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From the 11/12/2021 release of VAERS data:

Found 33,108 cases where Vaccine targets COVID-19 (COVID19) and Manufacturer is MODERNA and Serious

Government Disclaimer on use of this data



Case Details

This is page 14 out of 3,311

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VAERS ID: 924820 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Colorado  
Vaccinated:2020-12-31
Onset:2021-01-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Cough, Dysuria, Micturition urgency, Nausea, Pneumonia, Pollakiuria, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

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

Write-up: COUGH, RIGORS, NAUSEA, VOMITING, URINARY URGENCY/FREQUENCY, DYSURIA - FOUND TO HAVE LLL PNEUMONIA, CONCERNING FOR POSSIBLE CYRPTOGENIC ORGANIZING PNEUMONIA


VAERS ID: 924822 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Unknown  
Vaccinated:2020-12-29
Onset:2020-12-31
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 - / IM

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

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

Write-up: PATIENT DEVELOPED PROGRESSIVE NEW DYSPNEA, DIFFERENT FROM HER BASELINE. SHE HAS BEEN HOSPITALIZED TWICE FOR PERSISTENT DYSPNEA AND CENTRALIZED CHEST PAIN, WHICH HAS OTHERWISE HAD NEGATIVE WORK UP.


VAERS ID: 924835 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-01-04
Onset:2021-01-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025520A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test normal, Chest X-ray normal, Chills, Dizziness, Electrocardiogram normal, Headache, Injection site pain, Nausea, Pain, Pyrexia, Tachycardia, Troponin normal, Urine analysis normal
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Diagnosed with covid December 1st, recovered 3 and a half weeks prior to vaccine
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Troponin - normal Blood Panel - normal Chest x-ray- normal Urine analysis- normal EKG- normal showed tachycardia
CDC Split Type:

Write-up: 103.5 Fever that wouldn?t come down with Tylenol, chills, sharp headache, tachycardia, site pain, dizziness, body aches, nausea All symptoms started 11 hours after first dose of vaccine (3AM), went to hospital 15 hours after symptoms started and was treated for 9 hours until all symptoms abruptly stopped


VAERS ID: 925154 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-03
Onset:2021-01-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Avorstatin Aspirin Oxycodone
Current Illness: NONE
Preexisting Conditions: COPD
Allergies: None
Diagnostic Lab Data: Hospital
CDC Split Type:

Write-up: Deceased


VAERS ID: 925219 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Oregon  
Vaccinated:2020-12-30
Onset:2020-12-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Herpes zoster, Hypoaesthesia, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu, , does not regularly get Flue vaccine as have had several episoede of flu illness last flu vaccine three years ago a half
Other Medications: Lysine, levothyroxine, B complex, Emergency C Estraidiol patch
Current Illness: none
Preexisting Conditions: hypothyroid
Allergies: Septra
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Woke up Thursday am with hives on right lower abdomen and leg getting progressively worse throughout the day. By that afternoon had back pain in right back and continuing hives. Woke up Friday with numbness to right leg, hives, and back pain all on right side of body. Had numbness to foot, face but especially thigh, back and across upper buttocks. Saturday hives subsiding, numbness receding to face, upper thigh and foot only on right side of body. Sunday, back pain some improved, no hives or hives minimal, numbness persists upper thigh face and foot on right side of body. Monday, Tuesday and Wednesday the same. Woke up Thursday with shingles rash to upper thigh back, numbness to foot face and upper thigh persist only on right side of body. Darn!!!


VAERS ID: 925264 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2020-12-31
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-07
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Norco 5/325 1 tablet every 6 hours as needed. Warfarin 4mg , 2 tablets orally Monday and Friday Torsemide 100mg, 1/2 tablet orally once a day Sabcubitril-Valsartan 24/26mg 1/4 tablet orally twice a day Gabapentin 300mg, tablet once daily Ca
Current Illness: CHF HTN DM 2 CKD Obesity DDD
Preexisting Conditions: CHF HTN DM 2 CKD Obesity DDD
Allergies: NKDA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: PT was found deceased in his home on 1/5/2021


VAERS ID: 925925 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: New York  
Vaccinated:2020-12-28
Onset:2021-01-04
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / -

Administered by: Work       Purchased by: ?
Symptoms: Computerised tomogram, Electroencephalogram, Magnetic resonance imaging, Pyrexia, Seizure
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (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? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Leviteracetam for seizures because he had a first time seizure after testing positive for COVID-19. Gabapentin Osteo Bio Flex Vitamin D, Vitamin C
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: EEG , MRI, CAT SCAN
CDC Split Type:

Write-up: 1 day after the vaccine he had a low grade fever... 1 week later he had a seizure and then multiple ones in the ER...


VAERS ID: 926230 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-01-04
Onset:2021-01-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Echocardiogram, Electrocardiogram, Full blood count, Laboratory test, Sinus tachycardia, Supraventricular tachycardia
SMQs:, Supraventricular tachyarrhythmias (narrow), 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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Symbicort Levothyroxine Myrbetriq vitamin D vitamin C Calcium
Current Illness:
Preexisting Conditions: Asthma Hashimotos Thyroiditis Overactive bladder
Allergies: Penicillin Clindamycin
Diagnostic Lab Data: EKG CBC Chemistry ECHO
CDC Split Type:

Write-up: Patient experienced an episode of SVT and then sinus tachycardia for approximately 6 hours after injection


VAERS ID: 926433 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Florida  
Vaccinated:2020-12-28
Onset:2020-12-31
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram abnormal, Haemorrhagic stroke, Intensive care, Neurologic neglect syndrome, Visual impairment
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Elequis, Amiodoron, pravastatin, losartin, synthroid, timalol
Current Illness: high bp, high cholesterol,
Preexisting Conditions: deaf in rt ear - rt vestibular schwanoma,
Allergies: none
Diagnostic Lab Data: 2 CT scans showing large bleed. ,
CDC Split Type:

Write-up: Hemmoragic Stroke. Began with vision difficulty in the morning. Then I noticed she had left sided neglect. Went to ER. Treated with Andresxa (to counteract Elaquis). In SICU for 2 nights then telemetry unit for 3 nights. CUrrently in Rehab.


VAERS ID: 926454 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-04
Onset:2021-01-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal adhesions, Abdominal pain, Surgery
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hyperlipidemia DJD
Allergies: Avelox, Dilaudid, Percocet, Pylera
Diagnostic Lab Data: Surgery 1/6/2021
CDC Split Type:

Write-up: Following vaccination the patient had progressively worsening abdominal pain over the next 24 hours. Presented to the ER and was initially thought to have appendicitis. However, it was then discovered during surgery that the appendix was surgically absent. The surgeon did not that the patient did have a "Round, infarcted ligamentous tissue was wrapped around ascending colon. "


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