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

Found 875,292 cases where Vaccine is COVID19 and Patient Did Not Die

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 14 out of 8,753

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VAERS ID: 1860995 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Vaccine expired 11/5/21, given 11/8/21 no adverse events reported.


VAERS ID: 1860999 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / 4 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad), 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: Pt had a liver transplant
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received a 4th vaccine dose. He told the RPh administering that he was in need of a "booster dose" and was unable to produce his vaccine record card that showed the 3 doses he had already been given. Pharmacist questioned patient about which dose in the series he was receiving and patient told it was the "booster dose". Once the error was figured out, patient was informed and we also informed his transplant team. He reported no adverse reactions other than arm pain.


VAERS ID: 1861002 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Vaccine expired 11/5/21, given 11/8/21 no adverse events reported.


VAERS ID: 1861008 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / UNK RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Vaccine expired 11/5/21, given 11/8/21 no adverse events reported.


VAERS ID: 1861022 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-11-05
Onset:2021-11-08
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Patient was unintentionally given an expired Moderna booster vaccine on 11/5/2021. Expiration date was 11/3/2021 per the 30 day rule once in the fridge. Moderna vial used was placed in fridge on 10/04/2021. No known adverse events have occured at the time of reporting.


VAERS ID: 1861024 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-11-04
Onset:2021-11-08
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 unintentionally given an expired Moderna booster vaccination (0.25ml). Expiration date was 11/3/21 per the 30 day limit once Moderna is placed the fridge, which was 10/4/2021. The error was caught on 11/7/2021. No known adverse event occured at the time of reporting.


VAERS ID: 1861048 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-06
Onset:2021-11-08
   Days after vaccination:247
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Vaccine breakthrough infection
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Breakthrough COVID-19 case. Pt received Moderna on 2/6/21 and 3/6/21


VAERS ID: 1861062 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-11-05
Onset:2021-11-08
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / UNK - / -

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

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

Write-up: None stated.


VAERS ID: 1861093 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-11
Onset:2021-11-08
   Days after vaccination:242
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A NOT GIVEN A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A NOT GIVEN A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID-19 PCR positive on 11/8/2021
CDC Split Type:

Write-up: Patient received two doses of COVID-19 Moderna vaccines and subsequently was diagnosed with COVID-19 at our institution on 11/8/2021


VAERS ID: 1861134 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Injection site pain, Injection site rash, Injection site warmth, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Phentermine, Lexapro, One-a-Day Women''s, D3 Supplement, Zinc Supplement, Magnesium Supplement, B-Vitamin Complex
Current Illness: Seasonal Allergies
Preexisting Conditions: Asthma
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash on arm at injection site, developed larger over first 3 days. Hot, painful, itchy. Beginning to subside on day 4.


VAERS ID: 1861185 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-11
Onset:2021-11-08
   Days after vaccination:58
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HTN, Gerd, RA, HX of CA
Allergies:
Diagnostic Lab Data: PCR covid-19
CDC Split Type:

Write-up: breakthrough infection


VAERS ID: 1861186 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-02
Onset:2021-11-08
   Days after vaccination:220
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / UNK RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Hypoxia, Malaise, Mobility decreased, Pyrexia
SMQs:, Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: diagnosed with COVID was unable to say when his symptoms had begun. did become hypoxic and febrile during his hospitalization. He was treated with a 10 day course of dexamethasone for COVID pneumonia. He did receive remdesivir on 11/2/21, as well. He had a new oxygen requirement of 2L at the time of his discharge. He declined going to a skilled nursing facility despite requiring 2-person assist.


VAERS ID: 1861200 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: losartan 25mg azithromycin 250mg NAC 600mg
Current Illness: none
Preexisting Conditions: high blood pressure (controlled)
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, chills, body aches starting 10 hrs after injection lasting 24 hrs. Racing heartbeat, fatigue starting 48 hrs after injection


VAERS ID: 1861230 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-03-03
Onset:2021-11-08
   Days after vaccination:250
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / UNK - / -

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

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

Write-up: Tested positive for Covid on 11/08 with rapid test during community outbreak


VAERS ID: 1861241 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-11-06
Onset:2021-11-08
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Ejaculation disorder, Erectile dysfunction, Libido decreased, Myocarditis, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), Sexual dysfunction (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: Syncope
Other Medications: Daily multivitamin.
Current Illness: No known illnesses.
Preexisting Conditions: No known chronic or long-standing health conditions.
Allergies: No known allergies.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: I have noticed decreased sex drive and impotence. Ejaculation had become increasingly harder to reach. I also have signs and symptoms of myocarditis and pericarditis.


VAERS ID: 1861243 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-16
Onset:2021-11-08
   Days after vaccination:265
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Vaccine breakthrough infection
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Breakthrough COVID-19 infection. Pt received Moderna on 1/19/21 and 2/16/21


VAERS ID: 1861291 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-15
Onset:2021-11-08
   Days after vaccination:266
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Vaccine breakthrough infection
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Breakthrough COVID-19 infection. Pt received Pfizer on 1/28/21 and 2/15/21


VAERS ID: 1861325 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-11-05
Onset:2021-11-08
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure abnormal, Heart rate irregular
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (broad), Cardiac arrhythmia terms, nonspecific (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: Second shot. Afibu
Other Medications: Eliquis. Beta blocker famciclover
Current Illness: AFib from second vaccine
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme blood pressure. Very elivstr heartbrat


VAERS ID: 1861326 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 320308D / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Flushing, Injection site pain, Lymph node pain, Lymphadenopathy, Pelvic pain, Radiotherapy
SMQs:, Anaphylactic reaction (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ristela twice daily, collagen powder daily, amberen daily, vitamin d 1,000 units daily, vitamin c 1,000 mg daily, miralax daily, metamucil daily
Current Illness: none
Preexisting Conditions: Diagnosed with anal cancer July 15, 2020- underwent chemoradiation for 6 weeks from Aug 24- Oct 5th 2020
Allergies: none
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I experienced a flushing, an increase in pain and erythema in the pelvic area where I had received radiation therapy approximately 5 hours after administration of the vaccine. The following 2 days, the lymph nodes in my groin (also previously radiated) were swollen and tender, this was unexpected. My right arm was sore at the site of the injection (which I expected). Today, Thursday Nov. 11th, mild pelvic skin erythema and tenderness persist, but have not gotten worse. Left groin lymph node still feels tender, is no longer swollen or palpable.


VAERS ID: 1861336 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 3 RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 2 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Affect lability, Chest discomfort, Chills, Consciousness fluctuating, Cough, Crying, Dyspnoea, Feeding disorder, Feeling of body temperature change, Headache, Joint stiffness, Lymph node pain, Memory impairment, Mobility decreased, Musculoskeletal stiffness, Photophobia, Seizure, Sensory disturbance, Speech disorder, Suicidal ideation, Temperature regulation disorder, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (narrow), Suicide/self-injury (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Dementia (broad), Convulsions (narrow), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Hostility/aggression (broad), Glaucoma (broad), Cardiomyopathy (broad), Corneal disorders (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: DOXYCYCLINE MONO 100MG CAP, antibiotic for acne rosacea.
Current Illness: None known
Preexisting Conditions: None known
Allergies: Diary/lactose cow only All pollens
Diagnostic Lab Data: Patient unsure if covered. Patient us not insured till 2022.
CDC Split Type:

Write-up: 1. Convulsions, chills. So out of control that patient passed in and out of consciousness. Upon waking up, gasped for air as if unable to breathe while unconscious. Unknown amount of time between unconscious and conscious states. Shivering seemed to be an issue of temperature regulation as she reported feeling cold while her temperature remained above 98.5 degrees. (Continued for 7 hours). She could feel the heat of her body within her blankets but in her bones, she was freezing and unable to stop convulsing. Shaking so badly that she could not hold water to her face in order to drink. Could not effectively chew and swallow crackers without the danger of cooking. 2. Shortness of breath. Felt like a great weight on chest. Unable to complete sentences without multiple in/out breaths. 3. Patient would forget, mid sentence, what they were talking about or where they were going with current conversation. 4. Resting HR at 92bpm 5. Headache. Felt as though brain matter was trying to push through the skull. 6. Lymph node under the arm pit extremely sore as if stabbed. Injection site felt similar. 7. Joints, muscles Felt stiffened and unable to move freely. 8. Light sensitivity to the eyes. 9. Throat tensed tightly, leaving the patient barely able to breathe properly. 10. Temperature regulation continued to be abnormal after convulsions stopped. Too hot or too cold, no comfortable in between. 11. Patient would take very deep breaths, but it did not seem to help calm convulsions and it didn''t feel like enough air was taken in. 12. Movement caused light coughing. 13. Emotions were/are difficult to regulate. Crying while convulsing. After convulsions stopped, patient would attempt to talk and would become emotional at inappropriate times. 14. Thoughts of suicide should symptoms persist. 15. By day 4, patient remains short of breath when above resting HR.


VAERS ID: 1861356 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 RA / UN

Administered by: Private       Purchased by: ?
Symptoms: Diarrhoea, Feeling hot, Headache, Pain in extremity, Throat tightness, Tinnitus, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: flonase, multivitamin, vit D
Current Illness: no
Preexisting Conditions: no
Allergies: n/a
Diagnostic Lab Data: t
CDC Split Type:

Write-up: continuous headache; right arm whelp/pain; diarrhea (two days); ringing in ears (both); hot legs (as if lower body dipped in icy hot or bengay); tight throat


VAERS ID: 1861361 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Headache, Induration, Neck pain, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Naltrexone, nicotine patch, and had influenza vaccine 11/4/21
Current Illness: alcohol use disorder, undiagnosed diarrhea/GI symptoms, chronic/smoker cough
Preexisting Conditions: bipolar/depression, SICCA
Allergies: seroquel (nausea/vomiting) and topamax ( skin reaction)
Diagnostic Lab Data: none
CDC Split Type:

Write-up: bilateral rash 20 min after shot, R neck/headache and fever for several days, and local induration extending to axilla


VAERS ID: 1861460 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066F21A / 3 - / IM

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

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

Write-up: Pt presented to the vaccination site on 11/08/21. The client notified RN after 1-2 hours after receiving his second dose he felt like his heart was racing. The client went to the emergency room and they kept him in observation for 4-5 hours. They did not give him any medications. Client stated that he was then sent home. Client stated that the next day he felt the same symptom of his heart racing and returned to the hospital. Client stayed at the hospital in observation from 1100-2100 that day. Client stated that he felt his hear racing on and off the entire time. Client was sent home after staying in observation for 10 hours. Client was not given any medications. RN submitted a medical consult via text message to Vaccine Operations Leads, requesting to proceed with the COVID Moderna booster vaccine. Approval to proceed with COVID vaccine Moderna booster with 15 minute observation was obtained from medical consult team, Vaccine Operations Lead, RN via text message. Client received COVID Moderna booster vaccine Lot# 066F21A on 11/08/2021. The client did not report any symptoms during the observation period. RN educated client on worsening signs and symptoms of COVID vaccine and when to seek EMS, urgent care or when to return to ED if symptoms return. Client verbalized understanding. The client left the vaccination site at 1415.


VAERS ID: 1861477 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-26
Onset:2021-11-08
   Days after vaccination:255
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 LA / IM

Administered by: Work       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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 11/10 SARS/COV-2, NAAT, Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1861487 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-28
Onset:2021-11-08
   Days after vaccination:284
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Cough, Ear discomfort, Nasal congestion, Oropharyngeal pain, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Allergy history unknown o Anxiety o Asthma o DDD (degenerative disc disease), lumbar o Depression GERD, hyperli Hx: Hyperlipidemia, hypertension, insomnia and multiple thyroid nodules Systems cont: Left Ear: Hearing, ear canal and external ear normal. No drainage or tenderness. A middle ear effusion is present. Tympanic membrane is not injected, erythematous or bulging. Nose: Congestion and rhinorrhea present. Mouth/Throat: Pharynx: Uvula midline. Posterior oropharyngeal erythema present. No oropharyngeal exudate or uvula swelling. Tonsils: No tonsillar abscesses. Cardiovascular: Rate and Rhythm: Normal rate and regular rhythm. Heart sounds: Normal heart sounds. Pulmonary: Effort: Pulmonary effort is normal. No respiratory distress. Breath sounds: No stridor. No decreased breath sounds, wheezing, rhonchi or rales. Lymphadenopathy: Cervical: No cervical adenopathy. Skin: General: Skin is warm and dry. Findings: No rash. Neurological: Mental Status: She is alert and oriented
Allergies: Latex, sulfa antibiotics
Diagnostic Lab Data: SARS-CoV-2 PCR - IPOC Detected Abnormal
CDC Split Type:

Write-up: PT presents to the ICC with c/o sore throat, ear pressure, congestion, cough, and back pain x 3 days. PT has been taking Mucinex for her symptoms. Pt is a smoker. PT did get the COVID-19 vaccination (Pfizer). Physical Exam Constitutional: General: She is not in acute distress. Appearance: She is well-developed. She is not ill-appearing, toxic-appearing or diaphoretic. HENT: Head: Normocephalic. Right Ear: Hearing, ear canal and external ear normal. No drainage or tenderness. A middle ear effusion is present. Tympanic membrane is not injected, erythematous or bulging.


VAERS ID: 1861493 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058F21A / 3 LA / IM

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

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

Write-up: redness in arm


VAERS ID: 1861515 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 RA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR - / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levoxyl, Atorvastatin
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: EKG 11/08/2021
CDC Split Type:

Write-up: Pt. states that after receiving the 3rd Booster of Phizer 11/08/2021 (High-Dose Influenza also) , started experiencing symptoms 10 minutes after of fainting *few seconds. Paramedics evaluated *BP, EKG transported to local Emergency Room Department for observation. Discharged 2 hours after evaluation = Normal. Still experiencing fatigue with no other underlying symptoms. Primary visit scheduled for Follow-Up 11/12/2021.


VAERS ID: 1861531 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-10-29
Onset:2021-11-08
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS - / UNK RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Feeling abnormal, Pain, Pruritus, Rash, Skin irritation, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Dementia (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Skin redness and rash, non-localized, itchy, painful, warm to the touch and swollen/ irritated. Loratidine 10mg, soaking in oatmeal bath, topical hydrocortisone


VAERS ID: 1861577 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-07
Onset:2021-11-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breast mass, Breast pain, Breast tenderness, Pain
SMQs:, Lipodystrophy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown pt does not fill prescriptions
Current Illness: none reported
Preexisting Conditions: diabetes
Allergies: none listed
Diagnostic Lab Data: no medical tests so far, she has made and appointment with her dr to be seen and evaluated
CDC Split Type:

Write-up: patient states she woke up with arm soreness next day, but as day went on, soreness spread to her left breast, and a lump formed near nipple on left breast, present with shooting pains from the nipple. Felt like a pimple very tender to the touch, and has to take tylenol to control the pain.


VAERS ID: 1861621 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-07
Onset:2021-11-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Fatigue, Headache, Pain, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: vitamin D 2000
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: cipro and levaquin
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Fever, body aches, headache, chills, 2 days weak, tired, now hives on arms, and chest 4th day still have symptons


VAERS ID: 1861623 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-05
Onset:2021-11-08
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Activated partial thromboplastin time, Blood test, C-reactive protein, Cardiac monitoring, Chest X-ray abnormal, Chest pain, Diarrhoea, Echocardiogram, Electrocardiogram, Electrocardiogram abnormal, Full blood count, Headache, Human chorionic gonadotropin, Inflammation, Lipase, Metabolic function test, Muscle injury, Myocarditis, Nausea, Pericarditis, Prothrombin time, Red blood cell sedimentation rate, Respiratory viral panel, Sleep disorder, Troponin I, Troponin increased, Urine analysis, Vomiting
SMQs:, Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Omeprazole, Zyrtec, Sucralfate, Montelukast, birth control pills, Fluticasone nasal spray, Acetaminophen
Current Illness: None
Preexisting Conditions: Gastritis
Allergies: Doxycycline, soy, sesame, mold
Diagnostic Lab Data: 11/08/21: ECG 12-Lead, PT- APTT, Troponin 1 high-sensitivity, Lipase, Comprehensive metabolic panel, CBC, POC HCG Qualitative, Urinalysis Auto only, XR chest 1 view, C-reactive protein, Sedimentation rate, Troponin 1 high-sensitivity,CV Transthoracic E., Respiratory virus comprehensive panel 11/09/21: Troponin 1 high-sensitivity, Basic metabolic panel, CBC
CDC Split Type:

Write-up: It began around 2:30 am 11/08/21 I awoke to diarrhea stomach pains and began using the toilet while I was on the toilet I began to feel nauseas. I began vomiting while still using the restroom. Once I had finished using the restroom and vomiting I began having chest pains. The chest pain would not subside and it increased when I tried to lay back down. I decided to go to the ER where they discovered and abnormal EKG and elevated troponin levels. I was given Tramadol in the ER to help with the pain and given a chest x-ray then I was checked in to a hospital room and stayed from 11/08/21-11/09/21. The doctors believed I was suffering from myocarditis or pericarditis. During my visit my blood levels were examined every few hours and my heart was monitored through an EKG. I was given morphine when my pain increased around 12 pm on 11/08/21 and then tramadol at the end of 11/08/21 when my head was throbbing. The cardiologist did an ultrasound of my heart to see if the inflammation visible on the x-ray was pericarditis or myocarditis. On 11/09/21 I was told the inflammation had decreased on its'' own which lead the doctors to believe it was the result of the booster covid vaccine I received 11/05/21. The cardiologist told me I have microscopic damage to my heart muscles based on the elevated troponin levels and she believes I have pericarditis. I was released from the hospital with instructions of resting, not exercising, and eating a heart healthy diet. I have a follow up appointment with my PCP on 11/23/21 and my cardiologist said to make an appointment with her in a month. They prescribed Tramadol for me to take home in case of more chest pain in the future.


VAERS ID: 1862140 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-03-04
Onset:2021-11-08
   Days after vaccination:249
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029A21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol neb and inh, amlodipine, baby aspirin, fluticasone-salmeterol diskus, fluticasone inh, insulin glargine basaglar kwikpen, insulin lispro, lisinopril, lovastatin, metformin, triamcinolone cream
Current Illness:
Preexisting Conditions: uncontrolled DM II, HTN, HLD, and COPD
Allergies: levofloxacin
Diagnostic Lab Data: COVID status positive on 11/8/21.
CDC Split Type:

Write-up: Patient received Moderna COVID vaccine on 2/4/21 and 3/4/21. Patient lives in a multigenerational home with 8 other adults, 3 tested positive for Covid. On 11/8/21, patient tested positive for COVID and was admitted to our facility for COVID pneumonia and acute hypercapnic respiratory failure. Patient discharged home on oxygen two days later on 11/10/21.


VAERS ID: 1862157 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-03
Onset:2021-11-08
   Days after vaccination:219
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 04/03/2021 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Bacillus bacteraemia, COVID-19 pneumonia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen, amlodipine, diclofenac gel, folic acid, glipizide, hydroxychloroquine, leflunomide, lidocaine patch, methotrexate, metoprolol ER, omeprazole, prednisone, spironolactone, tamsulosin, tofacitinib
Current Illness:
Preexisting Conditions: rheumatoid arthritis, nephrolithiasis, GERD, hypertension
Allergies: Penicillin G
Diagnostic Lab Data: COVID status positive on 11/5/21.
CDC Split Type:

Write-up: Patient received Janssen COVID vaccine on 4/3/21. On 11/8/21, patient admitted to our facility with acute hypoxemic respiratory failure secondary to COVID-19 pneumonia (positive status on 11/5/21) and Bacillus bacteremia. As of 11/10/21 (today), patient is still admitted in our med/surg unit.


VAERS ID: 1862177 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arrhythmia, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations: Second dose
Other Medications:
Current Illness: No
Preexisting Conditions:
Allergies: Diflucan
Diagnostic Lab Data: Cardiac arrhythmia and rapid heart rate, I took the second and third doses of MODERNA medicine to the emergency room.
CDC Split Type:

Write-up: None stated.


VAERS ID: 1862362 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test normal, Chest X-ray normal, Electrocardiogram normal, Feeling abnormal, Feeling hot, Hyperhidrosis, Injection site haemorrhage, Injection site swelling, Loss of consciousness, SARS-CoV-2 test negative
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data: Had Chest X-ray, ekg, blood work, Co-bid test,blood pressure monitored while in the ER. Everything came back normal before I was released
CDC Split Type:

Write-up: As soon as needle went into my arm, started dripping blood. Person administering shot kept wiping blood off my arm. As soon as I left the booth my partner noticed the injection site was raised like a bump. I started feeling ?off?- hot/ sweaty. Passed out. Came to. Passed out again. Ambulance took me to the local Hospital. I was released after about 3 hours


VAERS ID: 1862376 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-22
Onset:2021-11-08
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Menstrual disorder
SMQs:

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

Write-up: Change in menstural cycle


VAERS ID: 1862378 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Wyoming  
Vaccinated:2021-11-01
Onset:2021-11-08
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Feeling of body temperature change, Influenza like illness, Injection site pain, Injection site warmth, Pain, SARS-CoV-2 test negative
SMQs:, Extravasation events (injections, infusions and implants) (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Asthma
Allergies: None
Diagnostic Lab Data: COVID 19 test and results were negative.
CDC Split Type:

Write-up: On Tuesday I was experiencing hot and cold flashes all day and the injection site was sore and warm to the touch. Wednesday I was feeling extremely tired, body aches and hot and cold flashes. Thursday feeling tired and experiencing what I would consider flu like symptoms. Went to the doctor and tested negative for COVID 19 but was til I was having a reaction to the booster.


VAERS ID: 1863376 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Unknown  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-11-08
Submitted: 0000-00-00
Entered: 2021-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal discomfort, Dyspnoea, Fatigue, Injection site erythema, Injection site pruritus, Injection site swelling, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Allergy to chemicals; Drug allergy; Latex allergy; Non-smoker; Seasonal allergy
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211124782

Write-up: DIFFICULTY BREATHING; ITCHY AT INJECTION SITE; BODY ACHES; UPSET STOMACH; REDNESS AT INJECTION SITE; SWELLING AT INJECTION SITE; FATIGUE; FEVER; This spontaneous report received from a patient concerned a 38 year old of unspecified sex. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: seasonal allergies, latex allergy, formaldehyde allergy, non smoker, non-alcoholic, medication allergy, and black rubber allergy. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, and batch number: 1822811 expiry: UNKNOWN) dose was not reported, administered on 08-NOV-2021 for prophylactic vaccination. No concomitant medications were reported. On 08-NOV-2021, the patient experienced difficulty breathing. On 08-NOV-2021, the patient experienced itchy at injection site. On 08-NOV-2021, the patient experienced body aches. On 08-NOV-2021, the patient experienced upset stomach. On 08-NOV-2021, the patient experienced redness at injection site. On 08-NOV-2021, the patient experienced swelling at injection site. On 08-NOV-2021, the patient experienced fatigue. On 08-NOV-2021, the patient experienced fever. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from difficulty breathing, upset stomach, and body aches, and had not recovered from itchy at injection site, swelling at injection site, fatigue, fever, and redness at injection site. This report was non-serious.


VAERS ID: 1863810 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-04
Onset:2021-11-08
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood glucose increased, Fatigue, Insulin resistance, Limb discomfort
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Lipodystrophy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Humalog (fast acting insulin) for Type 1 Diabetes via pod.
Current Illness: None known.
Preexisting Conditions: Type 1 Diabetes for 5 years (2016)
Allergies: Amoxicillin sensitivity.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Thurs, Nov 4 2:45pm first vaccine dose. Only minor arm discomfort for Thursday and Friday. Some fatigue on Saturday and Sunday. By Monday afternoon, November 8 she started having unexplained high blood sugar reading (via cgm). This continues for three full days so far and caused her to miss one day of online school. It is if there is massive insulin resistance -- that we giver her insulin to cover meals but the insulin does not act how it normally does (we switched pods and insulin bottles to ensure it was not an equipment issue). She is 10 and has some puberty hormonal bg swings but we have not seen anything like this. The insulin, though supposed to start to take effect in 15 minutes is taking many hours. By then we have over corrected and then she crashes low. In comparison to previous weeks, she is far above her average time in range, average bg number and standard deviation with 176bg, 51% in range , 10% very high and 60 SD. The week before in comparison was 150bg, 65% in rance, 1% very high and 42SD. These numbers do not show the immense fear and exhaustion that this has caused. We just want people to be aware that for Type 1 kids there may be a delayed amount of bg highs and lows due to increased insulin resistance. As T1D parents we always expect bg swings with any medicine or vaccine but this has been very different and social media searches indicate this is happening to others though overlooked and underreported as this is considered a ''normal'' response. But the severity needs to be noted. My kiddo should never be 400+ after eating anything if she has insulin on board. It is very scary and just want someone to know. We hope this wears off soon. Thank you.


VAERS ID: 1863814 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Oropharyngeal pain, Streptococcus test negative
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: POC Strep test = negative 11/11/2021.
CDC Split Type:

Write-up: Sore Throat and Fatigue.


VAERS ID: 1864277 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Pain in extremity, Pharyngeal swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BUPROPION
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Depression
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101551013

Write-up: Shortness of breath/difficulty breathing; Throat swelling; Arm soreness; This is a spontaneous report from a contactable nurse, the patient. A 41-year-old non-pregnant female patient received the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the left arm (also reported as left deltoid) on 08Nov2021 (at the age of 41-years-old) as a single dose for COVID-19 immunisation. Medical history included depression. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. Concomitant medication included bupropion (MANUFACTURER UNKNOWN), for an unknown indication from an unknown date and unknown if ongoing. The patient previously received sertraline hydrochloride (ZOLOFT) and experienced drug allergy. On 08Nov2021 at 17:30, the patient experienced shortness of breath, difficulty breathing, throat swelling and arm soreness. The events did not result in doctor or other healthcare professional office/clinic visit, and emergency room/department or urgent care. Therapeutic measures were taken as a result of the events and included treatment with cetirizine hydrochloride (ZYRTEC) and then diphenhydramine hydrochloride (BENADRYL). Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events shortness of breath/difficulty breathing, throat swelling and arm soreness were resolving at the time of this report. The lot number for BNT162b2 was not provided and will be requested during follow up.


VAERS ID: 1864500 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-11-04
Onset:2021-11-08
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091102119 / 3 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Raynaud's phenomenon
SMQs:, 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zebeta 10 mg qhs Losartin 50 mg qhs Synthroid 125 mcg daily Protonix 40 mg qd Neurontin 300 mg QAM, 600 mg hs Requip 2 mg bid MVI daily Effexor XR 150 mg qAM Effexor XR 75 mg qAM Remeron 7.5 mg hs Toradol 10 mg bid PRN Xa
Current Illness: Hypothyroidism hypertension Chronic pain Gastritis Reflux Restless leg
Preexisting Conditions: Hypothyroidism Hypertension
Allergies: Penicillin Sulfa
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Raynauds symptoms


VAERS ID: 1864509 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: Error: Incorrect Reconstitution-


VAERS ID: 1864536 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 3 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Limb injury, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Arthritis (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: Error: Shoulder Joint Injury (prolonged pain, tingling, etc.)-


VAERS ID: 1853849 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-11-08
Onset:2021-11-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211D21A / 1 RA / IM

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

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

Write-up: PATIENT WAS 17 AND RECEIVED THE JANSSEN COVID VACCINE.


VAERS ID: 1849222 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-11-06
Onset:2021-11-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (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: Same adverse reactions, fevers, headache, stiff joint and uncontrollable shaking ?-as if I had influenza. This was my experience
Other Medications: For the side effects of the vaccine: acetaminophen 500 mg pills, dose of 1000 mg at 2 PM following vaccination. Biktarvy daily at 9 AM. NyQuil 15 ML dose (325 mg acetaminophen, and 15 mg antihistamines) at 1 am , 11/7, to help treat sy
Current Illness: None.
Preexisting Conditions: HIV (long-term undetectable status )
Allergies: None.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Note form doesn?t not have option to indicate it was a booster. I just want to put into the record that every time I get these shots I end up uncontrollably shaking during the night after. These are like full body convulsions as if I was standing in snow outside. They are somewhat violent ?I can?t even poor NyQuil syrup without shaking it all over the place. This also happened in my second dose?but not the first. The symptoms can last up to say 30 minutes. No manner of blankets or breathing exercises can calm the shaking I just have to let it run it?s course.


VAERS ID: 1849227 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-10-06
Onset:2021-11-07
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 3 RA / IM

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

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

Write-up: Patient''s prior vaccine status was not verified when appoint make for vaccine clinic. Patient was scheduled for 1st/2nd dose clinic instead of booster clinic. Patient received 3rd full dose instead of half strength booster dose. Error was not discovered until patient did not come in for scheduled "2nd dose appointment" on 11/5/21.


VAERS ID: 1849342 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-11-06
Onset:2021-11-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Feeling abnormal, Headache, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Eosinophilic pneumonia (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: Moderma #2 - myalgia, headache
Other Medications: Metoprolol, Flomax, Lipitor, Ezetimibe, Synthroid, Vitamin D, Multi Vitamin, Baby Aspirin, Magnesium, Calcium
Current Illness: none
Preexisting Conditions: Heart disease, BHP, history of lung cancer,
Allergies: NKA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Fever (100.3), Myalgia, chills, headache, fatigue, brain fog


VAERS ID: 1849395 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-11-07
Onset:2021-11-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Throat irritation
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

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

Write-up: "itchy throat"


VAERS ID: 1849404 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-11-07
Onset:2021-11-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

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

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

Write-up: Received Vaccine and 5 minutes later in Observation Room Vomited. Recovered. Stayed in Observation room 30 minutes, no repeat of vomiting. Left with parents


VAERS ID: 1849421 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-11-07
Onset:2021-11-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / SYR

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

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

Write-up: Sore arm one hour after vaccine given.


VAERS ID: 1849428 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-11-07
Onset:2021-11-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (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? 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: Fainting / Unresponsive-Mild, Additional Details: Patient passed out for just a few seconds he was confused briefly he waited here with both parents 911 was called but mom decided that they did not need to come he was given water and they left after his parents were confident that he was fine


VAERS ID: 1849431 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-05
Onset:2021-11-07
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Self
Other Medications: Flu shot, estradiol, nortrytylne, simvasatin, hydroyzine
Current Illness: Fibromyalgia
Preexisting Conditions: Fibromyalgia. Bipolar type ii
Allergies: Velosef cephlaporins Food: Soy, almonds, sunflower seeds, mushroom
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen lymph node in arm pit


VAERS ID: 1849440 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-11-07
Onset:2021-11-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Mydriasis, Pallor, Respiratory arrest, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (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: N/A
Current Illness:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received her immunization and within 5 minutes collapsed and stopped breathing. When she began breathing again she was very pale and complained of abdominal pain and had dilated pupils. After a few more minutes of observation and drinking orange juice she began feeling fine again and had no abnormal chest or heart sounds.


VAERS ID: 1849465 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-11-01
Onset:2021-11-07
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Dizziness, faint


VAERS ID: 1849469 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-11-07
Onset:2021-11-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness, Muscle tightness, Musculoskeletal stiffness, Mydriasis, Seizure like phenomena
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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: No known medications, supplements, or herbals.
Current Illness: None
Preexisting Conditions: None
Allergies: No known allergies.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: A 9 year-old female patient was administered the COVID-19 pediatric vaccine in her left deltoid muscle. Approximately 1 minute later, she lost consciousness and had a seizure-like reaction with both arms pulled in tight and stiff. Her pupils were very dilated. This lasted for about 30 seconds, and then she regained consciousness. She stated that she felt dizzy. She was monitored for about 30 minutes and she appeared and stated that she was feeling normal with no difficulty breathing or other adverse effects. Parents were informed that they should contact her pediatrician and to monitor her closely throughout the day. Parents were also informed to contact emergency services if at anytime she were to experience anaphylactic symptoms.


VAERS ID: 1849474 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-06
Onset:2021-11-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Sleep disorder
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: None
Current Illness: None
Preexisting Conditions: Autoimmune ITP
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Starting around 4am, I was woken from sleep with severe pain in my left axillary lymph nodes. Separately, I took Aleve, used a heating pad, massaged the lymph nodes, and took a warm epsom salt bath. None of these helped. At the time of my report the pain has not subsided, and I would still classify it as moderate to severe, sharp pain. If pain persists I will visit the ER for pain relief.


VAERS ID: 1849478 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-06
Onset:2021-11-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 3 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Dizziness, Fatigue, Headache, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular 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: N/A
Current Illness: N/A
Preexisting Conditions: Asthma
Allergies: N/A
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Fever and chills: 3am-4:30 am Vomiting: 7 am Headache, fatigue, dizziness, nausea: 7 am -ongoing as of 1:33 pm


VAERS ID: 1849479 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-06
Onset:2021-11-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 2 RA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Cough, Headache, Pain, Pain in extremity, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Daily multi-vitamin
Current Illness: Upper respiratory infection one week prior.
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Cough, runny nose, head ache, body ache, right arm pain.


VAERS ID: 1849486 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-11-06
Onset:2021-11-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Epistaxis, Headache, Pain
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: As stated in my description of the event, I had a nose-bleed and other minor discomforts occurring after my 2nd Covid-19 shot ta
Other Medications: Metformin HCL Hydrochlorothiazide Losartan Potassium Atorvastatin
Current Illness: None
Preexisting Conditions: Type II Diabetes, High Cholesterol and High Blood Pressure
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: I received my Covid-19 booster shot yesterday afternoon at 3:45 pm. I had previously received the Moderna vaccine for my initial series of shots in the spring. I developed a nose-bleed within 24 hours of receiving my second dose = I was also sore at the injection site and experienced tension in my teeth. I reported it in the database system. Now, I decided to try the Pfizer vaccine for my booster - in case it had fewer side affects, and to gain any benefit from mix-n-matching. Within 24 hours of the booster, I woke in the middle of the night with a bad headache and a nose-bleed. It stopped relatively shortly, but the soreness persisted as did the headache for most of the morning.


VAERS ID: 1849493 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-11-06
Onset:2021-11-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 3 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Recent double mastectomy on 10/22/2021
Preexisting Conditions: Recent double mastectomy on 10/22/2021
Allergies: Aztreonam, carbapenems, diazoxide, loop diuretics, macrolides, ketolides, penicillins, sumatriptan, tamsulosin
Diagnostic Lab Data: None at this time.
CDC Split Type:

Write-up: The site is red, raised, warm to touch and has a palpable knot. Arm is sore in the general area between the shoulder and my elbow. Patient has been using ibuprofen and tylenol as recommended to manage pain and swelling. Symptoms will be monitored and followed up with by pharmacy and medical staff of patient.


VAERS ID: 1849498 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-20
Onset:2021-11-07
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, CSF protein normal, CSF white blood cell count negative, Computerised tomogram thorax normal, Constipation, Decreased vibratory sense, Electromyogram, Flushing, Gait disturbance, Guillain-Barre syndrome, Hypersensitivity, Hyporeflexia, Immunoglobulin therapy, Laboratory test normal, Magnetic resonance imaging spinal normal, Muscular weakness, Neurological examination, Paraesthesia, Urinary retention
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Demyelination (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lipitor 40mgm, Cozar 25mgm, Baby ASA, Multivitimins
Current Illness: None
Preexisting Conditions: Cervical fusion Surgery
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 09/30 onset of parathesias hands feet arms and legs, urinary retention, constipation, facial flushing, and elevated BP, Seen at ED on 10/3 MRI C/T/L wnl, CT C/T wnl. On 10/13 noted difficulty walking, weakness of rt leg. Admitted to Hospital with presumptive DX of Gillian Barre. Neuro exam showed absent achilles tendon reflex, hypersensitivity of all extremities, and decreased vibratory sensation of feet. CSF showed protein of 42, WBC 0. Other labs wnl. Given 3 day protocol of IVIG 2mgm/kg with dramatic improvement of sx. discharged on 10/18. EMG and other lab performed as OP.


VAERS ID: 1849500 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-11-07
Onset:2021-11-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213D21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: no known drug allergies
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: patient said he was feeling light-headed and like he was going to pass out, he started sliding out of the chair the pharmacist was able to catch his head so it didnt hit the floor. He was unconscious for about 5 seconds, when he woke back up he wanted to lay there for a few minutes. we got him a water and called 911 immediately


VAERS ID: 1849516 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-07
Onset:2021-11-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Dysgeusia, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Metallic taste in mouth, dizziness, nausea, and confusion


VAERS ID: 1849521 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-30
Onset:2021-11-07
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 3 LA / IM

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

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

Write-up: Pt (DOB 06/21/1942) received Moderna booster on 10/30 at the Pharmacy. She complained of developing rash around shoulder, right arm and under breast area. I counseled her to call primary care physician to make sure she is ok. Patient has used hydrocortisone cream for the rash which seems to have helped her. First dose: Moderna on 03/30 Second dose : Moderna on 04/27


VAERS ID: 1849524 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-04
Onset:2021-11-07
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038F21A / UNK - / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Diabetes 2
Allergies: Codeine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Raised red blotches that feel very warm to the touch.


VAERS ID: 1849529 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-11-07
Onset:2021-11-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling abnormal
SMQs:, Anticholinergic syndrome (broad), Dementia (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: Asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is 8 years old came with his parents to get the Pfizer Pediatric COVID-19 vaccine, After administration, I asked them to have a seat for 15 minutes to monitor patient, after approximately 10 minutes, patient''s parent came and said that their son doesn''t feel good, he feels dizzy. Applied cold ice to patient hand and wrists, patient felt better and I asked the parents to stay for 30 minutes instead of 15 minutes. Patient felt better later and was okay to leave.


VAERS ID: 1849535 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-07
Onset:2021-11-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Cold sweat, Feeling hot, Posture abnormal, Presyncope
SMQs:, Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (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? No
Hospitalized? No
Previous Vaccinations: Patient said she passed out after every flu shot she had ever gotten. Her last flu shot was 10 years ago.
Other Medications: Patient stated she doesn''t take any medication of any kind
Current Illness: Patient stated she has no other illnesses at the time of vaccination.
Preexisting Conditions: NO chronic or long-standing health conditions per patient and husband.
Allergies: No known drug allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The patient''s husband motioned for me to come out to the post vaccination area. This was about 10 minutes after the patient received her first Moderna Covid 19 vaccine. Patient''s husband motioned for me to come out and help with his wife who had received a COVID vaccine about 10 minutes earlier. He said she''s about to pass out. He said we knew this was going to happen that''s why I came with her. He said she always passes out. Said she did every time she received a flu shot and therefore she was expecting it. Technician announced code white and another tech brought an ice pack out for us. He held her head and I held her torso up in the chair so she wouldn''t slump down in the chair and slide out. She felt a little clammy so we got an ice pack for the back of her neck and we asked her if she felt hot and she said yes. She had her eyes closed but she would always respond when we spoke to her. She slumped over again and them came back to but was just too weak to really open her eyes or hold herself up. She responded to us whenever we would ask her any questions. Her husband asked her if she wanted a drink of water so we gave her an unopened bottle of water and she could hold it herself and drink herself. She started perking up after that and even started eating her hot balls from her purse. She stayed with us for about 30 to 45 minutes and said she felt okay now. Two associates in the store (-claims associate) walked out with the patient and her husband to make sure didn''t have any spells on the way to the car. The patient hugged me before she left and said that was the best shot she ever got and said she really appreciated us tending to her and she would be back to get her 2nd shot here.


VAERS ID: 1849542 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-11-07
Onset:2021-11-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain
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: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: NONE
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Upon receiving the vaccine patient stated he thinks may have hit a nerve in his arm. He did receive the vaccine and was observed for the 15 minutes and did not indicate any arm pain or muscle pain and that his arm was fine.


VAERS ID: 1849558 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-11-07
Onset:2021-11-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aphasia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Dementia (broad), Parkinson-like events (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)

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: mother reported that patient had "passed out" following previous 2 pfizer vaccinations.
Other Medications: UNAVAILABLE
Current Illness: NONE REPORTED
Preexisting Conditions: REPORTED HISTORY OF TRAUMATIC BRAIN INJURY REPORTED HISTORY OF SEIZURE REPORTED HISTORY OF PREVIOUS REACTION TO PFIZER VACCINE (FAINTING).
Allergies: UNAVAILABLE
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Immediately following injection, patient became non-verbal and started shaking. (4:55 pm), Patient did not loose consciousness but was moved to the floor (mother had brought blanket for patient to lie on in case something like this happened as she expected). (5:00 pm). Ice pack applied to injection site at this time. Patient remained on floor lying down for 10-15 minutes before sitting up. Patient moved to chair at 5:20 and left with mother on his own legs.


VAERS ID: 1849564 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-11-07
Onset:2021-11-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213D21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Blood glucose increased, Feeling cold, Hyperhidrosis, Loss of consciousness, Pallor, Vision blurred
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Lens disorders (broad), Retinal 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NA
Current Illness: Diabetes, possible thyroid condition
Preexisting Conditions: diabetes
Allergies: NKDA
Diagnostic Lab Data: Blood Glucose 1521: 113
CDC Split Type:

Write-up: At 15:10 providers were alerted to situation by wife. Pt. had loss of consciousness. Pt was pale, cool, diaphoretic. He was rousable to stimulation. Pt has HR of 48, O2 of 80, He had respirations of 8 with his head lolling on his shoulder, and his mouth open and deep breaths. A&O was 2 times person and place. With prompting from the paramedic on scene he was able to rouse himself. Upon second assessment at 15:19 he stated he had blurry vision, and was A&O x4. BP was 130/90, O2 90, HR 96. Paramedics were called to scene where they were able to asses BS at 113. Hx from wife Pt diagnosed in 1996 with Diabetes II. He is chronically untreated, and has not seen any MD since 2006. Pt. does not use a BS test kit, and will not check his own sugar. He goes by a "feeling" which he uses to tell him when to eat or not. Per wife pt often appears pale, cool, and diaphoretic. They recommended pt be transported by ambulance to ED to be assessed by physician. Pt. refused and signed out AMA. Paramedics departed scene without pt. 15:40. Paramedics recommended pt stay and be monitored for 15 minutes. Pt.departed scene at 1550. Pt. departed scene AMA. All providers on scene recommended pt. see a specialist for his chronically untreated diabetes.


VAERS ID: 1849569 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: New York  
Vaccinated:2021-11-06
Onset:2021-11-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 3 LA / -

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

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

Write-up: The day if my vaccination, no adverse reaction. The morning after, I woke up with a large and painful lump just under the left arm pit, I had received the shot in! It is painful and seems to be getting larger. It is APX. 4" WIDE 6" LONG AND 1 PLUS ".S HIGH!!!


VAERS ID: 1849579 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-07
Onset:2021-11-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

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

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

Write-up: While injecting client with 0.2 ml in left deltoid muscle patient moved unexpectedly causing needle to come out of the arm. The full 0.2 ml was administered but vaccine leakage noted from injection site. Patient was observed. It was escalated to AP hotline and DOH. As per DOH patient is good to go. Patient left observation area in stable condition. AP hotline called and advised to revaccinate client with full dose. Patient father was reached out via phone, he said she will come back tomorrow.


VAERS ID: 1849584 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-07
Onset:2021-11-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 2 RA / IM

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

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

Write-up: HE FAINTED AFTER ONE MINUTE FROM COVID VACCINATION; THANKFULLY, HIS PARENTS WERE WITH HIM. I ASKED HIM IF HE WAS OK. HE CAME BACK RIGHT AWAY. I GAVE HIM WATER. CALLED THE FIRST ASSISTANT FROM THE STORE. A MANGER ASKED PARENTS IF HE NEEDED ER SERVICE. THEY REFUSED THE SERVICE BECAUSE HE REGAINED HIMSELF WELL. WE WILL FOLLOW UP TOMORROW TO MAKE SURE HE IS OK.


VAERS ID: 1849588 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-11-05
Onset:2021-11-07
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK51L7 / 1 LA / IM

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

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

Write-up: Hives appeared first on face (mouth, ears, scalp) and then moved to trunk, both front and back.


VAERS ID: 1849601 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-05
Onset:2021-11-07
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F21A / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Arthralgia, Erythema, Pain in extremity, Peripheral swelling, Rash erythematous, Rash macular
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 48 hours after injection: Found that both hands are swollen with both palms having a red, blotchy rash with pain in joints and redness. Received injection in left arm, rash/swelling/pain are more prevalent in left hand. Symptoms improve with OTC antihistamines and analgesics.


VAERS ID: 1849609 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-07
Onset:2021-11-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hypoaesthesia, Motor dysfunction, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

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

Write-up: Shortly after the 15 minute observation period, pt reported some numbness and tingling in posterior forearm without loss of motor function. Volunteer doctor examined patient noting a parasympathetic response unlikely to be associated with vaccine. Pt reported no other symptoms and was discharged.


VAERS ID: 1849614 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-07
Onset:2021-11-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 3 RA / IM

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

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

Write-up: PATIENT WAS GIVEN .5ML OF VACCINE (IN TWO .25 SHOTS) AND SHOULD HAVE RECEIVED .25


VAERS ID: 1849618 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-11-07
Onset:2021-11-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 3 RA / -

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

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

Write-up: PATIENT WAS GIVEN .5ML OF VACCINE (IN TWO .25 SHOTS) AND SHOULD HAVE RECEIVED .25ML


VAERS ID: 1849619 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: New York  
Vaccinated:2021-11-07
Onset:2021-11-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Immediate post-injection reaction, Joint contracture, Muscle spasms, Pallor
SMQs:, Dystonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Arthritis (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: N/A
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: After vaccination client immediately turned pale with bilateral hand clenching. Client laid down on the floor while concious AOx4, legs raised, 4 sets of vital signs taken, ice packs used. No swelling of the face or tongue. Clients hands massaged to relieve cramping. EMS called and arrived on site at 5:05pm. At that time client was able to sit up in chair no complaint of dizziness. Clients hands unclenched was able to move fingers on command, able to stand and without assistance and verbalized no shortness of breath or pain. EMS took vitals and fingerstick. EMS recommended follow up lab work at the hospital. Legal guardian and patient refused. Signed AMA form. Client walked out with legal guardians, EMS and nurse to their car to go home in no visible in distress.


VAERS ID: 1849625 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-11-07
Onset:2021-11-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 3 RA / IM

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

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

Write-up: PATIENT WAS GIVEN .5ML OF VACCINE (IN TWO .25 SHOTS) AND SHOULD HAVE RECEIVED .25ML


VAERS ID: 1849628 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-11-07
Onset:2021-11-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 3 RA / IM

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

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

Write-up: PATIENT WAS GIVEN .5ML OF VACCINE (IN TWO .25 SHOTS) AND SHOULD HAVE RECEIVED .25ML.


VAERS ID: 1849643 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-07
Onset:2021-11-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: PATIENT WAS FINE AT THE TIME OF INJECTION. AFTER 5 MINUTES, PATIENT FELL OFF HIS CHAIR. HE WAS WAKE AND ALERT WITH NO BREATHING ISSUE. 911 WAS CALLED. AFTER 5 MINUTES MEDIC CAME AND TOOK HIS VITALS. HIS VITALS WERE ALL NORMAL. PATIENT WAS SWEATING AND WAS ADVISED BY TO SEEK FURTHER EVALUATION AT THE EMERGENCY ROOM. HE AGREED TO SEEK FURTHER EVALUATION AND LEFT.


VAERS ID: 1849648 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-11-06
Onset:2021-11-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Gait disturbance, Headache, Myalgia, Pain in extremity, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer, Covid, dose 2, similar reaction
Other Medications: Cephalexen, hydroxyzine, multivitamin, cranberry supplement
Current Illness: Urinary tract infection
Preexisting Conditions: Depression, anxiety
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills, fever, headache, sore Muscles, right leg sore enough to impede walking


VAERS ID: 1849649 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-06
Onset:2021-11-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / UNK - / IM

Administered by: Private       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:
Current Illness:
Preexisting Conditions:
Allergies: Mild hives with cefdinir and amoxicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Diarrhea, treating with fluids and rest.


VAERS ID: 1849654 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-11-06
Onset:2021-11-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Lymph node(s) pain, age 44, March 3, 2021, Pfizer
Other Medications: Birth control, gummy multi vitamin, vitamin D, omeprazole, magnesium, Allegra, and Claritin
Current Illness: None
Preexisting Conditions: Heart burn, obesity
Allergies: Bee stings
Diagnostic Lab Data:
CDC Split Type:

Write-up: Lymph node(s) in my left armpit are swollen and uncomfortable. Same happened after second vaccine except in my right armpit because injection was in my right arm. This booster shot is less severe, but the person who administered said I should report this.


VAERS ID: 1849657 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-04
Onset:2021-11-07
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site induration, Injection site mass, Injection site urticaria, Pain
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (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: Covid moderna- 33 years old. I received dose 1 in March 2021 and dose 2 in April 2021. After both doses, my menstrual cycle chan
Other Medications: Adderrall, xyxal
Current Illness:
Preexisting Conditions: Asthma, migraines, adhd, sinusitis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I have painful hives at injection site with a hard lump larger than two quarters under my skin at injection site. I will follow up with my pcp.


VAERS ID: 1849669 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-11-07
Onset:2021-11-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 3 LA / IM

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

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

Write-up: Patient developed a severe rash on back, underarms, up her neck with hives and severe itching, patient had received the vaccine at about 3:15pm 11/7/21 and called the pharmacy at about 7:20pm on 11/07/2021


VAERS ID: 1849673 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-07
Onset:2021-11-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

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

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

Write-up: Patient received vaccine without issue and walked out of vaccination room. Approximately 2-3 minutes afterwards, she started to faint. Assisted mother in lowering patient to ground for safety. She regained consciousness within 10-15 seconds. The patient laid prone for approximately 10 minutes for safety, at which point she was fully conscious and able to talk. She was assisted to a sitting position and given small sips of water. As this was happening, the store called called and paramedics arrived within 15 minutes. The paramedics accessed the patient and transported her for further evaluation.


VAERS ID: 1849676 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-11-02
Onset:2021-11-07
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 3 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site swelling, Pyrexia, Skin warm
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: injection site swollen (diameter approx 2 inches), warm to the touch, fever


VAERS ID: 1849679 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-07
Onset:2021-11-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Immediate post-injection reaction, Muscle contracture, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none known
Current Illness: noknown
Preexisting Conditions: no known
Allergies: none known
Diagnostic Lab Data: 10:45 BP 97/49 10:47 112/92 10:50 89/51
CDC Split Type:

Write-up: Patient fainted immediately after vaccine at approximately 10:42 am. After 30 seconds patient regained consciousness. He did experience muscle contractions. After 20 minutes he was able to be released to his parents after drinking some juice


VAERS ID: 1849681 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-07
Onset:2021-11-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Immediate post-injection reaction, Nausea, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: no known
Current Illness: no known
Preexisting Conditions: no known
Allergies: no known
Diagnostic Lab Data: 10:33 am bp 98/56 10:37 109/56 10:41 114/77
CDC Split Type:

Write-up: Patient received vaccine around 10:25 am, within a minute of receiving vaccine, patient fainted. After 15 minutes of laying down she was able to sit in a chair. She later felt nauseated and vomited around 10:47 to 10:50. She felt well enough to leave with parents around 11 am


VAERS ID: 1849683 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-11-05
Onset:2021-11-07
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058F21A / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: fever after dose 2 of Moderna COVID shot
Other Medications: Zyrtec, ibuprofen, metformin, zantac, lisinopril, atorvastatin
Current Illness:
Preexisting Conditions: diabetes type 2
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever (up to 101.2 degrees) starting about 28 hours after injection and lasting about 24 hours. Swollen lymph nodes in armpit of injection arm starting 36-48 hours after injection.


VAERS ID: 1849685 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-07
Onset:2021-11-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Crying, Emotional distress, Loss of consciousness, Muscle tightness, Seizure like phenomena
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Patient''s mom reported patient "looking very pale" after her previous vaccine at dr''s office
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: 945 am bp 91/36 pulse 100
CDC Split Type:

Write-up: Patient recevied vaccine around 9:30 am. During first five minutes of observation, she experienced a seizure-like event/tightening of muscles and she lost consciousness for 30-60 seconds. After waking up, she remained upset and crying. Due to the seizure-like activity, EMS was called. Fire Department arrived within 5 minutes and assessed the patient. She was advised to follow up with Emergency room and released with mother around 10 am.


VAERS ID: 1849689 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-10-20
Onset:2021-11-07
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Abnormal vaginal bleeding.


VAERS ID: 1849696 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-11-06
Onset:2021-11-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK AR / SYR

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Nausea, Pain, Sluggishness
SMQs:, Acute pancreatitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: Paxil Valacyclovir Meloxicam
Current Illness: N/A
Preexisting Conditions:
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Queasy, fatigue, achey, sluggish


VAERS ID: 1849711 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-11-07
Onset:2021-11-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PEDIATRIC DOSE / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ear pain, Tinnitus
SMQs:, Hearing impairment (narrow)

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

Write-up: Bilateral ear pain lasting only 5-10 min at 2.5 hours after vaccine. High pitched noise in right ear (no pain) 8 hours after vaccine


VAERS ID: 1849712 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-05
Onset:2021-11-07
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Rash macular
SMQs:, 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: Imodium, Ativan, neurontin, Aimovig, combipatch, divergel
Current Illness: No
Preexisting Conditions: Migraines, bladder disease
Allergies: Gluten
Diagnostic Lab Data:
CDC Split Type:

Write-up: 48 hours post inject a large red splotch appeared below injection site going down my arm. This did not happen with my first two injections


VAERS ID: 1849716 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-05
Onset:2021-11-07
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Local urticaria approx 3cm diameter. Pruritic. At injection site. Resolved in 1 hour after cold pack applied and children?s Claritin given.


VAERS ID: 1849730 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-07
Onset:2021-11-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Erythema, Pruritus, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer EW0153 expiration date 4/9/21. Pfizer EW0182 expiration 5/7/21. Age 32 years old at time of vaccination and both dates ha
Other Medications: Medications: seroquel PO before bedtime for sleep, botox injections every 3 months for migraines, lamictal 100 mg PO daily.
Current Illness: N/A
Preexisting Conditions: Diagnosed with fibromyalgia, migraines, irritable bowel syndrome, gallbladder issues (pending surgery per client).
Allergies: Allergic to grass, dust, cats, latex and all have the reaction of hives.
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Client stated, "I am starting to itch on my arms and neck. I expected this to happen because I reacted the same way to my first and second dose of Pfizer." Co Lead RN observed red scratch marks on client''s neck, upper chest, and inner forearms bilaterally near elbows. Client denied symptoms of shortness of breath or difficulty swallowing. Co Lead RN recommended to client the administration of Benadryl 50 mg PO once to alleviate mild allergic reaction symptoms. Client was in agreement, Secondary RN prepared and administered Benadryl 50 mg PO once to client at 12:24 PM. At 12:26 PM first set of vitals: B/P RA 132/76, pulse 103, O2 SAT 98%. Client stated, "my heart rate is usually high. It runs between 99-103 so that is normal for me. I am seeing a cardiologist for that to be cleared for my my gallbladder surgery." Client denied drinking caffeine and denied being a smoker. Client was provided 2 water bottles and 1 gram cracker. At 12:29 PM Co Lead RN recommended for client to call father on cell phone. Co Lead RN educated client to enroll in V-SAFE and follow up with PCP within 24 hours. Co lead RN educated client on when to call 911 or go to urgent care if adverse symptoms reappeared when client got home. At 12:55 client stated, "the itching is coming and going in waves, but I am starting to feel better. I know I''ve taken 100-125 mg of Benadryl to my reactions in the past." Client began to have slight rash appear above left eye brow. Co lead RN educated client that Benadryl 50 mg oral medication needed 30-45 minutes to begin having affect and could only be administered once per policy. Client appeared stable and stated, "I am starting to feel better with the itching." 1:00 PM vitals retaken by Secondary RN: B/P: 147/92, pulse 95, O2 SAT 100%. At 1:15 PM Co Lead RN reassessed client and she stated, "I am fine now. I am ready to go home." Co Lead RN confirmed that father was in the parking lot of vaccination site. Left eyebrow rash was no longer visible on client. No hives nor rash on upper extremities/neck/torso on client. At 1:17 PM Co Lead RN walked with client whom had a steady gait to parking lot and witnessed client meet up with father.


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