gait disturbance, Hypoaesthesia, Limb discomfort, Loss of personal independence in daily activities, Magnetic resonance imaging, Menstruation irregular, Muscular weakness, Musculoskeletal stiffness, Paraesthesia, Peripheral venous disease
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Fertility disorders (broad), Hypersensitivity (broad), Arthritis (broad), Hypoglycaemia (broad), Sexual dysfunction (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: EnerC 1,000 mg vitamin C
Current Illness: Possible pinworm infection
Preexisting Conditions: None
Allergies: Metronytozol creme
Diagnostic Lab Data: MRI Venious Insufficiency tests
CDC Split Type:

Write-up: I had all the symptoms they mentioned could happen plus some that started the next day and continued for months. The passing tingling and numbness is still occurring today when I sleep. Here''s a list of symptoms that occurred in the following days, weeks and months after the shot: heavy legs and arms (dropping things, unable to do house work, instability, left leg felt paralyzed or weak, entire body felt week mussels went loose starting in my legs first left then right then arms one after the other then my face. Tingling, numbness, and burning sensations were occurring through out the day and at night. Had to go to urgent care for bruising on inner thigh then for a vein check they said my femoral vein was not working (venous insufficiency ). Bruising continued on the right leg inner thigh but not as big. I could not walk up stairs the heavyness in my legs was so bad. I had stabbing back pain while walking. Face, arm and leg tingling, numbness and burning continued to the point that I got an MRI with negative results. Cheeks were flushed for weeks after the shot. My period was 16 days early after the shot. The right side of my neck was often stiff and my right arm still cannot bend all the way backwards with out crippling pain that feels paralyzing (it comes and goes) .


VAERS ID: 1583378 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-08-02
Onset:2021-08-14
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 1 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Rash, Rash erythematous, Rash vesicular, Skin discolouration, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 5 days ago patient developed a rash on his left forearm and hand that is now spreading to the right arm. He has an erythematous vesicular rash, warm to touch and very painful with swelling and purple discoloration of the right hand.


VAERS ID: 1583579 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-13
Onset:2021-08-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 LA / SYR

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

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

Write-up: Joint and leg pain - prior to this vaccine, had NO such pain in my legs.


VAERS ID: 1583820 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-08-12
Onset:2021-08-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: C-reactive protein increased, Cardiac imaging procedure abnormal, Chest pain, Myocarditis, Troponin increased
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No other illnesses at time of vaccination.
Preexisting Conditions: No medical comorbidities or health conditions.
Allergies: No allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient developed chest pain. On evaluation in the emergency department troponins were significantly elevated, elevated CRP. He was admitted to cardiology service. He was found to have myocarditis on cardiac MRI and was started on treatment. Chest pain resolved with treatment. He was hospitalized from 8/16-8/17.


VAERS ID: 1584218 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-10
Onset:2021-08-14
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Immediate post-injection reaction, Injection site bruising
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hypersensitivity (narrow)

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

Write-up: Menorrhagia prolonged period Immediate relatively big bruise locally at site of injection


VAERS ID: 1585390 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-05
Onset:2021-08-14
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Hypoaesthesia, Injection site hypoaesthesia, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (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:
CDC Split Type:

Write-up: Fever for several days; numbness in arm, hand and fingers of injection site; headaches; fatigue for serval days; Two weeks post injection patient is still suffering the effects


VAERS ID: 1586263 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Pneumonia, Septic screen
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), Acute central respiratory depression (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: CHRONIC TRACH FOR PAST 5 YEARS DUE TO HISTORY OF PNEUMONIA ON VENT 5 YEARS AGO, BUT NO RECENT PROBLEMS.
Allergies: NONE
Diagnostic Lab Data: FULL SEPTIC WORKUP AND TREATMENT FOR DOUBLE PNEUMONIA
CDC Split Type:

Write-up: ACUTE HYPOXIC RESPIRATORY FAILURE WITH OXYGEN ON PRESENTATION OF 68%


VAERS ID: 1586325 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-12
Onset:2021-08-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 2 LA / IM

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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Allergic: Rash Generalized-Medium, Additional Details: Patient presented to pharmacy on 8/17/2021 and stated that they developed a rash 2 days after their second vaccine and the rash on their entire body that has not gone away. The patient did not mention any other symptoms besides her rash throughout her body.


VAERS ID: 1586365 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysgeusia, Injection site pain, Nausea
SMQs:, Acute pancreatitis (broad), Taste and smell disorders (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Site: Pain at Injection Site-Medium, Systemic: Metallic taste-Medium, Systemic: Nausea-Severe, Additional Details: Patient reports sore arm, nausea, and metallic taste after receiving the COVID-19 shot.


VAERS ID: 1586594 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-22
Onset:2021-08-14
   Days after vaccination:114
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 2 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Cough, Haemoglobin normal, Hypogeusia, Hyposmia, Laboratory test normal, Limb injury, Productive cough, Renal function test normal, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Accidents and injuries (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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet allopurinol (ZYLOPRIM) 100 MG tablet Amino Acids-Protein Hydrolys (PRO-STAT) LIQD apixaban (ELIQUIS) 5 MG tablet ascorbic acid (VITAMIN C) 500 MG tablet cholestyramine (QUESTRAN) 4 g packet cyanocobalam
Current Illness: Exogenous obesity Obesity hypoventilation syndrome Edema Essential hypertension Anemia Tracheostomy dependent History of bariatric surgery Gastroesophageal reflux disease without esophagitis Decubitus ulcer of right thigh, stage 4 Multiple pressure ulcers to buttocks/bilateral LE Chronic diarrhea DVT of axillary vein, acute left Neurogenic bladder with chronic indwelling Foley COVID-19 virus detected Venous stasis ulcer of other part of right lower leg with fat layer exposed with varicose veins
Preexisting Conditions: OSA (obstructive sleep apnea) hx of Deep vein thrombosis (DVT) of right upper extremity Primary osteoarthritis of both knees Chronic midline low back pain without sciatica Pressure ulcer of upper thigh, left, stage III Advanced care planning/counseling discussion Generalized weakness Ulcer of right leg, with fat layer exposed Pancreatic cyst Lymphedema of both lower extremities PAD (peripheral artery disease) Skin ulcer of right ankle with fat layer exposed Candidiasis Acute encephalopathy Other chronic pain Skin ulcer of left calf with fat layer exposed Stage III pressure ulcer of buttock Pyelonephritis Aortic valve endocarditis Neuropathy Gout Uterine fibroid Reactive depression Pressure injury of skin Vulvar pain Diarrhea due to malabsorption Current mild episode of major depressive disorder without prior episode C. difficile colitis Other chronic pancreatitis Other specified anxiety disorders Addiction
Allergies: CodeineDizziness LisinoprilSwelling Keflex [Cephalexin]
Diagnostic Lab Data: COVID19 PCR-Positve 8/14
CDC Split Type:

Write-up: Patient is a 58 y.o. female with history obesity, gastric bypass surgery, obesity hypoventilation syndrome with chronic tracheostomy, a multiple healing wounds, chronic iron deficiency anemia, neurogenic bladder with chronic indwelling Foley catheter, and PICC line associated DVT on Eliquis. The patient presents from her rehab facility due to positive COVID test. The patient states she has been feeling in normal health. They started testing residents on her floor after staff members tested positive for COVID-19. She had several negative COVID tests earlier this week. When she woke up this morning she noticed decreased sense of taste and smell so she received another COVID test which was positive today. Patient denies fevers, chills, chest pain, shortness of breath, worsening cough, myalgias, or other new concern. She does have a chronic intermittently productive cough due to tracheostomy, which patient states is at baseline. The patient was sent to the hospital to verify positive COVID test. In the ER, patient vitals remained stable, afebrile, tachycardic heart rate 90-100, normotensive, with O2 sat 97% on room air. Lab work was unremarkable with normal renal function, no leukocytosis, stable hemoglobin 8.6. COVID test was positive. Patient''s facility declined to accept the patient back due to risk to other residents. At this time, patient does not meet admission criteria was placed in observation until appropriate discharge disposition could be arranged. Patient was transferred to Hospital and placed in observation with Internal Medicine.


VAERS ID: 1586606 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-13
Onset:2021-08-14
   Days after vaccination:123
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Malaise
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Symptoms on 08/14/2021


VAERS ID: 1586663 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-03
Onset:2021-08-14
   Days after vaccination:164
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Unevaluable event
SMQs:

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

Write-up: hospitalized 8/14/21


VAERS ID: 1586685 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-22
Onset:2021-08-14
   Days after vaccination:114
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Malaise, 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: Patient fully vaccinated and is symptomatic. Tested positive for COVID as of 8/17/2021.


VAERS ID: 1586686 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-12
Onset:2021-08-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Cough, Headache, Pain
SMQs:, Anaphylactic reaction (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: cyclobenzaprine 10 mg tablet atorvastatin 10 mg tablet levocetirizine 5 mg tablet, 1 tab daily by mouth zinc acetate 50 mg (zinc) capsule buPROPion HCL XL 300 mg 24 hr tablet, extended release, 1 tab daily vitamin D3 100 mcg, 1 tab dail
Current Illness:
Preexisting Conditions: Allergic Rhinitis Depression M/S injury Hyperlipidemia HTN Hx of Covid Vaccine - Moderna : 1st dose 8/12 Hearing aids Wears glasses/contacts
Allergies: dogs (Unknown) dustmites (Unknown)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cough, headache & body aches.


VAERS ID: 1586711 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-08-12
Onset:2021-08-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, Chills, Cough, Headache, Nasal congestion, Pain, Pyrexia, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: aspirin 325 mg tablet zinc gluconate 30 mg tablet Vitamin D3 25 mcg (1,000 unit) capsule tamsulosin 0.4 mg capsule, 1 tab daily by mouth simvastatin 20 mg tablet, 1 tab daily by mouth lisinopriL 20 mg tablet, 1 tab daily
Current Illness:
Preexisting Conditions: HTN BPH Hx of Covid Vaccine - MOderna : 1st injection 8/12 Hyperlipidemia
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: loss of taste & smell.. Has a low grade fever, headaches, chills, stuffy nose, cough & body aches. tested for covid this morning but have not received results yet


VAERS ID: 1586790 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-10
Onset:2021-08-14
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Chest X-ray normal, Chest pain, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: As a child had seizures
Other Medications: None
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: Went to the hospital on 8/17 and had blood drawn and chest x-ray done to rule out blood clots. No blood clots detected. Shortness of breath has since gotten better. Still have chest pain occasionally.
CDC Split Type:

Write-up: 4 days after vaccine I started to have trouble catching my breath. Had shortness of breath and chest pain for three days. Continue to have chest pain on occasion.


VAERS ID: 1586805 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Breast pain, Chest pain, Cold sweat, Confusional state, Dizziness, Fatigue, Headache, Hyperhidrosis, Irritability, Nausea, Pain in extremity
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Lipodystrophy (broad), Arthritis (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: valacyclovir phentermine Tylenol multi-vitamin metformin
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Left wrist pain, left arm pain, dizziness, nausea, headache, confusion, left side chest pain, left side beast pain, hot and cold sweats, fatigue and irritability.


VAERS ID: 1586876 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breast pain
SMQs:, Lipodystrophy (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: benedryl
Current Illness: none
Preexisting Conditions: none
Allergies: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: FEELING A SHARP PAIN BEHIND LEFT BREAST. STARTED SHORTLY AFTER VACCINATION. TOOK BABY ASPIRIN WHEN SHE WAS FEELING THE PAIN. THE PAIN HAS GOTTEN WORSE.


VAERS ID: 1586905 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-09
Onset:2021-08-14
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Anxiety, Injection site pain, Lymphadenopathy, Metabolic function test, Myalgia, Pain in extremity, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Famatodine 20mg
Current Illness: None
Preexisting Conditions: Mild anxiety
Allergies: None
Diagnostic Lab Data: Lab work was done yesterday for full metabolic panel no results back yet
CDC Split Type:

Write-up: Pain at injection site started day after injection and lasted about 3 days. Lymoh node swelling in left armpit noticed 2 days after injection. Swelling subsided several days later. Pain on inside of bicep near bone and at outter edge od ledt pectoral muscle started 4 days after injection and seemed to last about 5 days. Severe anxiety attacks started 5 days after injection. Today marks 5 days of this same anxiety attack. Dr started me on Lexapro and Atavan and melatonin. Body shakes still present and anxiety levels are super high.


VAERS ID: 1586942 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-03-01
Onset:2021-08-14
   Days after vaccination:166
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN62002 / 2 - / -

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? Yes
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: Patient fully vaccinated and was diagnosed and hospitalized with COVID 19 8/14/21. Patient was treated and discharged.


VAERS ID: 1586959 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-08-13
Onset:2021-08-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Paraesthesia, Sensory disturbance
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Arthritis (broad)

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

Write-up: Woke up at 3am with throbbing in legs and left arm. Pt said she felt super achy in joints. Felt a tinging in spine and still has to current day (8/19/2021)


VAERS ID: 1587076 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-13
Onset:2021-08-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Pain
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril 20mg once daily
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Dizzy for 1 day Difficulty Breathing on exertion x 2 days Body aches x 4days


VAERS ID: 1587111 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products, 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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient did not advise he had already received a full 2 shot series of the Moderna COVID-19 vaccine on 2/5/21 and 3/5/21 and indicated he wanted a first dose Pfizer COVID Vaccine. No reaction noted. It was discovered after patient left clinic


VAERS ID: 1587124 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-01-29
Onset:2021-08-14
   Days after vaccination:197
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Dyspnoea, Fatigue, Lung infiltration, Lung opacity, Pain, SARS-CoV-2 test positive, Total lung capacity decreased
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Acetaminophen/Oxycodone, Albuterol inhaler, Aspirin 81 mg, calcium, cyclobenzaprine, folic acid, hydroxychloroquine sulfate tabs, ibuprofen, levothyroxine, loratadine, losartan, montelukast, omeprazole, pilocarpine, predisone, sodium bicarb
Current Illness: none
Preexisting Conditions: HTN, hypothyroidism, Asthma, Rheumatoid arthritis, Lupus erythematosus, GERDs,
Allergies: Leflunomide metrotrexate
Diagnostic Lab Data: 8.14.2021 Cov19 Fluab RSV PCR- abnormal; notable for the componets, Covid-19 result Detected. 8/14/21: XR: impression: low lung volumes with minimal linear opacities in the rt. midlung which could represent bronchovascular crowding versus early infiltrate.
CDC Split Type:

Write-up: 8/13/2021 Complaining of shortness of breath, fatigue and body aches x 2 days.


VAERS ID: 1587127 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-12
Onset:2021-08-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Herpes virus test, Pruritus, Rash vesicular
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 08/18/2021: HSV culture.
CDC Split Type:

Write-up: Large widespread blister rash with itching.


VAERS ID: 1587146 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-13
Onset:2021-08-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Muscle tightness, Nausea, Night sweats
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient stated that she can provide a list of medication
Current Illness:
Preexisting Conditions:
Allergies: Ibuprofen cats insects
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient stated that she became very nauseated in the middle of the night. She was short of breathe and her chest was tighten. This only lasted for a few seconds, After that patient went in to a sweat. Caused a lot of tension in the back of the neck.


VAERS ID: 1587168 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: New York  
Vaccinated:2021-01-09
Onset:2021-08-14
   Days after vaccination:217
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Fatigue, Headache, Oropharyngeal pain, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose 12/23/20Lot#EK9231 2nd dose 01/09/2021,lot#EL3248 Diagnosed covid positive:08/15/21 Symptom onset:08/14/21 Exposure:Home Symptoms:Cough, fatigue,sore throat,runny nose,headache.


VAERS ID: 1587171 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: New York  
Vaccinated:2021-01-25
Onset:2021-08-14
   Days after vaccination:201
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Fatigue, Headache, Oropharyngeal pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), 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), 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: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose01/04/21 Lot#EL0142 2nd dose 01/25/21 ,lot#EL9261 Diagnosed covid positive:08/14/21 Symptom onset:08/14/21 Exposure: Symptoms:fever, cough, fatigue,sore throat, headache


VAERS ID: 1587173 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-10
Onset:2021-08-14
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Hypoaesthesia oral, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Junel Fe
Current Illness:
Preexisting Conditions:
Allergies: penicillin, sulfa, insect bites
Diagnostic Lab Data: blood test
CDC Split Type:

Write-up: Saturday nigh I started with some hives on the side of my stomach. I took Zyrtec and it calmed me down, but Sunday morning when I woke up my whole body and back was covered with rash. I had to go to the emergency room because my lips were also numb. They gave me several medications in the veins and also serum, they sent me home with oral medications


VAERS ID: 1587334 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Pain in extremity, Ultrasound scan
SMQs:, Anaphylactic reaction (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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: - LLE calf pain - chest discomofort - Ultrasound of left leg is pending


VAERS ID: 1587481 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-30
Onset:2021-08-14
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Intermenstrual bleeding
SMQs:, Haemorrhage terms (excl laboratory terms) (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: omeprazole hydrochlorothiazide atenolol atorvastatin
Current Illness: None
Preexisting Conditions: high blood pressure hemochromatosis auto immune - rheumatoid arthritis/sjogrens
Allergies: any medication that increases serotonin
Diagnostic Lab Data:
CDC Split Type:

Write-up: After not having a period since July 2017, I started spotting on Saturday, August 14 and by Tuesday, August 17, I was having a very heavy flow. it has started to subside but the bleeding has not stopped completely. I contacted my doctor on Wednesday, August 18 and had a virtual visit on Thursday, August 19. They recommended I complete this form and see a gynecologist. They did not know if it was related to the Covid vaccine or not.


VAERS ID: 1588546 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Activated partial thromboplastin time, Activated partial thromboplastin time prolonged, Alanine aminotransferase increased, Aspartate aminotransferase increased, Band neutrophil percentage, Blood albumin, Blood alkaline phosphatase normal, Blood bilirubin increased, Blood calcium increased, Blood chloride normal, Blood creatine phosphokinase increased, Blood creatinine normal, Blood culture negative, Blood fibrinogen, Blood lactate dehydrogenase increased, Blood magnesium increased, Blood phosphorus decreased, Blood potassium normal, Blood sodium decreased, Blood triglycerides increased, Blood urea normal, C-reactive protein increased, Carbon dioxide normal, Chest X-ray normal, Chills, Conjunctivitis, Diarrhoea, Differential white blood cell count, Echocardiogram normal, Ejection fraction, Electrocardiogram normal, Eosinophil count, Epstein-Barr virus antibody negative, Epstein-Barr virus antibody positive, Fibrin D dimer increased, Full blood count abnormal, Gait disturbance, Glomerular filtration rate, Haematocrit decreased, Haemoglobin normal, Headache, Hyponatraemia, Immunoglobulin therapy, Influenza virus test negative, International normalised ratio increased, Laboratory test, Liver disorder, Lymphocyte count, Mean cell volume decreased, Mental status changes, Monocyte count, Multisystem inflammatory syndrome in children, Nausea, Neutrophil count, Nitrite urine absent, Pain, Platelet count decreased, Protein urine absent, Prothrombin time, Pyrexia, Red blood cell sedimentation rate increased, SARS-CoV-2 antibody test negative, Serum ferritin increased, Soliloquy, Transaminases increased, Troponin increased, Ultrasound abdomen abnormal, Urine analysis normal, Urine leukocyte esterase, Vaccination complication, Vomiting, White blood cell count decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Liver-related coagulation and bleeding disturbances (narrow), Severe cutaneous adverse reactions (broad), Acute pancreatitis (narrow), Dyslipidaemia (narrow), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Peripheral neuropathy (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Toxic-septic shock conditions (broad), Dementia (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Biliary system related investigations, signs and symptoms (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Conjunctival disorders (narrow), Lipodystrophy (broad), Ocular infections (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: ADHD, PREDOMINANTLY INATTENTIVE PRESENTATION ANXIETY
Allergies: No known allergies
Diagnostic Lab Data: CBC: Recent Labs 08/19/21 0513 08/18/21 0517 08/17/21 0514 WBC 2.7* 2.0* 1.3* HGB 11.1* 10.7* 11.5* HCT 32.7* 31.9* 34.1* PLT 157 127* 139 Electrolytes Recent Labs 08/18/21 0517 08/17/21 0514 NA 134* 130* K 4.4 4.4 CL 106 98* CO2 22 25 BUN 15 6 CR 0.55 0.59 GFR NOT VALID <18YR NOT VALID <18YR Differential: Recent Labs 08/19/21 0513 08/18/21 0517 08/17/21 0514 NEUT 65.1 71.4 22.8 BAND -- -- 0.01 LYMPH 21.4 | 0.58* 14.5 | 0.30* 0.98* MONO 0.36 | 13.4 0.29 | 14.1 0.00* EOS 0.0 | 0.00 0.0 | 0.00 0.00 MCV 74.4* 74.6* 75.3* Ca++ / Mg++ / Phos+: Recent Labs 08/17/21 0514 CA 9.4 MG 2.0 PHOS 3.5 Liver Function Panel: Recent Labs 08/18/21 0517 08/17/21 0514 TBILI 0.3 0.6 AST 46* 72* ALT 41 54 ALKP 93 113 Troponin / INR / BNP/ESR/CRP: Recent Labs 08/19/21 0513 08/18/21 0517 08/17/21 0514 TROP 653* 852* 2,459* INR -- 1.1 1.2 BNP -- -- 59 Recent Labs 08/19/21 0513 08/18/21 0517 08/17/21 0514 ESR -- -- 52* CRP 18.4* 38.1* 92.3* Unresulted Labs (In-Process and Collected) None Recent Labs 08/18/21 0517 08/17/21 0514 08/16/21 0800 INR 1.1 1.2 1.5* PT 14.0 15.3 -- PTT 24* 32 42* DDIMER <0.27 0.72* 1.58* FIBRINOGEN -- -- 370 8/17/21 UA: negative for protein, leuk est, nitrites 8/16/21 08:00 FERRITIN: 168 8/17/21 05:14 FERRITIN: 194 (H) 8/18/21 05:17 FERRITIN: 158 8/16/21 09:22 LDH: 240 8/17/21 05:14 LDH: 296 (H) 8/18/21 05:17 LDH: 240 8/16/21 09:22 CK: 2,261 (H) 8/17/21 05:14 CK: 1,706 (H) 8/18/21 05:17 CK: 717 (H) 08/16/21 08:00 ASO, QUANT: negative 08/16/21 08:00 COVID-19 Nucleocapsid Antibody: negative 08/16/21 05:59 FLUVID: negative 08/16/21 08:00 EBV Antibody Panel: IgG+, IgM- 8/16/21 09:22 Blood Culture: no growth @3days
CDC Split Type:

Write-up: Immanuel B Esparza is a 13 year old 10 month old previously healthy male who presented on 8/16/21 w/ fever, nausea, headache and body aches x2d and vomiting, diarrhea, and altered mental status x1d secondary to MIS-C vs acute vaccine reaction in the setting of recent 2nd dose of Pfizer COVID-19 vaccine (8/14/21), admitted to the peds wards at MC on 8/16/2021 12:21 PM for IVIG, steroids, cardiac work-up, and supportive care. Patient received his second dose of the Pfizer COVID-19 vaccine on 8/14/21 and began to develop headache, fever, body aches, and nausea that night. The next morning he continued to have intermittent fevers defervesced by Tylenol but developed NBNB emesis x1 w/PO intake and multiple loose stools. Per dad, by Sunday evening patient had unsteady gait and AMS, seemingly talking to himself and not forming intelligible sentences. On Monday morning patient continued to have NBNB emesis x2 w/Pedialyte intake, fevers, and chills and presented to the ED. Pt denied recent trauma, LOC, seizures, change in vision/hearing, photo/phonophobia, runny nose, ear pain, sore throat, cough, neck pain, SOB, diaphoresis, chest pain, palpitations, hematemesis, melena, bloody stools. No extremity pain or swelling. No rash. No recent illness, travel, or sick contacts. Dad, with whom patient lives, is vaxxed against COVID-19 and they have no known COVID-19 contacts. Patient does not recall viral URI or cold sx in the past few weeks, although cites possibility of runny nose and sore throat sometime in July which self-resolved. ED course included labs significant for elevated trop (398), ESR (14), CRP (108.3), low Na (128), elevated transaminases (AST 83, ALT 85), Tbili (1.7), coags (APTT 42, INR 1.5), d-dimer (1.58), triglycerides (214), and CK (2,261). A CXR and EKG were unremarkable. US Abd was significant for "starry sky" appearance of the liver. Given his presentation and lab findings concerning for potential MIS-C, patient was transferred to LAMC for supportive care and additional work-up. Additional labs were ordered and in the ED he received 3 boluses, Zofran 4mg, Tylenol 857.8mg, Ibuprofen 400mg, and IVF were started. Given unremitting fevers, suggestive clinical features (GI sx, neuro sx, conjunctivitis), and significant lab findings (elevated CRP, ESR, hyponatremia, elevated trop and CK, elevated coags, elevated triglycerides) assessment on admission was likely MIS-C 2/2 COVID-19 vaccine or prior asymptomatic COVID-19 infection vs acute vaccine reaction. Pt spiked a fever a few hours after admission w/chills and rigor and was started on MIS-C treatment: 125g IVIG (2g/kg) (8/16-8/17), 30mg Solumedrol BID, GI ppx,Vitamin K 5mg QD x3d (8/16-8/18), Ofirmev 650mg/dose Q6 PRN, and Rocephin 1g/day DAILY until sepsis/infection could be ruled out. By 8/17/21 patient was no longer having fevers and blood culture at 24h demonstrated no growth, Rocephin was discontinued. Labs began to downtrend, including trop, d-dimer, ck, bnp, crp. Repeat EKG was unremarkable and ECHO demonstrated normal study for age w/no reduced LVEF or CAA. On 8/18/21 patient achieved $g48 hrs of no fever and improving labs, with good PO intake and ability to tolerate PO meds, as well as stable vital signs. However, his CBC panel indicated WBCs, HgB, and plts decreasing over the prior two days. On the morning of 8/19/21 his WBCs, HgB, and plts were rebounding and trop, CRP continued to downtrend. Patient was afebrile, stable, tolerating PO intake and meds well $g48h and was discharged home to f/u in 1 week with Cards for activity clearance and f/u ECHO at 1-2 weeks and 4-6 weeks after sx onset. Pt was also to f/u w/ID in 1 week w/repeat labs (CBC, manual differential, CRP, lytes, Albumin, Ddimer, Fibrinogen, Ferritin, AST/ALT , troponin, BNP) to be completed outpatient prior to f/u. Patient to continue outpatient PO steroids and pantoprazole. Of note, pt''s COVID-19 Nucleocapsid Antibody came back negative indicating patient does not have recent COVID-19 infection despite clinical signs/sx and lab findings consistent with MIS-C picture, including: unremitting fevers, GI sx (n/v and loose stool), neuro sx (AMS), conjunctivitis, elevated CRP, ESR, hyponatremia, elevated trop and CK, elevated coags, elevated triglycerides. Etiology of illness perhaps 2/2 acute vaccine rxn however inconsistent with sx peak presentation at 48h post-vax rather than within 24h. Some rare cases of MIS-C following COVID-19 vaccine reported to the CDC, however, in these patients there had also been prior known COVID-19 infection or SARS-CoV-2 PCR and nucleocapsid IgG positive.


VAERS ID: 1589056 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-13
Onset:2021-08-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NOT GIVEN / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Asthenia, Blood magnesium decreased, Blood potassium decreased, Blood thyroid stimulating hormone normal, C-reactive protein normal, Chest X-ray normal, Chest pain, Dyspnoea, Headache, Human chorionic gonadotropin negative, Hypomagnesaemia, Lymphadenopathy, Malaise, Pyrexia, Scan with contrast, Systemic inflammatory response syndrome, Tachycardia, Thyroid mass, Troponin I normal, White blood cell count, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (narrow), Sepsis (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: Amoxicillin (caused hives only as a toddler)
Diagnostic Lab Data: See above I''m sorry I added most there. Trying to finish quick enough now. MAGNESIUM 1.6 mg/dL (Low) TROPONIN I <0.02 ng/mL (Normal) THYROID STIMULATING HORMONE 1.26 uU/mL (Normal) Range: 0.46 uU/mL - 3.98 uU/mL HCG SERUM QUAL Ordered On: 14-Aug-2021 4:37 14-Aug-2021 5:06 HCG SERUM QUAL NEGATIVE C REACTIVE PROTEIN Ordered On: 14-Aug-2021 4:37 14-Aug-2021 11:55 C REACTIVE PROTEIN 0.36 mg/dL (Normal Temperature 100 f Pulse 143 Respiratory Rate 18 O2 SAT 99 % BP Systolic 140 mm[Hg] BP Diastolic 89 mm[Hg]
CDC Split Type:

Write-up: From Emergency Room Doctor: PERSISTENT TACHYCARDIA HYPOMAGNESEMIA FEVER Encounter Diagnosis: NONTOXIC SINGLE THYROID NODULE , LOCALIZED ENLARGED LYMPH NODES , HYPOMAGNESEMIA , OTHER CHEST PAIN , SHORTNESS OF BREATH , OTHER MALAISE , FEVER, UNSPECIFIED , ELEVATED WHITE BLOOD CELL COUNT, SYSTEMIC INFLAMMATORY REACTION SYNDROME OF NON-INFECTIOUS ORIGIN W/O ACUTE ORGAN DYSFUNCTION Mother''s notes are as follows and can be printed and sent to you via portal we set up. Heart rate was 148bpm; sustained around 122bpm x 12 hours. Fever 103 F; decreased after Toradol IV and (2) Tylenol and IV fluids x 3 or 4 L Major headache as well and overall weakness. ***** Hospital records report she signed out against medical advice which is a lie. As her mother I initially wanted badly for hospital to perform an echo to R/O pericarditis or myocarditis. Admission to hospital was the only way they would do that. Upon calling an internist or attending doc, they then tell us she will be admitted to a COVID + floor even though they had already tested her TWICE for COVID and she was NEGATIVE! I did not allow her to be admitted alone to a COVID floor. Now records stated she signed out against medical advice which is INCORRECT. Please see tests and results below: Please see COVID test results from hospital itself: Range: Negative Comments: NOTE: This assay has been cleared for SARS-Cov-2 (COVID19) testing under the Emergency Use Authorization (EUA). Assay Methodology: RT-PCR; Another COVID test: Range: Negative; Comments: The ID NOW COVID-19 has been authorized by the FDA under an emergency use authorization for use by authorized laboratories and patient care settings. The test has been authorized only for the detection of nucleic acid from SARS-CoV-2. Assay Methodology:Isothermal nucleic acid amplification technology Tests: CT CTA CHEST W/ CONTRAST Result: Age/Sex: 18/F EXAMS: 011059252 CT CTA CHEST W/ CONTRAST STUDY: CTA CHEST REASON FOR EXAM: Female, 18 years old. Tachy, -- RADIATION DOSAGE (If Supplied By Facility): DLP = ( 622.2 ) mGycm TECHNIQUE: The examination was performed with the intravenous administration of 75 cc of ISOVUE-370. Post-processing of the angiographic images was performed, with multiplanar reformation and 3D reconstruction. Individualized dose optimization techniques were used for this CT. COMPARISON: None. ___________________________________ FINDINGS: Normal enhancement of the main pulmonary artery and right and left pulmonary arteries. Normal enhancement of the bilateral peripheral pulmonary arteries. There is no demonstrated pulmonary embolism. Normal thoracic aorta and visualized great vessels. There is no demonstrated aortic dissection. Normal heart and pericardium. Normal mediastinum. Normal hilar regions. Normal visualized trachea and bronchi. The lungs are well expanded. Normal pulmonary parenchyma. Normal pleura. No pleural effusion or pneumothorax Multiple nonenlarged as well as few enlarged lymph nodes are seen within the left axilla with the largest measuring 2.5 x 1.5 cm is best seen on series 4 image 51. The right axilla contains few nonenlarged lymph nodes as well. No enlarged mediastinal nodes. Normal osseous structures. Normal visualized upper abdomen. PAGE 1 Signed Report (CONTINUED) Status: REG ER Dis Date Admit Diagnosis: TACHY,FEVER Radiology #: EXAM DATE: 08/14/2021 CT CTA CHEST W/ CONTRAST 7 mm nodule within the left thyroid lobe.___________________________ IMPRESSION: Normal CTA chest examination, without a demonstrated pulmonary embolism or arterial dissection. Multiple nonenlarged as well as few enlarged lymph nodes are seen within the left axilla with the largest measuring 2.5 x 1.5 cm. 7 mm hypodense nodule within the left thyroid lobe. ** Transcribed Date/Time: 08/14/2021 (1221) Printed Date/Time: 08/14/2021 (1222) BATCH NO: N/A PAGE 2 Signed Report Date: 14-Aug-2021 12:21 CXR: - CHEST PORTABLE Result: Status: REG ER Dis Date Admit Diagnosis: TACHY,FEVER Radiology #: EXAM DATE: 08/14/2021 CHEST PORTABLE INDICATION: Chest Pain -- EXAMINATION/TECHNIQUE: X-RAY - XR Chest 1 View COMPARISON: None. ____________________________________________ FINDINGS: LINES/DEVICES: None. LUNGS: No consolidation, edema or effusion. No pneumothorax. MEDIASTINUM AND CARDIOVASCULAR STRUCTURES: Cardiac silhouette not enlarged. Central airways and mediastinal contour are unremarkable. BONES AND SOFT TISSUES: Unremarkable. IMPRESSION: No radiographic evidence of acute cardiopulmonary disease. Transcribed Date/Time: 08/14/2021 (0605) Printed Date/Time: 08/14/2021 (0606) BATCH NO: N/A PAGE 1 Signed Report Labs showed elevated WBC count, low Potassium count of 3.5 Low Magnesium count of 1.4


VAERS ID: 1591138 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-27
Onset:2021-08-14
   Days after vaccination:199
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Unevaluable event
SMQs:

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

Write-up: hospitalized 8/14/21


VAERS ID: 1591285 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-10
Onset:2021-08-14
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031A21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Cough, Diarrhoea, Dyspnoea, Fatigue, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: SxS began 8/14/21: SOB, cough, fatigue, fever, chills, diarrhea


VAERS ID: 1591294 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A214 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products
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: NA
Current Illness: none listed
Preexisting Conditions: none listed
Allergies: None stated
Diagnostic Lab Data:
CDC Split Type: SC202143

Write-up: Patient received dose of Janssen COVID 19 vaccine after denying (written documentation on form 4260 and verbal confirmation of written responses during nurse interview). Upon entering documentation in , documentation of previous vaccination discovered for Moderna COVID 19 1st dose (lot 939676) on 07/14/2021 @ the Clinic., Regional Medical Director fornotified of occurrence. No further orders received.


VAERS ID: 1591329 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-08-14
Onset:2021-08-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products
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: none listed
Current Illness: non listed
Preexisting Conditions: none listed
Allergies: Aspirin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Client received dose of Janssen COVID 19 vaccine after denying (on written documentation form and verbal confirmation of written documentation during nurse interview) having received any previous COVID 19 vaccinations. Upon entering vaccine administration into website, documentation of previous vaccination discovered. Moderna COVID 19 dose one 0n 05/17/2021 lot # 040B21A and dose 2 on 06/14/2021 lot # 025C21A at Clinic. Questioned client regarding previous Moderna doses. Client again denied previously receiving COVID 19 vaccinations. Dr., regional medical director for notified of occurrence. No further orders received.


VAERS ID: 1591402 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-13
Onset:2021-08-14
   Days after vaccination:62
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 622B21A / 2 - / -

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 + on 08/17/2021


VAERS ID: 1591405 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-08-13
Onset:2021-08-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 LA / IM

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

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

Write-up: Swelling and redness at injection site


VAERS ID: 1591406 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-18
Onset:2021-08-14
   Days after vaccination:149
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001B21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016821A / 2 - / -

Administered by: Public       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: Tested Positive for Covid


VAERS ID: 1591495 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Unknown  
Location: Kentucky  
Vaccinated:1959-12-19
Onset:2021-08-14
   Days after vaccination:22519
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 1 AR / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 2 AR / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Myalgia, Oropharyngeal pain, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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? 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: sore throat, cough, muscle aches Tested positive for Covid 08/19/2021


VAERS ID: 1591508 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-08-05
Onset:2021-08-14
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus, Peripheral swelling, Rash, Rash pruritic, Vaccination site pain, Vaccination site swelling, Vaccination site warmth
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine this year my arm stayed red and swollen for a week and itched for 2 weeks.
Other Medications: Adderol, bupropion, nexium, losartan, busbar, meloxicam and mucinex d
Current Illness: Bronchitis 2 weeks prior to.
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Swollen arm 9 days after shot, lasted about 5 days. Arm at the site of the vaccine shot became red, swollen, hot, tender & very itchy. Face was also itchy with rash. Don?t know if that?s related.


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