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From the 6/11/2021 release of VAERS data:

Found 352,386 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 139 out of 3,524

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VAERS ID: 1341201 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-19
Onset:2021-05-18
   Days after vaccination:60
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, COVID-19 pneumonia, Cough, Fatigue, Fibrin D dimer normal, Haemoglobin decreased, Lung opacity, Metabolic function test, Platelet count normal, Pneumonia, Positron emission tomogram abnormal, Red blood cell sedimentation rate increased, SARS-CoV-2 test positive, Syncope, White blood cell count normal
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Eliquis, vit D, Hydrocodone, Victoza, levothyroxine, Celexa, Metformin, Protonix, Predmisone, Toujeo, Depakote, ferrous sulfate, coreg
Current Illness: None
Preexisting Conditions: Follicular lymphoma on chemo, atrial fibrillation, DM-2, depression, CAD, hypothyroidism, gerd
Allergies: terbinafine
Diagnostic Lab Data: New PET positive activity within the lungs with basilar and peripheral predominance in areas of ground glass opacities, most likely COVID pneumonia d dimer was normal blood cx were normal wbc 1.1 hgb 9.2, platelets normal esr 111 cmp normal
CDC Split Type:

Write-up: Pt is a fully vaccinated individual as of 3/19/2021 when he had his 2nd Pfizer covid 19 vaccine. He presented to the Emergency room on 5/18/2021 with concerns for covid 19 pneumonia. He is a 72-year-old male undergoing chemotherapy for follicular lymphoma through cardiology center who stated he had a PET scan done at other facility earlier today and stated the oncologist did not like the results and sent him to the emergency room. They were concerned about Covid pneumonia and sent him to be evaluated and admitted as well as treated. Patient stated he has been having trouble over the past several weeks where he has been weaker and more tired, just the week prior he had a syncopal episode. He has since felt more tired than usual and he has had a chronic nonproductive cough. He was admitted to the hospital after testing positive on nasopharyngeal PCR for covid 19 with PET scan findings of ground glass opacities and b/l pneumonia. He was treated with remdesivir and decadron and sent home on 5/19 to recover. He did not require oxygen during his hospital stay or on discharge.


VAERS ID: 1341288 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-26
Onset:2021-05-18
   Days after vaccination:53
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8728 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anticoagulant therapy, Arthralgia, Arthritis, Asthenia, Atrial fibrillation, Blood thyroid stimulating hormone increased, Cardiac telemetry abnormal, Cardiovascular examination, Computerised tomogram head normal, Computerised tomogram thorax normal, Dizziness, Echocardiogram normal, Electrocardiogram abnormal, Full blood count normal, Headache, Metabolic function test normal, Nausea, Palpitations, Troponin normal, Urine delta aminolevulinate normal, X-ray limb abnormal
SMQs:, Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypothyroidism (broad), Hyperthyroidism (broad), Vestibular disorders (broad), Osteonecrosis (broad), Arthritis (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: celexa 40mg daily, levothyroxine 150 mcg daily, metoprolol 50mg daily
Current Illness: none
Preexisting Conditions: anxiety, hypothyroidism, controlled HTN
Allergies: none
Diagnostic Lab Data: TSH 11 CMP and cbc normal ekg rapid atrial fib- no st changes CTA chest no pe, no acute abnormalities r shoulder x ray- arthritic changes, no fracture ct head neg
CDC Split Type:

Write-up: Pt recivied her 2nd covid 19 vaccine on 3/26. Patient is a 76-year-old female with a past medical history significant for hypertension, depression, hypothyroidism 2nd covid 19 vaccine on 3/26 who presented on 5/18 to the ER with complaints of lightheadedness and nausea that occurred over the weekend and was diagnosed with new onset rapid atrial fibrillation. She denied chest pain or shortness of breath but noticed intermittent bouts of palpitations. She went to see her PCP who referred her to the emergency room. EKG and telemetry in the emergency room were significant for new onset rapid atrial fib. She was given diltiazem and admitted to the hospitalist service. CT of the chest was negative for pulmonary emboli or focal consolidation. She had no electrolyte derangements she has no history of sleep apnea and no history of obesity. Her troponin and delta were unremarkable. She was subsequently admitted to the hospitalist service. She was treated with metoprolol and amiodarone along with Eliquis. She was seen by her cardiologist. Her recent echocardiogram was normal. Her TSH was actually elevated at 11.0 so her levothyroxine dose was increased to 175 mcg daily with a TSH in 6 weeks. At this time patient''s rate is much better controlled but she remains in atrial fib. She will be following up with her cardiologist closely post discharge. She is also complaining of persistent R shoulder pain and weakness since her vaccine. Her shoulder x ray showed arthritic changes. She also c/o the worst headache of her life that lasted a week starting on May 4th. CT head was neg.


VAERS ID: 1341479 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-05-15
Onset:2021-05-18
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Catheterisation cardiac abnormal, Chest X-ray abnormal, Chest pain, Echocardiogram, Electrocardiogram abnormal, Lipids, Magnetic resonance imaging heart, Metabolic function test, Myocarditis, Troponin, Ultrasound scan abnormal
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: testosterone cypionate 200mg/ml injection
Current Illness: possible gastroenteritis / stomach flu one week prior to second dose
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: EKG 12-Lead (performed 2x) , Chest X-Ray, Multiple blood tests (Troponin, Metabolic Panel, Lipid Panel, etc), Ultrasound of Heart, Cardiac Catheterization (ALL ON 5/18) Transthoracic Echocardiogram, MRI of Heart Function with Viability, blood tests (Troponin, Metabolic Panel) (ALL ON 5/19)
CDC Split Type:

Write-up: Received second dose on Saturday, woke up on Tuesday at 5 AM with chest pains. Went to the emergency room around 4PM Tuesday, transferred to another hospital, diagnosed with myocarditis, and treated and monitored there for 2 days and then discharged. On medication for the next 3 months due to condition.


VAERS ID: 1341601 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Headache, Hyperhidrosis, Nausea, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Headache-Mild, Systemic: Nausea-Mild, Systemic: Vomiting-Mild


VAERS ID: 1341984 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Dizziness, Electrocardiogram, Erythema, Eye movement disorder, Hearing disability, Injection site pain, Muscle twitching, Pallor, Speech disorder, Syncope, Urinary incontinence, Visual impairment
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Dyskinesia (broad), Dystonia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinipril -hydrochlorothiazide 20-25 mg
Current Illness: N/A
Preexisting Conditions: High blood pressure
Allergies: N/A
Diagnostic Lab Data: EKG in the ER Doctor check up the next day
CDC Split Type:

Write-up: The injection did hurt quite a bit more than other injections I have had in the past but it began to feel better and I sat in a chair and was on my phone to send a message, spoke to a stranger who was looking for where to go, and was ok until the feeling of fainting began 10 minutes after the shot. I put my head between my knees but it did not help so I called for help and eventually was helped onto the floor to lie down which began to help. I had vision trouble and hearing trouble and could not speak. I was told my neck became bright red as my face grew white and my hands twitched and my eyes rolled around. I found out later that I had also peed my pants. I have fainted only once before in 1989, and found this reaction pretty frightening although I do not believe it happened as a result of anxiety or fear, the adverse effect itself was frightening and unexpected- not listed on any paperwork I received and was not aware it could occur.


VAERS ID: 1342006 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-17
Onset:2021-05-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Brain scan abnormal, Cerebellar stroke, Computerised tomogram head abnormal, Ischaemic stroke, Magnetic resonance imaging head abnormal, Pyrexia, Vertigo
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Vestibular disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine, metoprolol, aspirin, metformin, glipizide, atorvastatin
Current Illness:
Preexisting Conditions: Diabetes CAD Hyperlipidemia
Allergies: Lisinopril
Diagnostic Lab Data: Brain MRI with Small region of acute ischemic stroke involving right cerebellar hemisphere that corresponds low density area noted on head CT. 5/22/21
CDC Split Type:

Write-up: Vertigo and fever occurred 24 hours after 2nd vaccination. Presented to ED and hospitalized for small right cerebellar stroke.


VAERS ID: 1342065 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-05-01
Onset:2021-05-18
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

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

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

Write-up: Itchy rash in the crook of both elbows


VAERS ID: 1342102 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Father called to get the covid vaccine for family. We informed him that only for children 12 years old and older are able to receive the Pfizer vaccine. Father, wife, and 2 children came to pharmacy as "walk-in" vaccines and again he was asked if the children are 12 and older. He said they were. Father filled out paperwork writing that one child was 12 years old, vaccines were administered and when we processed the paperwork later, it was discovered that the child was 11 years old because the father put his date of birth as Oct 8th,09. The correlation of October 8th, 2009 and the child being 11 years old was not made pre vaccination . We called the father that evening, 5/18, to see how the child was and to let him know that he was not eligible to receive this vaccine and that we would not be able to administer the second dose. The Father said the child was fine and that he needs the second dose because they will be traveling. I asked for the child''s MD name. The Father said that the MD will write a prescription so that the child can get the second dose. I let the Father know that that would not be possible unless they change the guidelines. I called the family on 5/19/21 to check in with them and see how everyone, including the child was doing. I was told that they were all doing well.


VAERS ID: 1342138 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-12
Onset:2021-05-18
   Days after vaccination:67
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M208 / 1 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Computerised tomogram head abnormal, Dysarthria, Fatigue, Fibrin D dimer increased, Gait disturbance, SARS-CoV-2 test positive, Speech disorder, Subarachnoid haemorrhage, Tongue disorder
SMQs:, Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Anticholinergic syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lipitor 40mg/d Aricept 5mg daily Keppra 500mg bid Seroquel 25mg daily Flomax 0.4 mg daily
Current Illness: none
Preexisting Conditions: past hx of CVA, BPH, demetia, HTN, Hyperlipidemia, OSA on cpap, prostate cancer hx, thyroid disease
Allergies: ace inhibitors cat dander
Diagnostic Lab Data: CT head small b/l hemorrhage covid 19 pcr positive cxr neg
CDC Split Type:

Write-up: This is an 81-year-old male with a history of dementia also a history non traumatic SAH over the right cerebral convexity in 7/17 thought due to amyloid angiopathy , stroke and TIA who is brought by his wife for evaluation of changes that she noted last night around 9:00. She stated around 9 when she was getting ready for bed she thought his speech was a little bit thick but thought she had worn about since they were outside doing a lot of walking and had been to a picnic. The morning of the admission he has been more tired his tongue has been thick his speech is been a little bit slurred and his gait was slow with a shuffling gait. In the afternoon when visiting her son he recommended she bring him in immediately for evaluation.head CT showed small amount of bilateral subarachnoid hemorrhage Neurosurgery at Medical Center was consulted and no surgical intervention was recommended. He was transferred to Hospital for further evaluation treatment . repeat ct head was stable. He was discharged on 5/20/2021 and his aspirin was stopped. He also tested positive for covid 19 despite being fully vaccinated. ddimer was 1787- venous doppler was not done. he did not require oxygen. He was placed on quarantine on dc. Called wife on 5/22 and she reports he is complaining of fatigue but no cough or sob. He also has a history of covid 19 on 12/20 and was hospitalized and discharged on 1/6/21 and tested negative on 1/7/21. during that admission he was treated with remdesivir and decadron. He did not require oxygen. His hospital stay was protracted due to deconditioning and confusion but he was ultimately discharged home . the baby aspirin was added on dc. mri during that admission was normal with no acute abnl seen.


VAERS ID: 1342259 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-17
Onset:2021-05-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Disturbance in attention, Eye pain, Headache, Muscular weakness, Sleep disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Depression (excl suicide and self injury) (broad), Arthritis (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: Adverse Events: Lack of muscle strength, thought capacity, sore eyes, sore left elbow. less coherent thoughts, headache, woken up from sleep. starting at 0230 all lasting approx. 6 hours. Treatment: 3x ibuprofen tablets taken approx 4 hours in. all events completely faded by 1000.


VAERS ID: 1342293 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-17
Onset:2021-05-18
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chest X-ray normal, Chest discomfort, Chest pain, Cough, Dyspnoea, Electrocardiogram normal, Laboratory test normal, Nausea, Sleep disorder
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Allergic to beans(food)
Diagnostic Lab Data: ECG, chest X-ray and all lab results were normal.
CDC Split Type:

Write-up: I woke up from sleeping with one big cough. I felt chest pressure and some pain, trouble breathing, nausea but did not vomit. My wife called 911 and I was admitted to the hospital.


VAERS ID: 1342383 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK RA / IM

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

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

Write-up: ON 5/18/21 CLIENT RECEIVED A THIRD DOSE OF JANSSEN VACCINE. SECOND DOSE WAS ADMINISTERED ON 4/06/21. DURING REGISTRATION (PER THE REGISTRANT) CLIENT DENIED RECEIVING ANY PREVIOUS COVID 19 VACCINE OR HAVING ANY VACCINATION CARD. CLIENT WAS TOLD BY REGISTRANT THAT JANSSEN VACCINE IS A ONE TIME ONLY DOSE, AND CLIENT VERBALIZED UNDERSTANDING. REGISTRANT PROCEEDED WITH VACCINE SURVEY AND DIRECTED CLIENT TO THE NURSE FOR HIS COVID 19 JANSSEN VACCINATION. PRIOR TO JANSSEN VACCINATION, NURSE REVIEWED ALL SURVEY QUESTIONS WITH THE CLIENT AND HE DENIED ONCE AGAIN RECEIVING ANY PREVIOUS COVID 19 VACCINATION, SO JANSSEN VACCINE WAS ADMINISTERED. CLIENT WAS MONITORED AFTER RECEIVING JANSSEN VACCINE. NO ADVERSE REACTIONS NOTED AND CLIENT REPORTED FEELING FINE AND WAS RELEASED FROM MONITORING AREA.


VAERS ID: 1342389 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-20
Onset:2021-05-18
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / SYR

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

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

Write-up: I got every symptoms of side effects that showed on the website after I got the second dose of vaccine and those symptoms stayed for almost a week. Beside that, I got unusual period. I use xulane for about a year, this is the last week before I have period, but I my period came when I still using my third patch. The first dose I only feel painful for my right arm almost a month, it got better after a week but I can still feel the pain if I press the place where I got the vaccine.


VAERS ID: 1342913 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-04
Onset:2021-05-18
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Migraine with aura
SMQs:

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: Migraine with aura following 10 days of pulsating headache


VAERS ID: 1343126 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-10
Onset:2021-05-18
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 2 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Arteriogram coronary abnormal, Arthralgia, Blood test normal, Chest X-ray abnormal, Echocardiogram normal, Infarction, Pulmonary embolism, Ultrasound Doppler normal
SMQs:, Myocardial infarction (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Cardiomyopathy (broad), Other ischaemic heart disease (broad), Arthritis (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Multivitamin, baby aspirin, Pro Biotic ( all over the counter)
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: All tests performed 5/18 - 5/20. Multiple blood tests including possible genetic causes for PE. to date I believe none have shown possible cause of PE. Please check with me.
CDC Split Type:

Write-up: On 5/18/21 AM, woke to pain in my right side under my shoulder blade. Went to ER. They performed many blood test, chest Xray, Chest CTA. Determined Pulmonary embolism and infarction. I was admitted, more blood tests, Echocardiogram, Venous Doppler study( No evidence of DVT). Released 5/20/21. Prescribed Eliquis to thin blood for easier natural clot dissolve. No Known cause of PE, yet. Follow up scheduled with my PCP.


VAERS ID: 1343273 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 LA / IM

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

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

Write-up: Right after administration, pt experienced injection site redness, swelling, and warmth that subsided after 30 minutes of observation. Injection site bruise on left arm appeared two days after injection. Pt reported to pharmacy 6 days after injection about bruise; pt was counseled to take a photo of the bruise everyday to monitor changes in color or size. Pain not reported.


VAERS ID: 1343324 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Decreased appetite, Fatigue, Hypersomnia, Malaise, Pain
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (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: Vitamin C and D
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient stated that Tuesday evening (the day she got vaccine) she became very tired. Pt stated she slept great through the night but woke up and fell like she "hit a brick wall". Pt stated she was extremely tired, achy, chills, no appetite and slept all day. Pt stated she felt better Thursday morning.


VAERS ID: 1343341 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / UNK - / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Blood pressure abnormal, Palpitations, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Hypertension (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

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

Write-up: BP147/83, patient reported tingling to R arm. Patient was administered 25mg of Benadryl Po. Complained of palpitations, probably related to anxiety. Ice pack was applied to back of the neck. Patient was discharged home.


VAERS ID: 1343343 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / IM

Administered by: School       Purchased by: ?
Symptoms: Dizziness, Fall, Joint injury
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (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: Patient fell on another student after feeling faint. Stated he hit his knee. Patient was put in trendelenburger with feet up until less fit. Remined seated for 20 min for observation.


VAERS ID: 1343437 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-15
Onset:2021-05-18
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Heart rate increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Dehydration (broad)

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

Write-up: after 20 minutes of the tennis lesson in the afternoon, she felt fast heart beat, light headiness and can''t catch her breath. she paused the lesson, sit aside and took few sips of water and rested for about 5 minutes, then resumed the tennis lesson.


VAERS ID: 1343481 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-17
Onset:2021-05-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / -

Administered by: Work       Purchased by: ?
Symptoms: Computerised tomogram, Electrocardiogram, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (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: Extidulac, bupropion, escitalopram,hydrochlorothiszide,buspropone,
Current Illness: Carpel tunnel
Preexisting Conditions: Depression
Allergies: None
Diagnostic Lab Data: Went to high point health, for ekg and ct scan with contact
CDC Split Type:

Write-up: Rapid heart rate


VAERS ID: 1343575 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Seizure, Syncope, Urinary incontinence
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Nurse for PCP reported a bicuspid valve issue but no other chronic conditions
Allergies: None
Diagnostic Lab Data: Blood pressure was initially 92/50 following the incident, however it did raise slightly to 98/62 before the patients father took him home.
CDC Split Type:

Write-up: Patient reported they couldnt stand the sight of blood and had fainted during draws before. Father was present in the vaccine office as well. Immediately fooling the administration of the vaccine patients eyes glazed over and he fainted. A few seconds later he began to have a spastic seizure that was short in nature, followed by a voiding of his bladder before he regained consciousness. Patient was given water, glucose tablets, and instructed to lay on the floor of the room with his feet elevated while a member of the staff stayed with him to treat and watch him. Followed up with patient and doctor soon after to learn this was the only time it has happened, patient fully recovered.


VAERS ID: 1343597 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-17
Onset:2021-05-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Confusional state, Dizziness, Dysstasia, Loss of consciousness, Migraine, Mydriasis, Skin warm, Speech disorder
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin C, D, Pristiq
Current Illness: none
Preexisting Conditions: none
Allergies: cedax- antibiotic
Diagnostic Lab Data: None
CDC Split Type:

Write-up: In the middle of the night he stood up to go to the bathroom, turned the light on, felt dizzy and light headed. Passed out and woke up confused unable to speak correctly and unstable when trying to stand up. Eyes were dilated. After he layed down for a few minutes he was ok, could walk and talk fine. Migraine Chills Slightly warm


VAERS ID: 1343654 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling abnormal, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Dementia (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: None
Current Illness: Chronic Obesity
Preexisting Conditions: Chronic obisity
Allergies: None
Diagnostic Lab Data: Saw FNP 5/24/21.
CDC Split Type:

Write-up: Pt stated she "felt funny" then developed Hives on her Arm.


VAERS ID: 1343656 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-15
Onset:2021-05-18
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: School       Purchased by: ?
Symptoms: Injection site pruritus, Injection site rash, Pruritus, Rash, Rash erythematous, Rash macular, Swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Magnesium Citrate Blueberry Extract Zinc Vitamin C Glucosamine Chondroitin L-carnitine Collagen B-12 Probiotic Dulcolax
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Itching began on Tuesday May 18 at 10pm on my thighs; then itching continued to back of the legs and knees with a slight swelling feeling. So much that I needed to look and see if I had gotten bit or something. I changed out of jeans and then saw my legs had developed rashes in large sections; some looked like hives, some like little red bumps, some with just read splotches. I washed my legs thinking maybe a bug or allergen and put anti itch cream on one leg to see if it would help or if I needed anything else. I went to bed shortly after and then woke at 6am (Weds. May 19) and when I changed out of pj''s, noticed rashes also at the injection site; the itching continued to come and go and when it would begin to itch, the rash/bumps would appear without scratching. The rashes would continue on primarily the legs and glutes but also injection side and a little on the shoulder/back of the same side of the injection site and small rash on each ear. This continued for three days intermittently. The rashes stayed for about 1-2 hours then new ones would appear as the old ones faded. Friday, I was finally itch-free by later in the evening. I did not take any medication or apply any more anti itch cream despite the intense itching sensation. I took pictures for documentation if you need them.


VAERS ID: 1343717 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-17
Onset:2021-05-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Pain
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: atorvastatin, clopidogret, furosemide, irbesartan, vitamin d3, garlic, vitamin b12, nexium, lorazepam
Current Illness: hypertension, heart attack 1/26/2021
Preexisting Conditions: hypertension, heart attack 1/26/2021
Allergies: penicillin, clindamycin, beta blockers, amlodipine, soy, etc
Diagnostic Lab Data:
CDC Split Type:

Write-up: chest pain and shortness of breath, constant dull pain


VAERS ID: 1343795 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-17
Onset:2021-05-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Dizziness, Fatigue
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

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

Write-up: Extreme dizziness - hit about 16 hours after injection, lasted 12-18 hours Extreme tiredness - same as above Sore armpit in same arm as injection - lasted 4-5 days


VAERS ID: 1343859 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-04
Onset:2021-05-18
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 1 LA / IM

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

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

Write-up: In menopause, did not have period for 18 months. Got period 2 weeks after vaccine.


VAERS ID: 1343933 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-11
Onset:2021-05-18
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiovascular examination, Chest discomfort, Dyspnoea, Echocardiogram, Electrocardiogram normal, Fatigue, Heart rate increased, Pain in extremity, Palpitations, Pleuritic pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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: None
Preexisting Conditions: Chronic nasal congestion, asthma, anxiety
Allergies: No known allergies
Diagnostic Lab Data: EKG-normal. Echocardiogram ordered. consult with Cardiology done.
CDC Split Type:

Write-up: Symptoms of heart beating faster, louder and harder with mild pleuritic chest discomfort starting about 5 days after second COVID vaccine, ongoing but improving. Got his second COVID vaccine on 5.13.2021. Feels like heart is beating out of his chest, constant throughout the day, worst when laying down. Heart rate up to 100 at home. intermittent shortness of breath. No chest pain. After the vaccine, he developed a high fever for 2 days, a sore arm and tiredness. vitals normal at time of clinic exam today, May 24, 2021 RX: slow breathing, albuterol inhaler, reading recommendation: Breathe by hcp


VAERS ID: 1343985 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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: pt checked box yes for fainting dizziness with vaccinations in the past
Other Medications: not known
Current Illness: none listed
Preexisting Conditions: none listed
Allergies: pt listed don''t know
Diagnostic Lab Data: none known
CDC Split Type:

Write-up: Post injection dizziness, sweating, lightheaded, lasting 7 and 1/2 hours laid down, gave water and electrolytes.


VAERS ID: 1344027 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-12
Onset:2021-05-18
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 2 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Herpes zoster, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

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

Write-up: Rash under right breast appeared on May 18th. Right side of body became sore on May 21st. Went to urgent care in May 22nd and was diagnosed with shingles. Currently taking Valtrex to treat.


VAERS ID: 1344041 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Propranolol 20 mg taken twice daily Tapazole 2.5 mg taken every other day Doxycycline 100 mg Vitamin D3 Vitamin E Biotin
Current Illness: None.
Preexisting Conditions: Hyperthyroidism
Allergies: None.
Diagnostic Lab Data: No tests have been performed. I did contact CVS on Monday 5/24, they told me to contact my Doctor which I did and to inform the CDC by filling out this form. My Doctor instructed me to contact him in the next couple of days to update him on my condition unless things get worse then I am to call his office immediately and he will see me that day.
CDC Split Type:

Write-up: About 3.5 hours after the injection on May 18th my right leg became slightly numb and tingling (pins and needles kind of feeling). By the next morning my leg was ok. Then on Sunday, May 23rd my right leg began to tingle and go numb again. Then the next morning (5/24) my leg was still numb/tingling and both my hands had a tingling sensation as well.


VAERS ID: 1344048 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syringe issue, Underdose
SMQs:, Medication errors (broad)

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

Write-up: Patient came in to be vaccinated when the needle was inserted and plunger pushed( needle was defective) 2/3 of the vaccine spilled out on to patients arm and the chair. As a result the patient was issued another dose as per CDC guidelines in opposite arm for full dose.


VAERS ID: 1344113 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-17
Onset:2021-05-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Blepharospasm
SMQs:, Dystonia (broad), Periorbital and eyelid disorders (narrow), Ocular motility 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: Adderal 10mg Estradiol (Lessina)
Current Illness: n/a
Preexisting Conditions: N/a
Allergies: N/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Myokymia in right lower eyelid (Constant twitches in lower eyelid) May 18- current


VAERS ID: 1344316 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Presyncope, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: About 3 min after getting vaccinated, patient fainted Reason for visit in ER: Near Syncope Diagnosis: Syncope and collapse


VAERS ID: 1344844 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-17
Onset:2021-05-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: The day after the vaccine, she had an episode of syncope while in the bathroom. She does not remember the event, but was at a friend''s house and was found in the bathroom after they heard a bang and was noted to be shaking. She then passed out again and continued shaking. She texted her mom and was given a cold rag on her forehead but has no recollection of any of that. Afterwards, she returned to normal.


VAERS ID: 1344887 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / UNK LA / IM

Administered by: School       Purchased by: ?
Symptoms: Asthenia, Chills, Dizziness, Epistaxis, Feeling abnormal, Pain, Pain in extremity, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, chills, body aches, dizziness, sore left arm, weak body, brain fog - these signs lasted from 9:30 PM, Tuesday 5/18/21 through 6:00 PM , Wednesday 5/19/21. On Monday, 5/24/2021, patient experienced 2 bloody noses. One when he woke up at 7:30 AM and then another at 5:15 PM. Bloody noses are not normal for him.


VAERS ID: 1344903 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-15
Onset:2021-05-18
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

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

Write-up: Hives and swollen eye (3 days after shot), and swollen lip (10 days after shot)


VAERS ID: 1345261 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-03-08
Onset:2021-05-18
   Days after vaccination:71
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802072 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Deep vein thrombosis, Ultrasound scan
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: amlodipine-valsartan10-320mg;metformin 500mg;Ozempic pen injector weekly; Lyrica 75mg; Crestor 20mg ; Eliquis 5mg; Cymbalta 60mg;
Current Illness: none
Preexisting Conditions: History of DVT''s and pulmonary embolism
Allergies: hydrochlorothiazide, Percocet
Diagnostic Lab Data: Ultrasound
CDC Split Type:

Write-up: DVT in left


VAERS ID: 1345282 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-11
Onset:2021-05-18
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Blood lactic acid, Blood thyroid stimulating hormone, Chills, Clostridium test, Culture, Culture stool, Diarrhoea, Gait disturbance, Parasite blood test, Reflex test, SARS-CoV-2 test, Urine analysis, Vomiting, White blood cell scan
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Flu shot when I was 22 yrs of age, unk brand too long ago
Other Medications: No meds
Current Illness: None, very healthy
Preexisting Conditions: None
Allergies: Codiene, macrodatin, sulfa
Diagnostic Lab Data: C Diff quick check complete, Covid-19 NAA-ID NOW, Culture , Stool (Prov), Lactic Acid, Plasma, OVA & Parasite Exam, Stool WBC, TSH w/reflex to FT4, Urinalysis with Microscopic, reflex culture
CDC Split Type:

Write-up: First 2 days after shot both knees ached, could hardly walk, third day pain gone, then on 18th all heck broke loose at 1:10 am, I had uncontrollable diarreah with velocity vomiting at EXACT same time. I was chilled to the bone with temp that ran between 95.4 to 96, The chills quit on the 20th. Diarreah has been on going since the 18th, haven''t held food or water for 6 days, goes right through me. I went to ER today, my blood pressure going in was 179/99 and after 2 bags of IV Fluid blood pressure was 122/68


VAERS ID: 1345386 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Nausea, Oropharyngeal pain, Pain
SMQs:, Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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: unknown
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 05/18/2021 evening patient devleoped headache and pain 05/20 patient developed nausea 05/23 patient developed sore throat


VAERS ID: 1345694 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: North Carolina  
Vaccinated:0000-00-00
Onset:2021-05-18
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Poor quality product administered
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210535482

Write-up: DOSE GIVEN OUTSIDE OF THE 2 HOUR WINDOW (VIAL WAS PUNCTURED AT 10 AM AND THE DOSE WAS GIVEN TO THE PATIENT AT 1 PM); This spontaneous report received from a pharmacist concerned a 44 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, and batch number: 207A21A expiry: 23-JUN-2021) dose was not reported, administered on 18-MAY-2021 13:00 for prophylactic vaccination. No concomitant medications were reported. On 18-MAY-2021, the subject experienced dose given outside of the 2 hour window (vial was punctured at 10 am and the dose was given to the subject at 1 pm). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of dose given outside of the 2 hour window (vial was punctured at 10 am and the dose was given to the patient at 1 pm) was not reported. This report was non-serious.


VAERS ID: 1345717 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-05-18
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Poor quality product administered
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210538801

Write-up: POOR QUALITY VACCINE ADMINISTERED; This spontaneous report received from a health care professional concerned multiple patients. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 206A21A, expiry: 23-JUN-2021) dose was not reported, administered on 18-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 18-MAY-2021, the subject experienced poor quality vaccine administered. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of poor quality vaccine administered was not reported. This report was non-serious. This case, from the same reporter is linked to 20210535199.


VAERS ID: 1345849 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-05-16
Onset:2021-05-18
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Induration, Neck mass, Tenderness
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None yet waiting to get into doctor if it does not go down itself
CDC Split Type:

Write-up: Tender hard lump on neck under collarbone won''t go away


VAERS ID: 1345939 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Rhode Island  
Vaccinated:0000-00-00
Onset:2021-05-18
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210544384

Write-up: POOR QUALITY VACCINE ADMINISTERED; VACCINE AFTER BEING AT ROOM TEMPERATURE FOR OVER 2 HOURS AFTER FIRST PUNCTURE; This spontaneous report received from a health care professional concerned a female of unspecified age. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 205A21A, and batch number: 205A21A expiry: 23/JUNE/2021) dose was not reported, administered on 18-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 18-MAY-2021, the subject experienced vaccine after being at room temperature for over 2 hours after first puncture. On an unspecified date, the subject experienced poor quality vaccine administered. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the poor quality vaccine administered and vaccine after being at room temperature for over 2 hours after first puncture was not reported. This report was non-serious. This case, from the same reporter is linked to 20210545147.


VAERS ID: 1346379 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Moderna vaccine given to patient under the age of 18, although not approved for that age. Spoke with parent after discovery, and no side effects to report.


VAERS ID: 1346400 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-04-30
Onset:2021-05-18
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Cough, Respiratory tract irritation
SMQs:, Anaphylactic reaction (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: Tylenol the day prior and morning prior
Current Illness: No illnesses for previous 2 years
Preexisting Conditions: None
Allergies: gluten free preference
Diagnostic Lab Data: To follow
CDC Split Type:

Write-up: About two weeks after receiving the vaccine, I have developed a mild, but persistent dry cough and uncomfortable sensation in my lungs. It feels as if there is a foreign body in my lungs that needs to be expelled. Please note; I am extremely healthy for my age (now 67). I do not have a history of allergies or somatic complaints, but I do have a history of a number of hospitalizations for pneumonia. I recently moved and will be seeing a new doctor on June 2nd. I understand that the symptoms I am reporting may have no relationship to the vaccine, however, I do hope it will be entered into your data base and that there will be an opportunity to provide follow-up in case there are an increased number of reports that are similar.


VAERS ID: 1346403 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Fatigue, Lethargy, Oropharyngeal pain, Pain
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Body Aches Generalized-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: sore throat-Severe, Systemic: Weakness-Severe, Additional Details: Pt has been having these symptoms since he has received the J&J vaccine. Pt''s mother called the pharmacy 4 days after he has gotten the vaccine, stating pt''s symptoms are worse. Recommended to take him to the hospital for a check-up. Tried calling the patient but lost follow-up.


VAERS ID: 1346422 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Fatigue, Feeling hot, Hyperhidrosis, Migraine, Nausea, Pain, Pain in extremity, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Fibromyalgia, Arthritis, Endometriosis
Allergies: Dairy, gluten, cortisone, seasonal "unknown allergies"
Diagnostic Lab Data:
CDC Split Type:

Write-up: Immediate and gradually worsening pain in arm. Around 6pm, started to feel extreme fatigue, dizziness, chills. By 7pm severe chills and nausea which lasted all night. Alternating shaking and chills with sweating and overheating. Severe headache (like migraine). Full body pain. Took Tylenol in the morning (7am). Chills mostly stopped around 8am, but aches and fatigue continued. Continued needing tylenol for 48 hours for pain and headache. Dizziness, nausea, and fatigue persisted. One week after vaccine, fatigue continues with mild body pain.


VAERS ID: 1346552 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-13
Onset:2021-05-18
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Injection site pain, Injection site rash, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), 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: Pain at Injection Site-Mild, Systemic: Allergic: Rash Generalized-Severe, Systemic: Headache-Mild, Additional Details: patient stated she has hives alll over her body , about 5 days after the vaccines. still have rash and itch on 05/24/2021 and will be seeing PCP may 25


VAERS ID: 1346598 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-01
Onset:2021-05-18
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 - / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chills, Dizziness, Headache, Hyperhidrosis, Injection site erythema, Injection site reaction, Insomnia, Nausea, Pain, Pyrexia, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Fever, extreme chills, sweating, extreme body ache, dizziness, nauseous. Could hardly walk, could not sleep, had headache for 3 days. Every inch of my body was throbbing in pain. Tylenol did nothing to help. 3 days later broke out in itchy circular rash where vaccine given and have picture to document size each day. Still have red mark there. Got my period today (week after vaccine) 8 days early?!


VAERS ID: 1346630 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-16
Onset:2021-05-18
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea exertional, Influenza like illness, Lymph node pain, Myalgia, Pyrexia, Throat tightness, Troponin
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness:
Preexisting Conditions:
Allergies: Penicillins
Diagnostic Lab Data: - Diffuse ST elevation and PR depression on EKG. - Initial troponin 15.89 -- $g 11.5 -- $g 4.1 - TTE showed globally reduced LVEF: 31% - No arrhythmias
CDC Split Type:

Write-up: 18-year-old healthy man received his second Pfizer COVID-19 vaccine on Sunday, may 16th. He had generalized muscle aches and mild flu-like symptoms which were not unexpected on Monday the 17th. On the 18th, he reported dyspnea on exertion, some chest tightness, and his throat felt like it was "closing". He also had tender anterior cervical lymph nodes and a fever to 100.8 ?F. He came into the ER for further evaluation. After evaluated by cardiology, given his stability, felt appropriate for discharge with immediate outpatient follow-up.


VAERS ID: 1346650 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Visual impairment
SMQs:, Anticholinergic syndrome (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen-codeine (TYLENOL #3) 300-30 MG per tablet acetaminophen-codeine (TYLENOL #4) 300-60 MG per tablet CALCIUM PO cetirizine (ZYRTEC) 10 MG tablet cholecalciferol (VITAMIN D3) 50 MCG (2000 UT) capsule clonazepam (KLONOPIN) 1 MG tab
Current Illness: avascular necrosis endometriosis
Preexisting Conditions: Endometriosis, site unspecified IBS (irritable bowel syndrome) Eustachian tube dysfunction, bilateral Chronic migraine Generalized anxiety disorder Persistent depressive disorder Chronic posttraumatic stress disorder Psychosis, unspecified psychosis type (HCC) Attention deficit hyperactivity disorder (ADHD), unspecified ADHD type Vitamin D deficiency Depression with suicidal ideation Personal history of self-harm COVID-19 (October 2020)
Allergies: Animal HairOther GlueOther LactoseGI Upset Other PrednisoneSwelling Seroquel [Quetiapine]
Diagnostic Lab Data: nA
CDC Split Type:

Write-up: Patient reported via a "side effects survey" that her "eye sight decreased drastically for 4 days" following vaccination (noted to have started within 4 hours of dose). No other care sought for this reported side effect.


VAERS ID: 1346729 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Injection site bruising, Injection site pain, Pain
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (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: Vitamin D
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderate pain at injection site: Started within 6 hours of injection, lasting 36 hours. Felt like severe bruising. No visual signs. Minor Fatigue: Started within 8 hours of injection. Lasted 36 hours. General tiredness. No visual signs. Minor to Moderate Aching: Started 12 hours after injection. Lasted for 24 hours. Whole body aching pain with minor chills, felt like I was coming down with a cold or flu. No visual signs. All adverse events were most pronounced the morning after injection, and had mostly subsided the morning after that.


VAERS ID: 1346777 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-04
Onset:2021-05-18
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chills, Contusion, Pain, Pyrexia, Rash erythematous, Rash macular
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: IBUPROFEN 800
Current Illness: None
Preexisting Conditions: Asthma, Neuro-cardio-genics syncope, mitral valve prolapse, CFS and I suffer from migraines
Allergies: Latex, amoxicillin
Diagnostic Lab Data: None yet. I see doctor 5/26/21 at 9:30 AM
CDC Split Type:

Write-up: 6 hours after shot I had severe body aches and chills. 12 hours after shot I had 106 fever while taking ibuprofen and Tylenol. 106 fever lasted for about 2 days and didn?t start to feel better till about 4-5 days after vaccine. Two weeks after shot I noticed a lot of bruising on arms and legs and started to get red/pink skin patches/rashes on my body.


VAERS ID: 1346783 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-04-08
Onset:2021-05-18
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Burning sensation, Herpes zoster, Neuralgia, Paraesthesia, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec, flonase, womens multi-vitamin
Current Illness: n/a
Preexisting Conditions: seasonal allergies
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Shingles - began with tingling/pain in left hip area on Tues May 18 and progressed to full rash outbreak by Thursday May 20. Symptoms include pain at rash site and around the nerve line from mid-back to hip and around to front of hip in groin/pelvic region. Itching, burning, and stabbing nerve shocks started the same day. Treatment with valacyclovir. The first day was within the six-week post vaccine period so I thought worth reporting.


VAERS ID: 1346842 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-05-14
Onset:2021-05-18
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Diarrhoea
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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: Medication, Lisinopril 40 mg, Aspirin 325 mg, Loratadine 10 mg, Furosemide 40 mg, Potassium Chloride ER 10 mg, Amlodipine Besylate 10 mg, Atorvastatin 40 mg, Tramadol HCL 50 mg, Fluticasone (Spray)Spray, Gabapentin 600 mg, Zolpidem Tartrat
Current Illness: Heart Disease, Hypertension
Preexisting Conditions: Chronic Heart Disease Degenerated disc
Allergies: Raw onion
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 4 days after vaccine, diarrhea began. It has persisted for 8 days now.


VAERS ID: 1346910 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-27
Onset:2021-05-18
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 1 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Catheterisation cardiac normal, Chest pain, Chills, Echocardiogram normal, Ejection fraction, Electrocardiogram ST segment elevation, Headache, Myalgia, Pain, Painful respiration, Pericarditis, Troponin increased, Ventricular hypokinesia
SMQs:, Rhabdomyolysis/myopathy (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: shrimp
Diagnostic Lab Data: Cardiac catheterization - normal cornoaries. Mild distal anterolateral hypokinesis Echocardiogram- normal LVEF 55%, no valvualar abnomalities, no effusion.
CDC Split Type:

Write-up: Received his second Pfizer COVID vaccine Tuesday 5/18/2021. On Wednesday started developing systemic symptoms such as chills, headache, myalgia. Also developed constant sub-sternal chest pain. Worse with movement or deep inspiration. No clear positional component. CP persisted until he came to the ED today. Initial ECG showed concave ST elevations lateral leads. Given his history this was felt to be most consistent with pericarditis. He received toradol, morphine and SL NTG with near complete relief of the pain. Repeat ECG showed resolution ST elevations. Troponin was elevated, peak 9.08 ng/ml.


VAERS ID: 1346928 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-13
Onset:2021-05-18
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac flutter, Electrocardiogram normal, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: EKG done on 5/25/21 shows normal rhythm
CDC Split Type:

Write-up: palpitations/heart flutter feeling started approximately 4 days after second vaccine dose


VAERS ID: 1347031 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Fatigue, Headache, Nasal congestion, Nausea, Pulmonary congestion, Rhinorrhoea, SARS-CoV-2 test negative
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Infective pneumonia (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: none
Current Illness: none
Preexisting Conditions: none
Allergies: metronidozole, Flagyl, silicone gloves, sulfa drugs, albuterol, Barctin
Diagnostic Lab Data: Covid test, nasal, negative, done on 5/20/21 Covid test, nasal, negative, done on 5/23/21
CDC Split Type:

Write-up: headache, fatigue. nausea, diarhea, congestion in head, congestion in chest, runny nose


VAERS ID: 1347090 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-06
Onset:2021-05-18
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 1 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chest X-ray normal, Chills, Headache, Hyperhidrosis, Influenza virus test negative, Laboratory test normal, Pain, Pyrexia, SARS-CoV-2 test negative, Urine analysis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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: Asprin-81mg, Via, C-1000mg, Carvedilol-6.25mg, Entresto-24/26MG , Rostovastin-20mg
Current Illness: none
Preexisting Conditions: Heart illness
Allergies: none
Diagnostic Lab Data: Covid-Rapid-5/19 Chest xray-5/23 Flu swab-5/23 Strep swab-5/23 Urine test-5/23 Blood draw-5/23 Antigen test-5/23
CDC Split Type:

Write-up: No masjor problems after 24 hrs. Days days after 2nd dose I started to get fever, headache, chills, overall aches/pains, sweats, lethargy, This started Tues evening 5/18 and I'' still experiencing same reactions today 5/25. I''ve been to primary care provider twive 5/23. Additional tests were run and came back negative. Two Covid tests have also been performed and have come back neg.


VAERS ID: 1347173 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Injection site erythema, Injection site pain, Injection site swelling, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: a few hours after vaccination: slight pain in the upper arm, soreness/swelling along with redness at the injection site and fatigue. Patient reported taking Tylenol and applied ice pack to the injection site with a little relief.


VAERS ID: 1347189 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-11
Onset:2021-05-18
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram normal, Physical examination normal
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ascorbic Acid, multivitamin, vitamin D
Current Illness: None
Preexisting Conditions: None
Allergies: Amoxicillin
Diagnostic Lab Data: Pending CBD w/diff, ESR, CRP and troponin.
CDC Split Type:

Write-up: Possible pericarditis. Substernal chest pain worse with inspiration and laying down starting 1 week after 2nd COVID vaccine. Normal EKG. Physical exam is normal/negative.


VAERS ID: 1347245 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-03-03
Onset:2021-05-18
   Days after vaccination:76
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 2 UN / SYR

Administered by: Public       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: chronic lung disease, heart disease, hypertension
Allergies:
Diagnostic Lab Data: PCR positive for COVID-19 on 05/18/2021
CDC Split Type:

Write-up: Hospitalized due to COVID-19 after being fully vaccinated.


VAERS ID: 1347323 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-01
Onset:2021-05-18
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: C-reactive protein increased, Contusion, Fatigue, International normalised ratio increased, Pyrexia, Vasculitis
SMQs:, Liver-related coagulation and bleeding disturbances (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Vasculitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (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: It has been 25 days since I took the AZ vaccine. Below are the side effects and significant blood test results: Day25: INR 1.29, CRP 4.8 Day 20 INR 1.05 In addition, I have been having an ongoing 37.3 fever since day 15 which goes back to normal 36.5 at night. Moreover i have been having light bruising on the arms and fee without any physical impact. my blood vessels / veins on hands, arms and legs are inflamed and cleary visible. i have been also having a feeling of tiredness and fatigue. Please advise on what I should do. Regards


VAERS ID: 1347344 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-05-17
Onset:2021-05-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Injection site erythema, Injection site nodule, Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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

Write-up: Reports she noticed a raised knot at injection site with redness about 4" diameter. Warm to touch and mild tenderness. Not relieved with OTC Ibuprofen,


VAERS ID: 1347390 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product preparation error
SMQs:, Medication errors (narrow)

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

Write-up: 0.9% NS diluent was not used for the Pfizer-BioNTech Covid-19 vaccine, when 0.3 mls was drawn up from the vial, not much was left should have enough for for 5 more doses. Diluent was recorded on the paperwork but not added due to stress and too much going on at that time and I got confused


VAERS ID: 1347400 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-05-17
Onset:2021-05-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / IM

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

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

Write-up: She has been breaking out with vesicles all over her body


VAERS ID: 1347467 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-21
Onset:2021-05-18
   Days after vaccination:58
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood folate normal, Blood glucose decreased, CSF culture negative, CSF oligoclonal band, CSF oligoclonal band absent, CSF test abnormal, CSF white blood cell count decreased, Demyelination, Grip strength decreased, HIV test negative, Magnetic resonance imaging spinal abnormal, Muscular weakness, Myelitis transverse, Protein total decreased, Red blood cell count increased, Spinal cord disorder, Spinal cord infarction, Treponema test negative, Vitamin B12 normal
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Optic nerve disorders (broad), Demyelination (narrow), Hypoglycaemia (narrow), Immune-mediated/autoimmune 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? Yes
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient states that symptom onset started at 8 AM. She awoke at 5 AM and felt fine. She complains of bilateral weakness in the distal upper extremities and in her bilateral grip. She states that she has never had this weakness, which is worse on the left than on the right. MRI C-spine showed an Abnormal cord signal from C3/C4 to C6/C7 involves both halves of the spinal cord with a predilection for the central gray matter. No pathologic enhancement. Findings may represent cord infarct although longitudinally extensive demyelinating disease (NMO or ADEM) or transverse myelitis are not excluded. CSF done - CSF studies reviewed clear less fluid white count 3 RBC 28 glucose 92 with protein 31.4 CSF bio fire negative oligoclonal bands in the CSF are pending serum RPR negative B12 647 folate 6.6 HIV negative The patient was treated with IV methyl-prednisone then oral prednisone. She had improvement in her weakness


VAERS ID: 1347564 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

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

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

Write-up: Patient lowered to floor by staff after feeling faint. Put in trendelenburger with feet up until less faint. Remained in seated position for approx 20 min w/observation.


VAERS ID: 1347612 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030B21A / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood albumin decreased, Blood alkaline phosphatase increased, Body temperature increased, Diarrhoea, Erythema, Full blood count, Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Lethargy, Metabolic function test, Nausea, Ocular hyperaemia, Pain, Pain in extremity, Periorbital swelling, Platelet count decreased, Protein total decreased, Somnolence, Swelling face, Tremor
SMQs:, Liver related investigations, signs and symptoms (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Haematopoietic thrombocytopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Biliary system related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: Tetanus toxoid per LTCF record but tetanus immune globulin per previous hospital record, unknown rxn
Other Medications: Lipitor, B12, Colace, Fosamax, Norco, Lasix, lisinopril, KCl, Xarelto, Zofran, Voltaren Gel, Vitamin C, & Protonix
Current Illness: HTN, hypercalcemia
Preexisting Conditions: CAD, GERD, CKD III, HTN, osteoporosis, recurrent UTI''s, CVA, aortic stenosis, hyperlipidemia, atrial flutter, CABG
Allergies: Tetanus Toxoid
Diagnostic Lab Data: CMP & CBC of 5/21/21 WNL except platelet 141, alkaline phosphatase 315, albumin 3.2, total protein 5.5.
CDC Split Type:

Write-up: 5/18/21 9:20pm - c/o general aches & soreness right arm 5/19/21 6:10pm - c/o general aches, sleepiness, soreness to right arm temp 99.8 5/20/21 11:21pm - redness adminstration site, redness & puffiness to eyes & face, arm very sore 5/21/21 11:02am - c/o pain at injection site, red, warm, swollen, afebrile 5/21/21 10:03p - arm red, warm, swollen at injection site, afebrile, states feels better today 5/25/21 4:27am - lethargic, tremoring, nausea, diarrhea, temp 103.4 pulse 128, SPO2 82%, sent to hospital


VAERS ID: 1347645 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-03
Onset:2021-05-18
   Days after vaccination:104
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cystitis haemorrhagic
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: allopurinol, apixaban, Sinemet, docusate, ferrous sulfate, finasteride, furosemide, melatonin, metolazone, multivitamin, optassium chloride 10meq tab, tamsulosin
Current Illness:
Preexisting Conditions: Parkinson''s, bph, anxiety, angina, CKD
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hemorrhagic cystitis


VAERS ID: 1347719 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-15
Onset:2021-05-18
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Balance disorder, Dizziness, Feeling abnormal, Hyperaesthesia, Magnetic resonance imaging head, Tinnitus, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine Escitalopram N-Acetyl-L-Cysteine Vitamin D Biotin
Current Illness: Prurigo nodularis diagnosed by skin biopsy on 02/22/2021. I am under the care of a dermatologist to try to clear the remaining nodules. It is still intensely itchy, especially on my lower right leg. Shingles diagnosed on 04/09/2021 by Dr. at a follow up visit for the prurigo nodularis. I had a small line of about 8 very itchy dots on the right side of my back near my waist. Though I could not get a good look at them, I never imagined it was shingles. I thought it might be some bug bites.
Preexisting Conditions: Low thyroid Driving anxiety/PTSD Hiatal hernia Chronic swelling of my left foot and ankle since 2006 (cause unknown)
Allergies: Latex Penicillin Cephalexin Macrobid Zithromax
Diagnostic Lab Data: 05/19/2021 15:00: Noncontrast MRI examination of the brain was performed utilizing T1, T2, FLAIR, and diffusion weighted imaging in multiple planes. CONCLUSION: Cortical and white matter changes generally associated with age and with small vessel disease are noted and described in the findings. There is no large or small vessel infarction, no hemorrhage and no diffusion abnormality.
CDC Split Type:

Write-up: 05/15/2021 1300: Received first dose of Moderna COVID vaccine. No issues. 05/16/2021: No issues. 05/17/2021: No issues. 05/18/2021 0800: Some occasional vision blurriness as if my reading/computer glasses were smudged. I kept wiping my glasses all day. That evening, I was anxious and unable to settle down. I did not go to bed until 1:00 AM. 05/19/2021 0500: Brief strange chest sensation (not pain; not pressure; just a strange sensation). 05/19/2021 0800: Dizziness and more noticeable blurred vision which continued throughout the day. 1st BP at home 122/81 2nd BP at home 117/77 05/19/2021 0940: Brief strange chest sensation (not pain; not pressure; just a strange sensation) while driving to doctor''s office. 05/19/2021 1015: I happened to have scheduled an annual wellness visit for May 19 at 10:15 AM with a new primary care physician because my previous PCP (in the same practice) has been on a very long medical leave of absence. I was dizzy and having some balance problems walking from the parking lot to the office. 1st BP 143/88 Temperature 97.2 Weight 222.1 EKG good 2nd BP 130/76 Heart: soft murmur Thyroid: symmetrical The blurred vision and dizziness were getting much worse during my appointment. Dr. said he thought the symptoms were likely a side effect of the vaccine but wanted to order an MRI to make sure my brain was OK. Dr. arranged a same day appointment at a Clinic for 3:00 PM. Dr. advised me to rest, stay well hydrated, and not skip meals. My balance was very bad leaving the office and remained bad for about 6 hours. Dr. called me with the results of the MRI and said there was no stroke or clot, and that he thought the symptoms would slowly dissipate. 05/20/2021 0800: I woke up with ringing in my left ear that sounded like a combination of soft static coupled with soft sounds at a higher pitch. The ringing lasted about 1 hour. I had dizziness and blurred vision throughout the day, but it was less severe than the previous day. 05/21/2021 through 05/25/2021: I have had much less dizziness and it usually occurs only in the morning. I still have occasional vision blurriness throughout the day. It is most noticeable when I am working at the computer. I feel as if I have a little brain fog because it takes me longer to figure out how to type some things such as my email address, passwords, etc.


VAERS ID: 1347773 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-02
Onset:2021-05-18
   Days after vaccination:46
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026B21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Tension headache
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SIngular, Allergy shots (Subcutaneous Immunotherapy - SCIT)
Current Illness: no
Preexisting Conditions: asthma
Allergies: Oak trees, mold, pollen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe localized headache/sharp isolated pain on right temple (right temporalis)


VAERS ID: 1348096 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Inappropriate schedule of product administration, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: patient denied medication use
Current Illness: patient denied other illnesses
Preexisting Conditions: patient denied chronic health conditions
Allergies: NKDA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: The patient is a 30 year old male who presented to the vaccine clinic. for the COVID vaccine. The patient was scheduled to receive his first Moderna dose. At registration, the patient did not have his COVID vaccine card. The vaccine survey from 05/06/2021 was missed by the person registering the client, so he received a second Moderna vaccine within 12 days of the first dose he received on 05/06/2021. The patient had neither allergic or adverse reactions from the first or second doses given within the 12 day timeframe. Follow up completed at the facility on 05/24/2021. The patient was no longer at the facillity but the nurse reports the patient reported fatigue but had no adverse events when he left the facility on 05/21/2021.


VAERS ID: 1348470 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril HCTZ 20-12.5mg 1QD
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had extreme arm soreness the day after vaccine and then developed a rash on 5/25 (original shot on 5/18/21). This rash is accompanied by some itching.


VAERS ID: 1348480 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-30
Onset:2021-05-18
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Appendicectomy, Appendicitis, Computerised tomogram abnormal
SMQs:

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: B-12 supplements
Current Illness: None
Preexisting Conditions: Low B12
Allergies: None
Diagnostic Lab Data: CT scan, appendectomy on 5/19/2021
CDC Split Type:

Write-up: Appendicitis that needed an appendectomy nearly 3 weeks after 2nd dose


VAERS ID: 1348482 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-15
Onset:2021-05-18
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Anticoagulant therapy, C-reactive protein increased, Catheter placement, Deep vein thrombosis, Fibrin D dimer increased, Pain in extremity, Peripheral swelling, Red blood cell sedimentation rate increased, Skin discolouration, Skin tightness, Skin warm, Tachycardia, Thrombectomy, Vascular test, Venogram
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (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? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Xanax, Prozac, Adderall, Gabapentin, levonorgestrel and ethynyl estradiol, methadone, ambien
Current Illness:
Preexisting Conditions: Anxiety, Asthma
Allergies: NKDA
Diagnostic Lab Data: See above
CDC Split Type:

Write-up: Patient is a 36 yo female with history of IVDU, Hep C, fibromyalgia who presents with left leg pain and swelling found to have significant left leg DVT now s/p femoropopliteal vein thrombectomy. HPI: Patient is a 36 y.o. female with history of IVDU, Hep C, fibromyalgia who presents with left leg pain and swelling. Patient woke up this morning with her entire left leg being painful, swollen, "tight", and "achy" throughout. She had been experiencing 1 week of left leg pain, followed by an acute worsening in the last 2 days. She denies any recent travel or leg trauma. She denied any fevers, chills, SOB, or chest pain. She denies any new tattoos, recent malignancies, or blood clotting disorders. Of note, she is currently undergoing evaluation for lupus due to fatigue and rashes. Per her IVDU, she injects heroin in her arm (last use 1 month ago after 4 years of sobriety), and is currently on methadone. This pain is different from her fibromyalgia. Of note, she got her first Moderna COVID vaccine last week. Highlights of ED course: Pertinent exam findings: tachycardia, marked LLE swelling (mid thigh 70 cm vs 64 cm on RLE) Warm bilateral LE, palpable pulses Important data gathered: LENI: left deep vein thrombosis extending from common femoral vein to distal posterior tibial veins, ESR 47, CRP 58, elevated d-dimer $g 4000 Key treatments administered: heparin gtt, oxyodone 5 mg for pain, vascular medicine, cardiology consult Patient was subsequently evaluated by vascular medicine, who brought her to cath lab for venography and endovenous intervention. She went to the cath lab. U/s guided access to L popliteal vein with micropuncture. J-wire into L CIV, serial dilation and placement of 12F sheath. Multiple passess with Penumbra lightning aspiration catheter. Femoropopliteal vein with restored patency, continued organized clot in iliac vein, infusion of 6mg TPA with 10 min dwell time. Further passages of aspiration catheter. Decision to leave 30 cm infusion cath. When seen on the floor, patient was hemodynamically stable. Still with pain in lower extremities and back. No chest pain or SOB. #DVT, s/p vascular surgery thrombectomy 2 days of acute left leg pain and swelling. Initial exam notable for purplish LLE in ED. LENIs notable for left DVT extending from CF vein to distal PT veins. Vascular evaluated and performed femoropopliteal vein thrombectomy with restored patency, continued organized clot in iliac vein, infusion of 6mg TPA with 10 min dwell time. Further passages of aspiration catheter. Decision to leave 30 cm infusion cath. On OCPs but no known other risk factors (quit smoking), suggesting unprovoked DVT. Other potential etiology includes venous congestion. Hypercoaguable w/u pending. Notably, Moderna vaccine 1 week ago, although limited evidence suggesting relation between mRNA vaccine and increased thrombosis risk. Hypercoagulability workup was sent. Patient transitioned from heparin to apixaban for discharge with vascular medicine and vascular surgery followup


VAERS ID: 1348882 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-17
Onset:2021-05-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breast tenderness
SMQs:

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

Write-up: Breast tenderness, starting the day after the vaccine and continuing for over a week. Still ongoing


VAERS ID: 1349018 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Nevada  
Vaccinated:0000-00-00
Onset:2021-05-18
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042172117 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site warmth, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Diabetes; Fibromyalgia; Non-Hodgkin''s lymphoma; Sulfonamide allergy
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210540039

Write-up: HOT SPOT SENSITIVE; ROUND BUMP RED CIRCLE ABOUT AN INCH ON ARM NEXT TO THE INJECTION SITE; FELT TIRED; MILD HEADACHE; This spontaneous report received from a patient concerned a 66 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included diabetes, fibromyalgia, non hodgkin''s lymphoma, and sulfa allergy.The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 042172117 expiry: UNKNOWN) dose was not reported, administered on 18-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 18-MAY-2021, the subject experienced felt tired. On 18-MAY-2021, the subject experienced mild headache. On 19-MAY-2021, the subject experienced round bump red circle about an inch on arm next to the injection site. On an unspecified date, the subject experienced hot spot sensitive. The action taken with covid-19 vaccine was not applicable. The patient recovered from mild headache on 18-MAY-2021, was recovering from felt tired, had not recovered from round bump red circle about an inch on arm next to the injection site, and the outcome of hot spot sensitive was not reported. This report was non-serious. This parent/child case is linked to 20210540029.


VAERS ID: 1349032 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Rhode Island  
Vaccinated:0000-00-00
Onset:2021-05-18
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210544591

Write-up: JANSSEN COVID-19 VACCINE ADMINISTERED AFTER BEING AT ROOM TEMPERATURE FOR OVER 2 HOURS; JANSSEN COVID-19 VACCINE BEING AT ROOM TEMPERATURE FOR OVER 2 HOURS; This spontaneous report received from a health care professional concerned a male of unspecified age. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, and batch number: 205A21A expiry: 23-JUN-2021) dose was not reported, administered on 18-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 18-MAY-2021, the subject experienced janssen covid-19 vaccine administered after being at room temperature for over 2 hours. On 18-MAY-2021, the subject experienced janssen covid-19 vaccine being at room temperature for over 2 hours. The action taken with covid-19 vaccine was not applicable. The outcome of the janssen covid-19 vaccine administered after being at room temperature for over 2 hours and janssen covid-19 vaccine being at room temperature for over 2 hours was not reported. This report was non-serious. This case, from the same reporter is linked to 20210545147.


VAERS ID: 1349045 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:2021-05-18
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Body temperature, Chills, Fatigue, Feeling abnormal, Headache, Malaise, Muscle discomfort, Nausea, Paraesthesia, SARS-CoV-2 test positive, Sensory disturbance, Somnolence
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ZILEUTON; FLOVENT DISKUS; NASONEX; LISINOPRIL; FISH OIL; LEVALBUTEROL [LEVOSALBUTAMOL]
Current Illness: Abstains from alcohol; Blood pressure high; Eosinophilic asthma; Nasal polyps; Non-smoker
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19; Night sweats
Allergies:
Diagnostic Lab Data: Test Date: 2021; Test Name: Body temperature; Result Unstructured Data: 99.7 F; Test Date: 202101; Test Name: COVID-19 virus test positive; Result Unstructured Data: Positive
CDC Split Type: USJNJFOC20210544941

Write-up: ANXIOUS; EXPERIENCING GROGGINESS; FEELING TIRED; FELT HORRIBLE; CHILLS; HEADACHE; NAUSEA; FELT ILL; FEEL ALMOST PARALYZED; MUSCLE STIFFNESS AND ACHINESS / BACK STIFF AND ACHY; SLIGHT TINGLING IN BOTH LEGS; This spontaneous report received from a patient concerned a 70 year old female. The patient''s height, and weight were not reported. The patient''s past medical history included covid-19 infection, and night sweats, and concurrent conditions included asthma (severe eosinophilia asthma), nasal polyps, high blood pressure, non smoker, and abstains form alcohol. The patient experienced drug allergy when treated with acetylsalicylic acid for drug used for unknown indication. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, and batch number: 206A21A expiry: 23-JUN-2021) dose was not reported, administered on 18-MAY-2021 16:00 for prophylactic vaccination. Concomitant medications included fluticasone propionate for asthma, zileuton for asthma, beclometasone dipropionate for drug used for unknown indication, fish oil for drug used for unknown indication, lisinopril for hypertension, and mometasone furoate for nasal polyps. On 2021, Laboratory data included: Body temperature (NR: not provided) 99.7 F. On JAN-2021, Laboratory data included: COVID-19 virus test positive (NR: not provided) Positive. On 18-MAY-2021, the subject experienced feel almost paralyzed. On 18-MAY-2021, the subject experienced muscle stiffness and achiness / back stiff and achy. On 18-MAY-2021, the subject experienced slight tingling in both legs. On 18-MAY-2021, the subject experienced felt ill. On 19-MAY-2021, the subject experienced felt horrible. On 19-MAY-2021, the subject experienced chills. On 19-MAY-2021, the subject experienced headache. On 19-MAY-2021, the subject experienced nausea. On 21-MAY-2021, the subject experienced experiencing grogginess. On 21-MAY-2021, the subject experienced feeling tired. On an unspecified date, the subject experienced anxious. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from feel almost paralyzed, muscle stiffness and achiness / back stiff and achy, slight tingling in both legs, felt horrible, chills, headache, and nausea on 20-MAY-2021, had not recovered from feeling tired, and experiencing grogginess, and the outcome of felt ill and anxious was not reported. This report was non-serious.This spontaneous report received from a patient concerned a 70 year old female. The patient''s height, and weight were not reported. The patient''s past medical history included covid-19 infection, and night sweats, and concurrent conditions included asthma (severe eosinophilia asthma), nasal polyps, high blood pressure, non smoker, and abstains form alcohol. The patient experienced drug allergy when treated with acetylsalicylic acid for drug used for unknown indication. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown, and batch number: 206A21A expiry: 23-JUN-2021) dose was not reported, administered on 18-MAY-2021 16:00 for prophylactic vaccination. Concomitant medications included fluticasone propionate for asthma, zileuton for asthma, beclometasone dipropionate for drug used for unknown indication, fish oil for drug used for unknown indication, lisinopril for hypertension, and mometasone furoate for nasal polyps. On 2021, Laboratory data included: Body temperature (NR: not provided) 99.7 F. On JAN-2021, Laboratory data included: COVID-19 virus test positive (NR: not provided) Positive. On 18-MAY-2021, the subject experienced feel almost paralyzed. On 18-MAY-2021, the subject experienced muscle stiffness and achiness / back stiff and achy. On 18-MAY-2021, the subject experienced slight tingling in both legs. On 18-MAY-2021, the subject experienced felt ill. On 19-MAY-2021, the subject experienced felt horrible. On 19-MAY-2021, the subject experienced chills. On 19-MAY-2021, the subject experienced headache. On 19-MAY-2021, the subject experienced nausea. On 21-MAY-2021, the subject experienced experiencing grogginess. On 21-MAY-2021, the subject experienced feeling tired. On an unspecified date, the subject experienced anxious. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from feel almost paralyzed, muscle stiffness and achiness / back stiff and achy, slight tingling in both legs, felt horrible, chills, headache, and nausea on 20-MAY-2021, had not recovered from feeling tired, and experiencing grogginess, and the outcome of felt ill and anxious was not reported. This report was non-serious.


VAERS ID: 1349688 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER 8734 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Headache, Pain in extremity
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021567839

Write-up: Bruising under both of my hands; Headaches; severe arm pain; This is a spontaneous report from a contactable consumer (patient). A 21-year-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE; lot number: ER 8734), via an unspecified route, administered in left arm on 18May2021 at 08:15 (at the age of 21-year-old), as first dose, single for covid-19 immunization at Pharmacy/drug store. The patient was not pregnant at the time of vaccination. The patient did not have any medical history and concomitant medication. The patient did not have any allergies at the time of reporting. Prior to vaccination, the patient was not diagnosed with COVID-19 and since the vaccination, the patient was never tested for COVID-19. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The patient experienced bruising under both of her hands, headaches and severe arm pain on 18May2021 13:00. No treatment was received for the events. The outcome was reported as recovering for the reported events.


VAERS ID: 1350293 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 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? 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 High


VAERS ID: 1350401 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-01
Onset:2021-05-18
   Days after vaccination:47
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood glucose normal, C-reactive protein increased, COVID-19, Chest X-ray abnormal, Fibrin D dimer increased, Infusion, Pneumonia, SARS-CoV-2 test positive, White blood cell count decreased
SMQs:, Haematopoietic leukopenia (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (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: Celebrex, B complex vitamin, folic acid, leflunomide, levothyroxine, multiple vitamin, protonix, phenazopyridine, prednisone, lyrica, sertraline, tolterodine, trazodone, upadacitinib
Current Illness:
Preexisting Conditions: Hypothyroid, dyslipidemia, rheumatoid arthritis, depression, osteoarthritis, arthropathy of left and right shoulders, GERD, cataracts, anxiety, fibromyalgia, osteopenia, psoriasis
Allergies: NKA
Diagnostic Lab Data: 5/18 ED visit: D-dimer 510, COVID-19 PCR positive, chest x-ray normal. 5/21 ED to hospital admission: glucose 54, chest xray positive for streaky opacities in the lung bases, d-dimer 650; 5/22 CRP 21.8, WBC 2.97, d-dimer 710, 5/23 CRP 11.9, , d-dimer 550, 5/24 CRP 8.7, d-dimer 710
CDC Split Type:

Write-up: Pt had second dose on 4/1/2021 and tested positive for COVID on 5/18/2021. Received antibody infusion on 5/20. Was admitted to the hospital on 5/21/2021 for pneumonia secondary to COVID-19 infection.


VAERS ID: 1350680 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-05-17
Onset:2021-05-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Injection site inflammation, Injection site pain, Injection site swelling, Limb discomfort, Pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Gabapentin, metformin, glipizide, bupropion, lisinapril, lovastatin, escapram, trazadone and etodolac
Current Illness: None
Preexisting Conditions: Spinal surgery October 2020 type 2 diabetes and overweight
Allergies: Sulfa&penicillin
Diagnostic Lab Data: Several blood tests and a urine test
CDC Split Type:

Write-up: Severely tired and achy and at injection site it was raised and enflamed and was extremely sore. By afternoon I started to get pins and needles up both arms from fingertips up arm thru my shoulders and up both sides of my neck. They also were throbbing with pain and hurt if someone was to grab my arms.


VAERS ID: 1350684 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-04-22
Onset:2021-05-18
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram peripheral abnormal, Pulmonary embolism, Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Multivitamin, Claritin-D
Current Illness: none
Preexisting Conditions: IBS, Post-Menopausal, Impaired glucose tolerance
Allergies: NKDA
Diagnostic Lab Data: Patient had CT Angiogram on 5/18/2021 to confirm
CDC Split Type:

Write-up: Patient seen in ER with pulmonary embolism , (L) lower extremity blood clot


VAERS ID: 1350852 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Concerta Oxcarbazepine Trazadone Lithium Risperidone As Needed: Hydroxyz
Current Illness:
Preexisting Conditions:
Allergies: Amoxicillin: Reported by Guardian, "hives head to toe."
Diagnostic Lab Data:
CDC Split Type:

Write-up: Spoke with clients guardian about adverse event. Guardian reported nurse calling her after she went back to school after vaccine due to a rash on chest, lower abdomen, and from inside of arms from elbows to wrist on client. Mother took client to ER to be checked out. Per report of Guardian, ER doctor said, "this rash shouldn''t stop client from receiving second vaccine." Guardian also reported ER doctor prescribing Prednisone for 5 days and Benadryl as needed. Guardian did not say what ER doctor ended up diagnosing the rash cause. Guardian reported client reporting rash was itchy, but Guardian reported she did not see client actively itching. Guardian also reported client very nervous about vaccine and was being told mixed messages about vaccine from peers from school. Per CDC guidelines instructed Guardian to have client evaluated by allergist before receiving second Covid-19 Vaccine. Guardian reported client is doing well now.


VAERS ID: 1350876 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / UNK LA / IM

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

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

Write-up: Patient was administered Pfizer Covid-19 Vaccine under the age of 12.


VAERS ID: 1350883 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Fall, Head injury, Hypopnoea, Mental status changes, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

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

Write-up: Episode of syncope after receiving the covid vaccine. Secondary injury to back of head after falling out of chair. 3:05 PM Vital Signs: BP 118/62 HR 92 Resp 18 O2Sat 98 Skin Signs: Warm and dry Initial Treatment: Initial impression: altered mental status, shallow breathing, pupils Perla. Patient regained consciousness and was able to respond to questions. Patient was placed in a wheel chair and taken to triage area. Vitals taken. 3:20 PM Vitals: BP 116/82 HR 82 Resp 16 O2Sat 98 Skin Signs: Warm and dry Circulation: Cap refill <2sec Respiratory: Breath sound clear bilaterally Follow up Treatment: Denies nausea. AOx1 No longer feeling ''shaky''. Very sight swelling at the site of head injury. Ice pack in place. 3:35 PM Vitals: BP 116/66 HR 78 Resp 16 O2Sat 99 Skin Signs: Warm and dry Circulation: Cap refill <2sec Respiratory: Breath sound clear bilaterally Follow up Treatment: Home with mother with CHI instructions.


VAERS ID: 1350918 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-18
Onset:2021-05-18
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Pain, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: mango
Diagnostic Lab Data:
CDC Split Type:

Write-up: my left arm has been sore at and around the injection site ever since I got the second dose. It is an on-going dull pain.


VAERS ID: 1350972 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-07
Onset:2021-05-18
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 mg tablet albuterol HFA (PROAIR HFA) 90 mcg/actuation inhaler amoxicillin (AMOXIL) 500 mg capsule apixaban (ELIQUIS) 5 mg tablet diclofenac (VOLTAREN) 75 mg EC tablet estradioL (ESTRACE) 0.5 mg tablet flecainide
Current Illness:
Preexisting Conditions: Nervous Chronic pain Paresthesia of left lower extremity Rib pain on left side Acute pain of right knee Lumbar radiculitis Respiratory Chronic bronchitis OSA (obstructive sleep apnea) Circulatory Atrial fibrillation Benign essential hypertension Palpitations Venous stasis Paroxysmal atrial flutter CHF (congestive heart failure) Digestive Diverticulosis of intestine Obesity, morbid, BMI 50 or higher BMI 50.0-59.9, adult Genitourinary Nocturia Urinary retention Urethral hypermobility Urge incontinence of urine Stress incontinence, female Musculoskeletal Arthritis Disc degeneration, lumbosacral Osteoarthritis Tendinitis of right rotator cuff Shoulder impingement, right De Quervain''s tenosynovitis, left Arthritis of left wrist Presence of left artificial knee joint Shoulder impingement, left Left knee injury, subsequent encounter Right knee injury, subsequent encounter Primary osteoarthritis of right knee Lumbar spondylosis Patellar tendinitis of left knee Patellar tendinitis of right knee Tendinitis of right quadriceps tendon Tendinitis of left quadriceps tendon Rotator cuff tendonitis, right Contusion of right shoulder, subsequent encounter Complete tear of right rotator cuff, unspecified whether traumatic Nontraumatic complete tear of right rotator cuff Tendinitis of left wrist Closed displaced fracture of fifth metatarsal bone of left foot with routine healing, subsequent encounter Closed nondisplaced fracture of fifth metatarsal bone of left foot with routine healing, subsequent encounter Pes anserinus bursitis of left knee Primary osteoarthritis of left hip Hematologic Leukopenia Other Anxiety Vertigo Chronic edema Localized swelling, mass or lump of neck Hoarseness Fall Pre-op examination S/P reverse total shoulder arthroplasty, right Presence of artificial shoulder joint, right Aftercare following right shoulder joint replacement surgery Surgery follow-up examination
Allergies: MetronidazoleNausea and Vomiting
Diagnostic Lab Data: 05/17/21 2041 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 05/17/21 1218 | Final result | Specimen: Swab from Nares COVID-19 SARS-CoV-2 Overall Result DetectedCritical
CDC Split Type:

Write-up: ASYMPTOMATIC


VAERS ID: 1351031 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-14
Onset:2021-05-18
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: dicyclomine (BENTYL) 20 mg tablet escitalopram (LEXAPRO) 20 mg tablet levothyroxine (SYNTHROID) 25 mcg tablet mesalamine (DELZICOL) 400 mg capsule (with del rel tablets) triamcinolone (KENALOG) 0.1 % cream
Current Illness:
Preexisting Conditions: Circulatory; Venous insufficiency; Digestive Morbid obesity due to excess calories (CMS/HCC) Ulcerative pancolitis without complication (CMS/HCC) Genitourinary Genital warts Vulvar hypertrophy Musculoskeletal Candidal intertrigo Xerosis cutis Hirsutism Eczema Endocrine/Metabolic IFG (impaired fasting glucose) Hematologic Mesenteric adenitis Splenomegaly Iron deficiency anemia Other Anxiety and depression Excessive daytime sleepiness History of recent stressful life event Fatigue Hx of preeclampsia, prior pregnancy, currently pregnant, third trimester History of cesarean delivery Cesarean delivery delivered Adjustment disorder with anxious mood Weight loss FH: colon cancer in relative <50 years old
Allergies: KetorolacFatigue, Agitation MetforminNausea and Vomiting
Diagnostic Lab Data: 05/20/21 1557; COVID-19 (SARS CoV-2,RNA Molecular Amplification); Collected: 05/19/21 1326 | Final result | Specimen: Swab from Nares; COVID-19 SARS-CoV-2 Overall Result; Detected Critical
CDC Split Type:

Write-up: Contact with and (suspected) exposure to covid-19; Suspected COVID-19 virus infection; COVID 19 MAB Infusion Navigator Initial Patient Assessment; Ordering Prescriber has completed required FDA EUA elements. COVID-19 Positive Result Date (and on chart/file): 05/19/2021; Start of Symptoms Date: 05/18/2021; Body mass index (BMI) ?35; Chronic kidney disease; Diabetes; Immunosuppressive disease ? 65 years of age ?55 years of age AND had Cardiovascular Disease OR Hypertension OR COPD/other chronic respiratory disease


VAERS ID: 1351052 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-10
Onset:2021-05-18
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amenorrhoea
SMQs:, Fertility 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: Levothyroxine, pre natal, folic acid, b12, vitamin d.
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Gyn recommended to fill this form..
CDC Split Type:

Write-up: Delayed Periods by 11 days and still counting


VAERS ID: 1351141 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-08
Onset:2021-05-18
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, COVID-19, Nasal congestion, Oropharyngeal pain, SARS-CoV-2 test positive
SMQs:, Taste and smell disorders (narrow), 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: levonorgestreL-ethinyl estrad (SEASONALE) 0.15 mg-30 mcg (91) per tablet
Current Illness:
Preexisting Conditions: Digestive GERD (gastroesophageal reflux disease) Infectious/Inflammatory COVID-19 virus infection Other Anxious depression Non-smoker Body mass index (BMI) of 23.0-23.9 in adult
Allergies:
Diagnostic Lab Data: 05/19/21 1700 POCT COVID-19 PCR Collected: 05/19/21 1659 | Final result | Specimen: Swab from Nares POC COVID-19 PCR DetectedAbnormal Lot # m153720 Point of Care COVID-19 PCR Testing Method Abbott ID NOW Lot Expiration Date 09/16/2021
CDC Split Type:

Write-up: Sore throat Loss of taste Congestion of nasal sinus COVID-19 virus infection


VAERS ID: 1351240 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-17
Onset:2021-05-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 LA / IM

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

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

Write-up: Rash


VAERS ID: 1351284 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-25
Onset:2021-05-18
   Days after vaccination:54
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Exposure to SARS-CoV-2, SARS-CoV-2 test
SMQs:, 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: cyanocobalamin, vitamin B-12, 1,000 mcg tablet docosahexaenoic acid-epa 120-180 mg capsule Lactobacillus acidophilus 100 million cell capsule niacin 500 mg tablet olmesartan (BENICAR) 40 mg tablet(Expired) pediatric multivitamin no.29 (GUMM
Current Illness:
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data: Probable COVID-19 Specimen information: Swab / Nares Added: 5/18/2021 by POCT COVID-19 Antigen (Collected 05/18/21) Onset date: 5/18/2021 Resolve
CDC Split Type:

Write-up: Close exposure to COVID-19 virus Upper respiratory infection, acute Contact with and (suspected) exposure to covid-19


VAERS ID: 1351429 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Headache, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: headache and nausea starting a few hours after shot. Nausea off and on since then, headache for the 8th day now, and not getting better


VAERS ID: 1351904 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-17
Onset:2021-05-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Fatigue, Hypersomnia, Pyrexia, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: ALMOST EXACTLY 24 HOURS LATER, FEVER 101, COLD CHILLS, TIRED, SLEEPY. SLEPT 2 HOURS WHEN I GOT HOME FROM WORK . GOT UP FROM NAP AND WENT TO BED. ALL NORMAL IN THE MORNING.


VAERS ID: 1351936 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pruritus, Scab, 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: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: UNKNOWN
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: PT INDICATES THE NIGHT AFTER RECEIVING THE FIRST SHOT, SHE HAD HIVES IN THE BACK, AND THEY KEEP COMING IN HER WHOLE BODY. THEY ITCH AND FORM A CRUST.


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