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

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

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 139 out of 10,493

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VAERS ID: 1984347 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 090H24H / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Nausea, Pain in extremity, Pyrexia, Vomiting
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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Headache, chills, age 49, 1st dose Moderna on 3/13/2021
Other Medications: Ibuprofen 400mg
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Sore arm and mild chills beginning around 7:00pm. Chills increased in severity throughout the night. Did not experience fever, only chills. Nausea began at night around 11:00pm and vomiting at least three times during the night up until after 4:30am. Nausea continues mildly into morning,, 12/28/2021. Able to eat dry toast to stave off nausea and vomiting.


VAERS ID: 1984351 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3198 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Vomiting-Mild, Additional Details: Patient remained in pharmacy until blood pressure was normal and felt better for about 1 hour


VAERS ID: 1984352 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1611 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Feeling abnormal, Flushing, Hyperhidrosis, Hypoaesthesia, Hypotension, Paraesthesia
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Chills-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Patient stated feeling fuzzy and hand tingling-Severe, Systemic: Flushed / Sweating-Severe, Systemic: Hypotension-Severe, Systemic: Numbness (specify: facial area, extremities)-Severe, Systemic: Tingling (specify: facial area, extemities)-Severe


VAERS ID: 1984361 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: New York  
Vaccinated:2021-12-21
Onset:2021-12-27
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 068H21A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (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:
CDC Split Type:

Write-up: Site: Itching at Injection Site-Mild, Site: Redness at Injection Site-Mild, Systemic: Allergic: Rash Generalized-Mild, Additional Details: Patient presented 6 days later stating he just started having a rash on his arm where the injection took place. It was his 3rd dose but previously had the pfizer vaccine for his first 2 doses


VAERS ID: 1984362 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Connecticut  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028K21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Flushing, Hyperhidrosis, Seizure, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Confusion-Medium, Systemic: Dizziness/Lightheadedness-Medium, Systemic: Fainting/Unresponsive-Medium, Systemic: Flushed/Sweating-Medium, Systemic: Seizure-Medium.


VAERS ID: 1984363 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / 3 LA / IM

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

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

Write-up: Patient is 15 years and 10 months old and was administered a booster dose of Pfizer vaccine. Not currently approved or indicated in this age. Description of reported administration error: "Patient came into office today and her mother wanted patient to get a COVID pfizer booster. Dr approved of the vaccine booster. After the vaccine was given, we realized she is only 15 and 10 months, and not yet 16, which is the approved age for the pfizer booster. Mother was called and a message was left for her to call us back."


VAERS ID: 1984552 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: New York  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3197 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Nausea
SMQs:, Acute pancreatitis (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: Systemic: Nausea-Medium, Additional Details: Patient felt nauseous ~5mins after vaccine. She laid on the floor which she said helped, she did not feel lightheaded or other symptoms. Pharmacist sat with her for 15 mins and she said she felt better and went home, no ambulance required.


VAERS ID: 1984562 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-28
Onset:2021-12-27
   Days after vaccination:243
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive, Vaccine breakthrough infection
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: covid+ test
CDC Split Type:

Write-up: covid vaccine breakthrough


VAERS ID: 1984585 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058H21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Muscular weakness, Tremor, Visual impairment
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal 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: None
Current Illness: None
Preexisting Conditions: Aspergers with sensory processing disorder
Allergies: Nickel
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient is a 19 yo sophomore in college. He has very high functioning ASD - he was diagnosed with Aspergers at age 3-4. He is home on Christmas Break and he chose to get his covid booster while home. His first series of immunizations were Pfizer, with only very minor side effects. Yesterday he received a Moderna booster at noon. He felt fine all day. Patient came to find me at 10:30 to tell me that he had started feeling shaky. He was visibly shaking and it was fairly severe. I asked him multiple times if he had chills, and he consistently said he didn''t feel cold and wasn''t shivering. He had eaten dinner at 6:00 and didn''t feel hungry. His temperature was 98.6. I had him drink some water and gave him a banana to eat, and then sat with him giving him "hand hugs" (a sensory processing relief technique) and told him to relax as I did so and try to fall asleep. He fell asleep within 30 minutes, and the shaking subsided the deeper he fell into sleep. His shaking was not just of his extremities, but also his core. When he got up this morning, he also reported having felt "like his legs wouldn''t support him" when he got up to go to the bathroom, and that his vision "got a little dark." He took his temperature and it was 100.4. He feels fine today. I did not take him to the doctor since the incident resolved on its own.


VAERS ID: 1984586 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-03-16
Onset:2021-12-27
   Days after vaccination:286
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac telemetry, Chest X-ray, Computerised tomogram head normal, Electrocardiogram normal, Fall, Laboratory test abnormal, Leukopenia, SARS-CoV-2 antibody test, SARS-CoV-2 test positive, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Haematopoietic leukopenia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (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? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: benztropine 1 mg Tablet Directions: 1 tablet oral daily every morning (Active) carBAMazepine 200 mg Tablet Directions: 1 tablet oral twice a day (Active) cholecalciferol (vitamin D3) 50 mcg (2,000 unit) Tablet Directions: 1 tablet oral
Current Illness:
Preexisting Conditions: HTN, DM , schizophremia, Mental retardation, barrets esophagus, cellulitis, GI Bleeding vaccinated x2 w Moderna . Significant Surg Hx Tonsillectomy. Smoking Status Never Smoker.
Allergies: NKDA
Diagnostic Lab Data: 12/27/2021 - SARS-CoV-2 Antigen (++) 12/27/2021 - SARS-CoV-2 IgM 0.10; IgG 0.02
CDC Split Type:

Write-up: 61 year-old-male with a PMH significant for HTN, DM, squizophrenia, mental retardation, Barretts esophagus, cellulitis, GIB, vaccinated x2 w Moderna who was sent to the ER due to syncope. He is a poor historian, hx collected from records and caregiver. Reportedly, while at Behavioral day program he was found "unresponsive for several minutes", Caregiver was told by the facility "he was sleeping in the chair and fell off the chair". In the ER, he arrived awake and alert with VS 97.5F, BP 125/77, RR 18, pulse ox 95% on RA. CXR w pending read. CT head without acute abnormalities. EKG with NSR at 73 bpm, no ST changes. Lab significant for leukopenia with 23% bands. He is admitted to cardiac telemetry with a cardiology, neurology and ID consultations.


VAERS ID: 1984596 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-10-13
Onset:2021-12-27
   Days after vaccination:75
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, Palpitations, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Hypertension
Allergies: NKDA
Diagnostic Lab Data: 12/27/2021 - SARS-COv-2 Antigen (++)
CDC Split Type:

Write-up: 46 y/o male presented with palpitation cough weakness. NO fever/CPV/D. NO COVID Exposure. vaccinated.


VAERS ID: 1984599 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-04-27
Onset:2021-12-27
   Days after vaccination:244
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Cough, Diarrhoea, Nausea, SARS-CoV-2 test positive, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Denies
Allergies: NKDA
Diagnostic Lab Data: 12/27/2021 - SARS-COV-2 Antigen (-) and PCR (++)
CDC Split Type:

Write-up: C/O N/V/D x 1 day. Had covid few days ago.Had cough which is better. No CP,SOB,LOC,seizures


VAERS ID: 1984601 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-15
Onset:2021-12-27
   Days after vaccination:287
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Fluid intake reduced, Hyperhidrosis, Hypophagia, Hypoxia, Malaise, Pneumonia, SARS-CoV-2 test positive
SMQs:, Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: BPH, Depression, DM, GERD, HTN
Allergies: NKA
Diagnostic Lab Data: SARS COV2 PCR Covid19-Detected 12/27/21 at 0943 . Pt has been becoming more weak and debilitated on a daily basis per family. Severe sweating noted. Does not want to eat or drink. Had to be placed on Oxygen at 5L NC. Currently on oxygen at 4L NC. Remains an inpatient in the hospital.
CDC Split Type:

Write-up: Pt presents to ED with COVID symptoms and Hypoxia/PNA. Rm air sat 85%, Pt fully vaccinated with Pfizer -1st dose 2/22/21 and 2nd dose 3/15/21. He did not have a Booster. Pt exhibited severe sweating and was not eating or drinking. Wife tested + for Covid on 12/16/21. Pt with past medical history of BPH, Depression, DM, GERD, HTN, Cataract sx and ORIF. Pt received IV ABX and IV Steroids.


VAERS ID: 1984605 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-07
Onset:2021-12-27
   Days after vaccination:234
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asymptomatic COVID-19, Vaccine breakthrough infection
SMQs:, 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: Fully vaccinated, not boosted. COVID infection breakthrough, asymptomatic. Admitted to the hospital with non COVID diagnosis.


VAERS ID: 1984607 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-18
Onset:2021-12-27
   Days after vaccination:284
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest discomfort, Chest pain, Dizziness, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: carvedilol (Coreg) 3.125 mg Tablet Directions: 1 tablet oral twice a day (Active) levothyroxine 200 mcg Tablet Directions: 1 tablet oral daily (Active)
Current Illness:
Preexisting Conditions: HTN, Hypothyroidism; lymes, GI bleed s/p polyps and hemorrhoids. Significant Surg HxTonsillectomy, gastric bypass, breast reduction. Smoking Status Former Smoker Former Smoker Detail Smoking Quit Date 22 Year ago.
Allergies: Morphine
Diagnostic Lab Data: 12/27/2021 - SARS-CoV-2 Antigen (++)
CDC Split Type:

Write-up: Patient is a 58 year old female with PMH of hypothyroidism, HTN, lyme disease and rectal bleeding s/p polyps and hemorrhoids who presents with c/o chest pressure. Patient states that she had chest tightness and intermittent sharp substernal pain. Patient is unable to score the pain on a scale of 1-10 but describes it as "annoying". As per patient, she ate some cheese on Christmas eve and thought that may be he cause. The patient did an at home test for Covid Christmas eve and it was negative. Yesterday the patient developed dizziness associated with the chest tightness and took another at home Covid test but this one was positive. Patient is fully vaccinated with Pfizer including the booster. Patient denies nausea, vomiting and shortness of breath.


VAERS ID: 1984611 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-21
Onset:2021-12-27
   Days after vaccination:189
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: metoprolol tartrate 25 mg Tablet Directions: 1 tablet oral twice a day (Active)
Current Illness:
Preexisting Conditions: Hypertension, prior hysterectomy
Allergies: NKDA
Diagnostic Lab Data: 12/27/2021 - SARS-CoV-2 Antigen (-); PCR (++)
CDC Split Type:

Write-up: 88 year old female with a PMH of dementia and hypertension, who was brought in for fever and cough for few days. No SOB. Vaccinated with JnJ in June 2021


VAERS ID: 1984624 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: New York  
Vaccinated:2021-12-10
Onset:2021-12-27
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Intermenstrual bleeding, Menstruation irregular
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Fertility 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: I have irregular breakthrough bleeding. Irregular period/spotting. Early period. Like the link between hormonal oral contraceptives and depression, it appears that again side affects relating to women?s reproduction are not worth considering.


VAERS ID: 1984653 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-06-30
Onset:2021-12-27
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: simvastatin 10 mg po daily metoprolol 25 mg po daily methimazole 5 mg po daily on Monday-Friday only Aspirin 81 mg po daily Claritin 10 mg po daily
Current Illness:
Preexisting Conditions: As Listed Common CAD, Congestive Heart Failure, Dyslipidemia, HTN, Hyperthyroidism; Addt''l Med History Afib, CAD, s/p MI, carotid artery ds., Complete heart block/SSS. Significant Surg Hx As Listed Common CABG, Addt''l Surgical History Cholecystectomy Skin cancer resection-2017 Along with stent-1998 AAA repair with stent-2002 CABG x4-2011 Cardiac stents-2004 Left Carotid artery endarterectomy with stent -2010, 2011 Prostate laser surgery Cardiac ablation-2015 Endoscopy Medtronic Micra leadless pacemaker.
Allergies: amiodarone Citric Acid digoxin "extracts" "lemon juice" Penicillin V Penicillins Sulfa (Sulfonamide Antibiotics)
Diagnostic Lab Data: 12/26/2021 - SARS-CoV-2 Antigen (++)
CDC Split Type:

Write-up: 93-year-old male with history of persistent Afib, complete heart block with symptomatic bradycardia and as result had a Medtronic micra leadless permanent pacemaker placed in the past, CAD s/p CABG x4v, L carotid artery stent, AAA s/p repair 2002, hyperthyroidism, and worsening dementia. The patient came to ER with C/O low grade temps, body aches, generalized weakness, mild cough, and decreased oral intake


VAERS ID: 1984660 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 3 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? 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: NO
CDC Split Type:

Write-up: PATIENT WAS VACCINATED AT 3.5 MONTHS INSTEAD OF THE 6 MONTHS LIMIT. PATIENT REPORTED NO SIDE EFFECTS WHILE WAITING AFTER THE SHOT FOR 15 MINUTES AND WAS CALLED TODAY AND REPORTED NO ADVERSE EVENTS. SHE IS NOT IMMUNOCOMPROMISED.


VAERS ID: 1984662 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3197 / 3 LA / IM

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

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

Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA: Vaccine recipient was 15 years old at the time they received the booster (3rd dose). No reported adverse events.


VAERS ID: 1984667 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 331308A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Back pain, Malaise, Mobility decreased, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Patient reports sharp pain in back starting roughly an hour after receiving vaccine. Extreme arm weakness, to the point of difficulty lifting. Feels extremely weak and unwell.


VAERS ID: 1984684 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-26
Onset:2021-12-27
   Days after vaccination:245
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asymptomatic 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 12/27/21 on binax rapid antigen test- asymptomatic


VAERS ID: 1984695 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

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

Write-up: Patient developed a localized, itchy rash around the injection site minutes after vaccination. Patient did not show any other symptoms of respiratory compromise, hypotension, angioedema, or spreading of rash. Patient was consulted to go to the Emergency room if the child developed any worsening of the rash or the aforementioned symptoms. Attempted to follow up with patient''s parents 2 hours after administration and 9:00AM the next day but was directed to voicemail each time.


VAERS ID: 1984698 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-12
Onset:2021-12-27
   Days after vaccination:229
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Atelectasis, Chest X-ray abnormal, Chest pain, Chills, Cough, Diarrhoea, Dyspnoea, Myalgia, Nasal congestion, Nausea, Polyuria, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tubulointerstitial diseases (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Hypokalaemia (broad)

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

Write-up: 12/27/21: 45-year-old with past medical history of bipolar disorder who comes to the ED because of shortness of breath. She has had fevers, chills, chest pain. She has had diarrhea she says, nausea, vomiting, abdominal pain. No bloody stools. She has been experiencing symptoms of cough, nasal congestion, shortness of breath, myalgias, polyuria for the past 5 days. She has been vaccinated with Johnson and Johnson. She had chest x-ray that shows linear stranding, right base, suggesting atelectasis.


VAERS ID: 1984699 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-29
Onset:2021-12-27
   Days after vaccination:151
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Vaccine breakthrough infection
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: Breakthrough COVID infection.


VAERS ID: 1984702 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-13
Onset:2021-12-27
   Days after vaccination:289
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Asthenia, COVID-19, Mental status changes, Nasopharyngitis, Sepsis
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), Dementia (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Pt has a history of recurrent lung cancer, CAD, COPD, and CKD. Pt came to ER due to weakness and altered mental status. She started with cold like symptoms one week prior. Pt admitted for acute hypoxic respiratory failure due to COVID and sepsis.


VAERS ID: 1984704 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-06-03
Onset:2021-12-27
   Days after vaccination:207
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient vaccinated against and then tested positive for COVID19


VAERS ID: 1984710 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-08
Onset:2021-12-27
   Days after vaccination:263
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient vaccinated against and then tested positive for COVID19


VAERS ID: 1984711 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 LA / IM

Administered by: Private       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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE KNOWN
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: This patient is a male age 12. Recommendations are that only patients 16 years and older receive pfizer boosters.


VAERS ID: 1984718 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041J21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Nausea, Product administered to patient of inappropriate age
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: no known
Current Illness: no known
Preexisting Conditions: no known
Allergies: no known
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Patient is 16 years old but was given the Moderna. She should have received Pfizer COVID-19 since she is less than 18 years old. Patient reports no adverse effects other than mild nausea.


VAERS ID: 1984723 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-12
Onset:2021-12-27
   Days after vaccination:290
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031A21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Vaccine breakthrough infection
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: HOSPITALIZATION DUE TO COVID-19 BREAKTHROUGH CASE.


VAERS ID: 1984724 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 03155BA / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect 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: Patient was given the Pfizer COVID vaccine for 12+ instead of for 5-11 years old.


VAERS ID: 1984750 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078J21A / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Dysstasia, Joint swelling
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Severe pain in both ankles and inability to stand on them. No injury occurred during time frame to justify the pain and swelling.


VAERS ID: 1984760 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-03
Onset:2021-12-27
   Days after vaccination:268
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN 6206 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN 7533 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH 8028 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, COVID-19, Chest pain, Dyspnoea, Exposure to SARS-CoV-2, Flank pain, Pain, Painful respiration, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Lupus, anemia, anxiety
Allergies: NKA
Diagnostic Lab Data: SARS CoV 2 PCR Covid19 detected on 12/27/21.
CDC Split Type:

Write-up: Pt presented to ED with c/o SOB x1 week and c/o CP with deep breath that radiates to Left side and shoulder. Febrile Tmax 101.9, HR 110''s and RR 30''s. Pt is fully vaccinated with booster. Had exposure to coworkers who tested positive for Covid19. Pt now Covid +. Given po/IV steroids and abx.


VAERS ID: 1984793 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

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

Write-up: Though ped pfizer was 0.1ml, found to be 0.2 ml


VAERS ID: 1984801 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-30
Onset:2021-12-27
   Days after vaccination:272
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Exposure to SARS-CoV-2, Fatigue, Headache, Muscular weakness, Myalgia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No chronic health conditions
Allergies: NKA
Diagnostic Lab Data: SARS CoV 2 PCR Covid19 Detected 12/27/2021.
CDC Split Type:

Write-up: Pt admitted with c/o HA, Fatigue, Cough and muscle pain/weakness. States had exposure to close contact that is Covid+. Pt states is fully vaccinated and now with Covid19.


VAERS ID: 1984844 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

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

Write-up: Patient was given incorrect vaccine/dose. Patient was given the Pediatric Pfizer for ages 5-11 years old. The patient is 12 years old and should have received the Pfizer age 12 and up.


VAERS ID: 1984845 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-02-28
Onset:2021-12-27
   Days after vaccination:302
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030M20A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram pulmonary normal, COVID-19, Cough, Dyspnoea, Fibrin D dimer increased, Pain, Pneumonia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Haemorrhage laboratory terms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Dementia, Alzheimer''s
Allergies: NKA
Diagnostic Lab Data: SARS CoV 2 PCR Covid19- detected on 12/26/21
CDC Split Type:

Write-up: Pt presented to ED with c/o SOB/PNA, 2 day history of cough and body aches. +d-dimer -CTA chest negative for PE. Pt Covid19+. PMHX of dementia/Alzheimer''s dz. Pt received IV Abx and IV/po steroids. Pt informed MD that he has been fully vaccinated with booster.


VAERS ID: 1984870 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-11-07
Onset:2021-12-27
   Days after vaccination:50
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939904 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram pulmonary, COVID-19, Chills, Cough, Decreased appetite, Dyspnoea, Emphysema, Fibrin D dimer, Headache, Interchange of vaccine products, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Medication errors (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: From history and physical on 12/27/21: PT is a 70 y.o. female with HO AAA repair, HTN, HLP, COPD on 2 LPM oxygen chronically (also on azithromycin 3 times a week w/ her duo nebs) as well as prior breast cancer in 2016 (Stage IIIB (T4N1M0) ER positive, PR positive,. Completed 4 cycles of neoadjuvant chemotherapy with Taxotere Cytoxan and mastectomy, as well as adjuvant radiotherapy with Dr. who had headache 1 1/2 weeks ago and now has had cough and congestion since 12/20/2021 she describes fever, chills, shortness of breath and decreased appetite. She presented to the ED today with worsening shortness of breath, COVID positive, oxygen sats on presentation were 79%. Oxygen saturation 93-94% on 4 liters. ED w/u = COVID19 +; D dimer 2.12; CTa chest w/ pleural based density LUL (3x1cm) - malignancy vs radiation therapy change, consider PET if no radiation, no PE or focal infiltrated, mild emphysematous changes First dose vaccine = Janssen on 3/10/21 (Lot# 1805025), Moderna on 11/7/2021.


VAERS ID: 1984893 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-12
Onset:2021-12-27
   Days after vaccination:229
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dizziness, Fall, Oropharyngeal pain, Pyrexia, SARS-CoV-2 test positive, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Accidents and injuries (narrow), Cardiomyopathy (broad), Vestibular disorders (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? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Anxiety, Aortic Valve regurg, arthritis, depression, DM, Hyperlipidemia,HTN, Murmur
Allergies: Ativan, Black pepper, contrast dye, Iodine, Morphine
Diagnostic Lab Data: SARS CoV 2PCR Covid 19 Detected 12/27/2021
CDC Split Type:

Write-up: Pt presented to the ED with Fever, sore throat, dizziness and Syncope/Fall. Covid19 detected.


VAERS ID: 1984895 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Cough, Pruritus
SMQs:, Anaphylactic reaction (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Citalopram - 40mg Cetirizine hydrochloride -10mg D3 - 125mg C - 500mg Ferrous sulfate iron - 325mg Calcium - 600mg
Current Illness: No illness for 2 weeks prior to vaccination. Did have a non-covid winter cold started 11/29 and ended 12/11
Preexisting Conditions: None
Allergies: Montelukast
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tight chest, cough, itchy neck about 30 mins after shot. Took 25mg Benadryl and symptoms were mostly alleviated within 40mins. Took another 25mg Benadryl and symptoms went away in about 30mins


VAERS ID: 1984906 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855191 / 2 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Dry throat, Feeling hot, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (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:

Write-up: Patient presented to the vaccination site on 12/27/21. Patient stated to vaccinator that she had a severe allergic reaction to her first dose COVID Pfizer vaccine. Vaccinator alerted RN. Patient stated that her PCP prescribed her 25mg oral benadryl TID 12/06/21-1/03/21 and was given an epi-pen to bring with her for COVID second dose vaccine. RN submitted a medical consult via text message to Vaccine Operations Leads, requesting to proceed with the COVID vaccine Pfizer second dose. Per CDC guidance, approval to proceed with COVID vaccine Janssen second dose was obtained from medical consult team, Vaccine Operations Lead, RN via text message. Client received COVID vaccine Janssen Lot# 1855191. Patient was asked to stay in observation for 30 minutes. Patient alerted EMT and stated that her throat felt tight and she felt warm. EMT alerted RN and other RN. EMT took patients vital signs. BP:136/86, HR: 103, O2: 98%. Patient stated that she felt warm and that her throat felt dry and tight. RN called EMS at 1709. EMt retook patients vital signs at 1714. BP: 136/80, HR: 79, O2: 98%. EMS arrived at 1716. EMS assessed patient. Patient signed AMA form at 1722. EMS left vaccination site at 1722. Patient was asked to stay an extra 30 minutes for observation. EMT retook vital signs and reassessed patient at 1735. BP: 138/86, HR: 91, O2: 99%. Patient still felt like her throat was dry but it did not feel as tight. Patient stated that she no longer felt warm. EMT retook vital signs and reassessed patient at 1745. BP: 132/86, HR: 85, O2: 97%. Patient stated that her symptoms are improving. Patient stated that she is no longer hot. Patient completed her extra 30 minute observation. Patient left vaccination site at 1746 with her husband unassisted and with a steady gait.


VAERS ID: 1984913 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-26
Onset:2021-12-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041321A / 3 LA / IM

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

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

Write-up: Patient has developed rash all over body, and has some nausea


VAERS ID: 1984914 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / ID

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

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

Write-up: severe rash all over entire body, pronounced on both arms, reddened, itchy, bumpy, painful (some soft the touch- some rough to touch)


VAERS ID: 1984918 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 4 LA / IM

Administered by: Private       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: Aricept, Citalopram, hydrochlorothiazide, levothyroxine, biotin, B-12, Timolol, Vitamin D, Flonase, Turmeric, Acetaminophen, Combigan, Azopt, Latanoprost
Current Illness: Osteopenia, memory loss, hypothyroidism, HTN, Glaucoma, Mixed hyperlipidemia, vitamin D deficiency, B12 deficiency, memory loss
Preexisting Conditions: Osteopenia, memory loss, hypothyroidism, HTN, Glaucoma, Mixed hyperlipidemia, vitamin D deficiency, B12 deficiency
Allergies: PCN Sulfa
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient received a second COVID booster at our facility. Medical Assistant who administered the vaccine wasn''t aware that patient had already received a booster. Original booster date was 9/26/21 given at a store pharmacy.


VAERS ID: 1984947 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H21A / 1 LA / IM

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

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

Write-up: PATIENT RECEIVED MODERNA INSTEAD OF PFIZER BY MISTAKE MODERNA NOT APPROVED FOR HER AGE


VAERS ID: 1984963 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: New York  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL8095 / 2 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: No adverse event, Underdose
SMQs:, Medication errors (broad)

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

Write-up: Pt had recently turned 12, but was mistakenly administered by the RN his second dose of pfizer as a 5-11 year dose instead of a 12 and up dose. No adverse effects were seen. Based on CDC guidelines, he is considered vaccinated and no repeat dose was necessary. Parent was informed.


VAERS ID: 1984979 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-12-26
Onset:2021-12-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid
Current Illness: Non
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: I have been exercising my left arm as much as possible.
CDC Split Type:

Write-up: I had the Pfizer Booster shot, and my lymph node under my left arm is swollen and really soar to the touch.


VAERS ID: 1984994 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066H21A / 3 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Myalgia, Pruritus, Somnolence, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer 2nd dose on May 6th. Exhaustion, muscle aches and headaches.
Other Medications: None.
Current Illness: None.
Preexisting Conditions: None.
Allergies: Iodine dye
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: I developed itchy hives only on my neck (front). Waking up the next day hives were still visible but no longer itching. Next morning experienced marked drowsiness and muscle aches. Tylenol helped.


VAERS ID: 1985036 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33130BA / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Feeling cold, Heart rate increased, Malaise, Musculoskeletal stiffness, Myalgia, Nasopharyngitis, Pain, Pain in extremity, Peripheral coldness
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi vitamins, and various other vitamins for health i.e. Vitamin C
Current Illness: None to report
Preexisting Conditions: None
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Starting from 10:30pm the same day of my booster Pfizer appt, I started feeling very tired then my whole body started to ache really bad. My hands and feet were really cold and I felt like I was freezing. I put on more clothes and went under my comforter and was still freezing cold. No fever but my whole body''s muscles ached really bad and I felt like my left arm was going to fall off. The muscles on the left side of my neck started to become stiff and my heart started beating extremely fast. I took a Tylenol and some of the symptoms went away but today (12/28) I still feel like I am sick maybe with a terrible cold and my whole body aches.


VAERS ID: 1985045 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Back pain, Breast pain, Chills, Discomfort, Dry mouth, Lymphadenopathy, Mobility decreased, Musculoskeletal pain, Myalgia, Nausea, Pain in extremity, Pain in jaw, SARS-CoV-2 test negative, Spinal pain
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Lipodystrophy (broad), Osteonecrosis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zn, D3, prenatal Vitamins
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Negative PCR- test on 12/24/2021
CDC Split Type:

Write-up: Dry mouth, chills, swollen Lft. axilla, sore arm, myalgias, nausea, pain in breasts (fatty tissue) and pecs, pain in jaw bone bilaterally, pain in back, spine, gluts (muscles and fat), 101 F temps, weakened mobility and discomfort.


VAERS ID: 1985046 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-27
Onset:2021-12-27
   Days after vaccination:244
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Dyspnoea, Pneumonia, Presyncope, Syncope, Tachypnoea
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (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: Unknown
Current Illness: Unknown
Preexisting Conditions: Bronchitis, hypertension, Type 2 diabetes mellitus
Allergies: N/A
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: CHIEF COMPLAINT: pt states that she is feeling weak SOB and had a syncopial episode HISTORY OF PRESENT ILLNESS: 94 years old female with past medical history of hypertension, hyperlipidemia, hypothyroidism, coronary artery disease, patient presents to the ER with near syncope, she is awake and alert able to answer questions oriented to x2 person on place poor historian. She was found to have left lower lobe pneumonia mildly tachypneic and short of breath in the ER. She was afebrile.


VAERS ID: 1985050 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028K21A / 1 LA / SYR

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

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

Write-up: Hives


VAERS ID: 1985066 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

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

Write-up: PATIENT WAS 11 YEARS OLD WHEN HE RECEIVED HIS FIRST DOSE AND HE WAS GIVEN PEDS DOSE. HE WAS 12 YEAARS OLD FOR HIS SECOND DOSE AND RECEIVED PEDIATRIC DOSE INSTEAD OF ADULT DOSE.


VAERS ID: 1985068 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-10-12
Onset:2021-12-27
   Days after vaccination:76
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Injury, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Accidents and injuries (narrow), Hostility/aggression (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: Positive for COVID by PCR on 12/27/21. Pt had a slight cough at time of testing. Pt was admitted to the hospital for a mechanical injury.


VAERS ID: 1985077 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-12-26
Onset:2021-12-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 060H21A / 2 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F / 1 LA / IM
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 1 RA / SYR
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Decreased appetite, Dizziness, Fatigue, Gait disturbance, Headache, Neurological examination normal
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin C, Vitamin E and magnesium
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Blood pressure check multiple times, reading 150/70. Most recent 130/65.
CDC Split Type:

Write-up: My mom is 78 years old, healthy and with no medical issues, no medications, exercises daily and has a well balanced healthy diet. She felt tired all day yesterday, 12 hours after 2nd dose of Moderna, had little appetite. In afternoon, she felt better and we went for walk. After an hour she felt lightheaded and could not take a step. She swirled for about 10 seconds and I brought her to ground. She never lost consciousness nor did not hit anything. I am a physician and her neurologic exam was normal with strength and sensations preserved, no deficits noted. The only concern was that her blood pressure was 150/70 and remains high until now although lower, 135/65. She has never have blood pressure issues and usually runs low. She also had a headache which has improved. She continues to eat and feels better today.


VAERS ID: 1985081 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-12-23
Onset:2021-12-27
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33030BB / UNK UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Angiogram cerebral abnormal, Arteriogram carotid, Cerebral artery occlusion, Computerised tomogram head, Dysarthria, Embolic stroke, Facial paralysis, Feeling abnormal, Hemiparesis, Magnetic resonance imaging head, Neurological symptom
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hearing impairment (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: tramadol
Current Illness: none known
Preexisting Conditions: long time smoker
Allergies: NKDA
Diagnostic Lab Data: CT head 12/28/21 CTA head and neck 12/28/21 MRI brain 12/28/21
CDC Split Type:

Write-up: Acute embolic stroke to right MCA M2 branch - received vaccine (3rd dose "booster") on 12/23 and says he "never felt right" afterwards. On 12/27 he developed stroke symptoms including left facial droop, left side weakness, slurred speech. He presented late to the hospital 12-14 hours later and CTA showed occlusion of M2 branch with abrupt loss of flow in distal M2 branch . He was not a candidate for interventional procedure based on late presentation.


VAERS ID: 1985091 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Kentucky  
Vaccinated:0000-00-00
Onset:2021-12-27
Submitted: 0000-00-00
Entered: 2021-12-28
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: DM, Anemia, Diverticular Disease, Esophagitis, HTN, Smoker
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient hospitalized despite having received the Pfizer vaccination. Patient unable to provide the dates for vaccine administration.


VAERS ID: 1985114 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-06
Onset:2021-12-27
   Days after vaccination:355
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5230 / 1 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: Pepcid 20mg/2x daily
Current Illness:
Preexisting Conditions: None listed by NP
Allergies: No known allergies
Diagnostic Lab Data: 12/27/21 COVID-19 Result Detected Abnormal
CDC Split Type:

Write-up: None listed


VAERS ID: 1985123 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-05-20
Onset:2021-12-27
   Days after vaccination:221
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Tested COVID + coughing


VAERS ID: 1985148 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059H21A / 3 AR / IM

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

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

Write-up: Patient was given a booster dose of Moderna Covid vaccine.


VAERS ID: 1985160 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-05
Onset:2021-12-27
   Days after vaccination:236
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 2 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 1 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Decreased activity, Fatigue, Headache, Myalgia, Oropharyngeal pain, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol HFA 108 mcg/ACT inhaler, Aurovela FE, Zyrtec 10mg
Current Illness:
Preexisting Conditions: Seasonal allergies
Allergies: No known allergies
Diagnostic Lab Data: 12/27/21 COVID Result IPOC Detected Abnormal.
CDC Split Type:

Write-up: 12/27/21 presenting today for Fever (sore throat, chills, headache) Review of Systems Constitutional: Positive for activity change, chills, fatigue and fever. Negative for appetite change and diaphoresis. HENT: Positive for congestion and sore throat. Respiratory: Positive for cough. Negative for shortness of breath and wheezing. Gastrointestinal: Negative for abdominal pain, diarrhea, nausea and vomiting. Genitourinary: Negative for dysuria. Musculoskeletal: Positive for myalgias. Negative for arthralgias. Skin: Negative for rash. Neurological: Negative for headaches.


VAERS ID: 1985173 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Sore arm, mild body aches


VAERS ID: 1985178 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-10-09
Onset:2021-12-27
   Days after vaccination:79
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 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? 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: Fully vaccinated and tested positive for covid-19


VAERS ID: 1985194 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-10
Onset:2021-12-27
   Days after vaccination:292
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031A21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Nasal congestion, Pain, Pyrexia, Sinus congestion
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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Taking OneTouch Delica Lancets 33G - Miscellaneous as directed - 2x/day, Taking Ritalin 20 MG Tablet 1.5-2 tablets Orally Three to four times a day, Taking Omeprazole 20 mg Capsule Delayed Release 1 capsule Orally Once a day, Taking Metopro
Current Illness: none
Preexisting Conditions: DM II - 2018; Lifestyle mgmt, HTN, Narcolepsy, diagnosed 06/02/02 (Vaaler), Seasonal allergies, Esophagitis on EGD - 5/2018, Obesity.
Allergies: PENICILLIN DRUGS: Rash - Allergy.
Diagnostic Lab Data:
CDC Split Type:

Write-up: sinus congestion, body aches, chills, nasal congestion, fever 101 yesterday. starting 12/27/21


VAERS ID: 1985195 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H21A / UNK LA / IM

Administered by: Private       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? 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: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna vaccine given to patient who was 17 years 6 months of age at time of vaccine. No adverse reactions.


VAERS ID: 1985218 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered
SMQs:, Medication errors (narrow)

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

Write-up: Guardian brought 12 year old to 5 to 11 vaccine event for COVID 19 vaccine. Staff did not catch that the child was 12 and not 11.


VAERS ID: 1985221 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure normal, Dysphagia, Heart rate normal, Lymphadenopathy, Oropharyngeal pain, Oxygen saturation normal, Pain, SARS-CoV-2 test negative
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amytriptyline 10 mg
Current Illness: none
Preexisting Conditions: none
Allergies: sudafed, morphine, fetanyl
Diagnostic Lab Data: Blood pressure, normal, o2. heart rate. normal. I took a PSR covid test at home before going to urgent care and shipped it off. Urgent care also did a rapid covid and it came back negative. Was advised to continue to take tylenol and zyrtec as reccommended and see if swelling, pain d/c in 48 hours.
CDC Split Type:

Write-up: On December 27th 2021 I was feeling well and went to get my booster. I choose Pfizer. I received the injection at 230 pm. By 730 pm, I began to have symptoms and they worsened throughout the night and the next day ( today). Severe sore throat not relieved by water or warm liquids, swollen lymph nodes in throat and under jaw. Difficulty swallowing, painful. I took a zyrtec for possible allergic reaction at 1230 pm and two 500 mg tylenol for pain. Went to urgent care, had a rapid covid test ( negative). Sore throat and swollen throat lumph nodes ARE NOT listed on the CDC website as side effects. WHY NOT? NP determined it was a side effect/reaction to the vaccine. Did not think it would need a throat culture.


VAERS ID: 1985229 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Lethargy, Lymphadenopathy, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Second dose, Pfizer for Covid-19 - severe muscle aches, vomiting, diarrhea
Other Medications: Magnesium and tryptophan
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Extreme muscle aches, headache, lethargy, very swollen lymph node in left arm pit.


VAERS ID: 1985251 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066H21A / 3 LA / SYR

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

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

Write-up: Pt given Moderna booster (0.25ml) less than 6 months after initial series.


VAERS ID: 1985252 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FS1611 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Incorrect route of product administration, Joint range of motion decreased, Periarthritis, Shoulder injury related to vaccine administration, X-ray
SMQs:, Drug abuse and dependence (broad), Arthritis (narrow), Tendinopathies and ligament disorders (broad), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: xrays, clinical exam 12-28-21 in ER
CDC Split Type:

Write-up: 3rd COVID vaccine (booster) administered by Pharmacy patient says vaccine administered on L arm and was too high (proximal) into shoulder joint. she presents with L shoulder pain and limited ROM. I suspect injection was possibly intra-articular not in deltoid muscle. she has frozen shoulder from this and was treated with sling, immobilization, nsaids, pain meds, and ortho followup


VAERS ID: 1985268 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 LA / IM

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

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

Write-up: The patient did not have a reaction to the Pfizer vaccine, the patient received a third dose(booster) of Pfizer. The patient should not have receive a third dose of the vaccine because she is not 16+ years.


VAERS ID: 1985283 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-12-20
Onset:2021-12-27
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood urine present, Constipation, Haematochezia, Kidney enlargement, Movement disorder, Pain, Pyrexia, Sleep terror, Somnolence
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No prior illness
Preexisting Conditions: Low lung capacity due to years of smoking, but no Chronic issues.
Allergies: Penicillin - mild allergy, causes itching, rash, and breakouts within 1 day of administration
Diagnostic Lab Data: I could not afford to go to a doctor over this. But I almost had to go to the hospital, but chose not to do it. I would have had to pay them up front for the care.
CDC Split Type:

Write-up: Severe fever over 101F, inability to move with severe pain throughout entire body, Kidney swelling and severe constipation. Sleepiness and intense vivid night terrors. Blood in urine and stool.


VAERS ID: 1985459 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: none listed. Patient denies
Diagnostic Lab Data: observation post vaccine administration
CDC Split Type:

Write-up: Employee was receiving her booster for Covid vaccine. Janssen vial was opened and one dose was extracted and administered to employee. It was then discovered that the vial expired on 12/21/21. Date vaccine given was 12/28/21. Pharmacy provided vial to me in error as some had been extended in expiration date but this was not.


VAERS ID: 1985461 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 330368D / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, 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: N/A
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer booster dose (3rd dose) given to patient at 15 years of age. Patient does not meet the minimun age of 16 years for qualification of Pfizer booster. Patient had received two previous Pfizer doses, with the second dose on 6/7/21. No adverse reaction was observed during 25-30 min after vaccine was administered. Spoke to mother at 6pm; no adverse reaction and not concern regarding the age. Mother wanted the patient get the booster and was aware of the age issue.


VAERS ID: 1985723 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066H21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tomiramate, Pirmella 1/35
Current Illness: None
Preexisting Conditions: Seizure disorder
Allergies: None listed
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pt reported to have 2 small seizures at approximately 6:20 P.M. Pt reported to be recovered per conversation 12/28/2021 at 4:30 p.m.


VAERS ID: 1985724 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine was administered 3 days outside of the BUD (while under refrigeration). Error was discovered after administration. Patient was notified and given further guidance. No adverse events reported at this time.


VAERS ID: 1985728 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine was administered 3 days outside of the BUD (while under refrigeration). Error was discovered after administration. Patient was notified and given further guidance. No adverse events reported at this time.


VAERS ID: 1985731 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-23
Onset:2021-12-27
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Activated partial thromboplastin time normal, Contusion, Full blood count, International normalised ratio normal, Laboratory test, Petechiae, Platelet count decreased, Prothrombin time normal
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Accidents and injuries (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Did have viral respiratory illness about 2 weeks prior to vaccination
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Labs drawn on 12/28/2021 - CBC notable for platelet count of 6. PT, PTT and INR all within normal limits.
CDC Split Type:

Write-up: Received COVID-19 vaccine on 12/23/2021. Presented to my clinic on 12/28 after 2 day history of petechial rash and bruising on face trunk, arms and legs bilaterally.


VAERS ID: 1985748 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-02-05
Onset:2021-12-27
   Days after vaccination:325
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 AR / SYR

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

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

Write-up: Tested Postive for Covid-19, has bad cough.


VAERS ID: 1985749 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-19
Onset:2021-12-27
   Days after vaccination:283
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 2 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045J21A / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cough, Headache, Nausea, Pain, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ?Cymbalta 60 MG Capsule Delayed Release Particles 1 capsule Orally Once a day ?traMADol HCl 50 MG Tablet (Schedule IV Drug) TK 1 TO 2 TS PO Q 6 H PRN P Oral ?Plaquenil 200 MG Tablet 1 tablet with food or milk Orally Once a day ?Me
Current Illness: none
Preexisting Conditions: Primary osteoarthritis of right shoulder posterior cervical occiput fusion (C1-T2) 2012 Left cubital tunnel syndrome, scheduled for transposition ulnar nerve 2014, 11/23/20
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: headache, body aches, cough, congestion, nausea. starting 12/27/21


VAERS ID: 1985755 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-02-03
Onset:2021-12-27
   Days after vaccination:327
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNWON / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Cough, Nasopharyngitis, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: positive COVID rapid test on 12/27/21
CDC Split Type:

Write-up: cold symptoms- cough, congestion


VAERS ID: 1985761 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Axillary pain, Fatigue, Feeling abnormal, Gait disturbance, Headache, Heart rate increased, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer 2nd shot, same symptoms but more severe + chills and shaking, at age 25, 4/27/2021
Other Medications: N/A
Current Illness:
Preexisting Conditions:
Allergies: Amoxicillian, hives minocycline, dizziness, prolonged QT
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme brain fog an hour after vaccine, moderate pain in armpit of vaccine arm, extreme muscle soreness day after vaccine (can''t walk), 99.6 fever, heart rate in 90s all day while laying down (55 resting), mild headache, extreme fatigue


VAERS ID: 1985772 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, Loss of consciousness, 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), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Patient had vasovagal fainting episode immediately following injection. He was seated entire time. He regained consciousness in a few seconds and was observed and had no other issues. We followed up with parents that night and he was fine the rest of the day.


VAERS ID: 1985941 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2020-12-28
Onset:2021-12-27
   Days after vaccination:364
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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:
CDC Split Type:

Write-up: fully vax COVID + 12/27/21 dose 1 12/28/2020 dose 2 1/18/2021


VAERS ID: 1985955 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Injection site bruising, Injection site pain, Lymph node pain, Lymphadenopathy, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: headache, body aches, and injection site soreness/bruising. Age at vaccination was 23. Vaccination rates are 04/23/2021 and 05/2
Other Medications: Hailey 24 Fe daily oral birth control pill.
Current Illness: None
Preexisting Conditions: Chronic allergies Frequent sinus infections
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Around 8:00 PM on December 27, 2021 I noticed soreness and bruising of the injection site and I began getting a fever, which continued to climb as the day went on. Later that evening I developed a headache, body aches, and nausea. The highest the fever reached was 102 degrees Fahrenheit. On the morning of December 28, 2021 the symptoms continued, but the fever started to decrease. Around 9:00 PM that same day, the fever, headache, and body aches were gone. Soreness and bruising of the injection site continued, and lymph nodes under the right arm were swollen and sore.


VAERS ID: 1986131 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-12-16
Onset:2021-12-27
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

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

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

Write-up: Started with itchy scalp, then became hives / bumps like bug bites in multiple spots on body, from neck shoulders arms and legs.


VAERS ID: 1986145 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-02
Onset:2021-12-27
   Days after vaccination:116
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, COVID-19, Cough, Infection, Joint swelling, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (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: Side effects from all three doses of Moderna.
Other Medications: Diltiazem, Lisinopril, HCTZ, Synthroid, Estradiol, Enbrel
Current Illness:
Preexisting Conditions: Hypertension, hypothyroidism, obesity, psoriasis, psoriatic arthritis
Allergies: Prednisone, Iodine and narcotics
Diagnostic Lab Data: COVID-19 test.
CDC Split Type:

Write-up: Breakthrough infection of COVID-19. Triple full dose vaccination and tested positive on 12/27/2021 from test administered by a medical professional. Moderna mRNA vaccine: Dose 1, 03/12/2021. Dose 2, 04/09/2021. Dose 3, 09/02/2021. Symptoms: persistent dry non-productive cough, lower extremity joint swelling and pain.


VAERS ID: 1986150 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-18
Onset:2021-12-27
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: COVID-19, Cough, Fatigue, Oropharyngeal pain, SARS-CoV-2 test positive, Sinus disorder
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: Sertraline Gabapentin
Current Illness: None
Preexisting Conditions: Depression Anxiety PTSD
Allergies: None
Diagnostic Lab Data: At home covid-19 test came out positive on 27 December 2021
CDC Split Type:

Write-up: Cough, soar throat, flared up sinuses, fatigue Currently 36 weeks pregnant. Due January 27, 2022


VAERS ID: 1987589 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Heart rate increased, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Citalipram 40mg
Current Illness: None
Preexisting Conditions: Asthma, high cholesterol and anxiety
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fever, chills, body aches, increased heart rate


VAERS ID: 1988243 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855835 / 1 - / OT

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysgeusia
SMQs:, Taste and smell disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Multiple sclerosis
Preexisting Conditions: Comments: Patient had no known allergies.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211258614

Write-up: VERY FAINT METALLIC TASTE (5 MINUTES AFTER THE VACCINE WHEN STARTED SALIVATING); This spontaneous report received from a pharmacist concerned a female of unspecified age. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: multiple sclerosis, and other pre-existing medical conditions included: Patient had no known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1855835 expiry: UNKNOWN) dose was not reported, administered on 27-DEC-2021 for prophylactic vaccination. No concomitant medications were reported. On 27-DEC-2021, the patient experienced very faint metallic taste (5 minutes after the vaccine when started salivating). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from very faint metallic taste (5 minutes after the vaccine when started salivating). This report was non-serious.


VAERS ID: 1988293 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-23
Onset:2021-12-27
   Days after vaccination:218
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Pharmacy       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: NONE
Allergies: sesame, macordantin
Diagnostic Lab Data: 12-27-2021 Antigen Test Binax now
CDC Split Type:

Write-up: COVID


VAERS ID: 1988370 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / 4 RA / IM

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

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

Write-up: Error: Booster Given Too Early-


VAERS ID: 1988445 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-25
Onset:2021-12-27
   Days after vaccination:246
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 - / IM

Administered by: Private       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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient hospitalized


VAERS ID: 1988449 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013H21B / 3 AR / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect 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: Error: Wrong Dose of Vaccine - Too Low-


VAERS ID: 1988461 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3197 / 3 LA / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too High-


VAERS ID: 1988495 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 2021-12-28
   Days after onset:1
Entered: 2021-12-29
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 3 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Injection site rash, Injection site urticaria, Rash, Reaction to previous exposure to any vaccine
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: rash with all vaccines~COVID19 (COVID19 (Pfizer-BioNTech))~2~5.00~Patient
Other Medications:
Current Illness:
Preexisting Conditions: Past reactions to vaccinations
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Target site rash and hives - given Benadryl.


VAERS ID: 1988617 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-04-23
Onset:2021-12-27
   Days after vaccination:248
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CETIRIZINE, LO/OVRAL
Current Illness: NONE
Preexisting Conditions: ALLERGIC RHINITIS, ACNE, ASTHMA
Allergies: GARDASIL
Diagnostic Lab Data: 12/27/21: POSITIVE SARS-COV-2 RNA
CDC Split Type:

Write-up: FEVER, BODY ACHES, SNEEZING, COUGH


VAERS ID: 1988620 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-31
Onset:2021-12-27
   Days after vaccination:271
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, COVID-19, Chromaturia, Dysuria, Headache, Hepatic enzyme increased, Nausea, Paraesthesia, SARS-CoV-2 test positive, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No chronic problems
Allergies: Nickel
Diagnostic Lab Data: SARS CoV 2 PCR Covid19- Detected 12/28
CDC Split Type:

Write-up: Presented with painful urination, Dark urine, Nausea and vomiting, Tingling bilat hands and feet, Back pain, occasional headaches and increase liver enzymes. + Covid test


VAERS ID: 1988621 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-04-27
Onset:2021-12-27
   Days after vaccination:244
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029K20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cough, Fatigue, Malaise, Oropharyngeal pain, 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? Yes
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: 12/27/21: POSITIVE SARS-COV-2 RNA
CDC Split Type:

Write-up: COUGH, FEELING TIRED/SICK, SORE THROAT


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