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From the 7/16/2021 release of VAERS data:

Found 479,813 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 14 out of 4,799

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VAERS ID: 1463380 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Nausea-Mild, Systemic: Weakness-Mild


VAERS ID: 1463383 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Fatigue, Lethargy, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Exhaustion / Lethargy-Mild, Systemic: Nausea-Mild, Systemic: Weakness-Mild


VAERS ID: 1463394 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW 0178 / 2 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein, Chest pain, Computerised tomogram thorax, Decreased appetite, Dyspnoea, Electrocardiogram, Fibrin D dimer increased, Full blood count, Laboratory test normal, Malaise, Pyrexia, Sinus tachycardia, Troponin normal
SMQs:, Anaphylactic reaction (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: protonix, Zyrtec, Zofran, Claritin, , albuterol
Current Illness: none
Preexisting Conditions: . Chronic abdominal pain, asthma
Allergies: , Keflex, nystatin, food dye, yellow #6
Diagnostic Lab Data: . See item 18
CDC Split Type:

Write-up: . Patient developed fever, malaise and loss of appetite. Within a couple of hours of receiving his second dose. On 07/11/2021 patient woke with severe chest pain and shortness of breath. Presented to the emergency room. Found to have sinus tachycardia with nonspecific ST and T-wave changes on EKG, normal troponin, but elevated d-dimer and CRP. CBC within expected limits. Chemistries basically normal. CT scan of the chest with PE study negative for PE


VAERS ID: 1463414 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-17
Onset:2021-07-09
   Days after vaccination:114
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH GR8734 / 2 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Ear pain, Lymphadenopathy, Oropharyngeal pain, Pharyngitis
SMQs:, Agranulocytosis (broad), Oropharyngeal infections (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: Birth control (Ocella)
Current Illness: No
Preexisting Conditions: Ulcerative Colitis
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen lymph nodes and throat infection for one week. Extreme pain in ear and throat on left side only. Visited a Physician Assistant at Ear Nose Throat clinic and was prescribed antibiotic Cefdinir. I am halfway through the antibiotics and seeing great improvement so far.


VAERS ID: 1463415 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Electric shock sensation, Hypersomnia, Injection site pain, Neuropathy peripheral, Paraesthesia
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Depression (excl suicide and self injury) (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol .5, Hydrochlorothiazide 25mg, Levothyroxine 137 mcg, Amlodipine 10mg, Esmeprazole , FLonase
Current Illness:
Preexisting Conditions: Type 2 Diabetes, Metabolic Syndrome, High Blood Pressure
Allergies: Fluconazole
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: After my first Covid 19 shot I started to feel jabs of electrical jabs consistent with neuropathy in various parts of my body. Now, my hands and feet keep getting pins and needles. I keep feeling neuropathy sensations elsewhere as well. I am uncomfortable and have to keep moving to try and get rid of the sensations, but even that doesn''t help. I had expected pain in the area where the dose was injected and I slept a lot...... I did NOT expect to experience pins and needles consistent with nueropathy all over, and especially in my hands and feet, that are affecting me almost two days later still. I now have deep reservations about my follow up shot. I am keeping a copy of this report for my records.


VAERS ID: 1463419 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 2 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Chills, Decreased appetite, Disorientation, Feeling abnormal, Hyperhidrosis, Lymphadenopathy, Malaise, Pain, Tinnitus
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hearing impairment (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin (One-a-Day for Men)
Current Illness: None
Preexisting Conditions: None
Allergies: Ibuprophen (eyes swell shut)
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient received vaccine appx. 11am, went golfing after work, appx. 4:30pm. Began feeling "crummy" appx. 8:30pm, feeling "achy" and somewhat "sick with no appetite". Went home, began feeling more achy with chills. Ongoing sweating, chills, aching throughout night. Appx. 2am reports feeling "disoriented/confused", thought he was "hearing noises (unable to clearly describe these)". Reports feeling "crummy" after first vaccine, but nothing similar to this. Spent following day in bed, not feeling much better. Took Tylenol PM 650mg on following night; next morning reported feeling somewhat improved, but still under the weather with new notice of visible lymphadenopathy of left axillary nodes; describes as golf-ball sized and tender.


VAERS ID: 1463421 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Chills, Fatigue, Headache, Pain, Pain in extremity, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: -fever -chills/shaking - joint pain - pain in injection arm - full body pain -headache -fatigue


VAERS ID: 1463430 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PFIZERFA6780 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysgeusia, Feeling abnormal, Headache
SMQs:, Taste and smell disorders (narrow), Dementia (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: klonopin, lopressor, levothyroxine, zetia
Current Illness:
Preexisting Conditions: MVP, tracheobronchial mylagia, fibromyalgia
Allergies: floxin, cipro, statins
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: B/P remains elevated at 170/90 with headache..metallic taste in mouth, feelings that "I am out of my body"


VAERS ID: 1463442 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ear pruritus, Throat irritation, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall xr 10 mg po qd
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: full body onset of hives with severe itching in ears, throat. hives noted to neck, anterior and posterior torso, bilateral lower extremities. Benadryl 25 mg orally given. methylprednisone 4 mg given. Full recovery in 1 hour after medication administration Parent of the patient is a nurse practitioner who managed care in the home setting


VAERS ID: 1463448 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-12
Onset:2021-07-09
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Depression, Lethargy, Malaise, Pain
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (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
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: No adverse effects after 1st shot. On Friday approximately 6 hours after 2nd shot at approximately 9pm CST, daughter started feeling depressed, body aches, lethargic. Saturday morning still not feeling well. Saturday afternoon she took about a 3 hour nap, felt 90% better. By Saturday evening, she was 100%.


VAERS ID: 1463456 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Decreased appetite, Headache, Hyperhidrosis, Nasopharyngitis, Nausea, Oropharyngeal pain, Pain, Urticaria, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Within the first two hours soreness and headaches. The rest of the afternoon extreme headaches, nausea, body aches. By 8:30pm beyond cold shivers and sweating buckets of sweat/ overheating yet was cold. 2am vomiting, 5am sore throat and still sweating and shivering with hives and head aches. Lasted all of Friday and Saturday. Saturday night just headaches, sore throat, hives, and intense sweating. Sunday morning body aches, head aches, and still lose of appetite. This experience is the worst thing I?ve ever encountered. The head aches were undesirable.


VAERS ID: 1463475 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / IM

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

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

Write-up: Patient received her shot in the afternoon and called us 3 or 4 hours later to report she was experiencing swelling in her cheeks. She did not have any shortness of breath or swelling. She took a benadryl on 7-9-21 and again on 7-10-21 and on 7-11-21 she stated her swelling has gone down significantly.


VAERS ID: 1463481 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-04
Onset:2021-07-09
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939676 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pyrexia, Tonsillar hypertrophy
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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 listed
Current Illness: Acute bronchitis prior to vaccination, had cleared at time of administration per patient.
Preexisting Conditions: None listed
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient states noticed tonsil swelling on July 9, 5 days after receiving first dose of Moderna vaccine. Swelling and inflammation present, patient states still persists but does not report any breathing or swallowing difficulty. Pt also reports using OTC tylenol for mild fever after vaccination. Patient states he is seeking tonsil examination as soon as available but does not report any additional side effects.


VAERS ID: 1463513 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-07-03
Onset:2021-07-09
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Dysmenorrhoea, Menstrual disorder, Pelvic pain
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: CETIRIZINE WHEN NEEDED. I HAD NOT TAKEN THE MED FOR THAT DAY.
Current Illness: NO
Preexisting Conditions: ELEVATED BLOOD PRESSURE - NO MEDICATION / PERIMENOPAUSE
Allergies: LATEX
Diagnostic Lab Data: I WILL CONTACT MY PCP.
CDC Split Type:

Write-up: FRIDAY, 7/9/2021: ONE HUGE MENSES CLOT IN MASS AND LENGTH. FOLLOWED BY CRAMPING. LASTED MINUTES. SATURDAY, 7/10/2021: SLIGHT PELVIC ACHE RANDOMLY THROUGHOUT DAY. SUNDAY, 7/11/2021: AT 6:10 AM, TWO SMALLER MENSES CLOTS COME OUT. PELVIC ACHE ALL DAY.


VAERS ID: 1463515 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Severe, Systemic: Nausea-Severe, Systemic: Weakness-Severe, Additional Details: Reported yesterday with the details above for a different patient, but the incident was with this patient. I went back to the drug usage report to verify and called patient this morning but call went to voicemail. The COVID vacc was appropriately recon, dosed, timed and administered by my immunization certified technician. The paperwork errror is that I put the name on the "EVENT REPORTING SYSTEM" as this patient not other patient. Please make the correction accordingly.


VAERS ID: 1463549 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Hypoaesthesia, Insomnia, Muscle spasms, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 205A21A

Write-up: Around 9:45I started to feel like I was about to puke, then I got the chills, then a fever, then really bad body aches. I felt tired but couldn''t sleep because my body hurt so bad. I had also felt numb and tingling in my hands, feels, and face. I also had cramps being to happen. They all ended up fading with 48 hours.


VAERS ID: 1463574 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-28
Onset:2021-07-09
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / UNK LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Burning sensation, Erythema, Fatigue, Headache, Nausea, Pain in extremity, Pruritus, Vaccination site reaction, Vertigo
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexapro, vitamin D3 (5k UI), Allegra, acidophilus all taken daily
Current Illness: N/A
Preexisting Conditions: Depression
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: My arm was mildly sore the 2 days following the shot, then I had no noticeable symptoms until 7/9, when I noticed a circular red spot around the vaccination site that often itches, and burns when I unthinkingly scratch it. I have also noticed increased fatigue in the last few days as well as random bouts of nausea/vertigo that last no more than a minute or two. I had a severe headache yesterday that I''m uncertain if it was related but it lasted several hours.


VAERS ID: 1463587 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-06
Onset:2021-07-09
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Burning sensation, Pain, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac, Levothyroxine, Lisinopril-HCTZ, Topamax, Singulair.
Current Illness: None
Preexisting Conditions: High blood pressure, hypothyroidism, migraine, depression.
Allergies: Keflex
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Swollen armpit, burning pain.


VAERS ID: 1463591 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Nasal congestion, Paraesthesia oral, Pharyngeal paraesthesia, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (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: Vomited after MMR vaccine as a child
Other Medications: Standard supplements (fish oil, vitamin D, etc)
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Sensitive to all meds. Sulfa allergy
Diagnostic Lab Data: Treated at home
CDC Split Type:

Write-up: Throat closing, nasal passages closing, tingling throat and tongue


VAERS ID: 1463617 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-07-01
Onset:2021-07-09
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 2 - / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Heavy menstrual bleeding
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: heavy menstrual flow. The heaviest iv ever had in my life.


VAERS ID: 1463654 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-08
Onset:2021-07-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysmenorrhoea, Headache, Heart rate increased, Intermenstrual bleeding, Nausea
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Dehydration (broad)

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

Write-up: The night of first dose I had a fast heart beat all night I couldn?t sleep The second day a terrible headache and nausea Now I have bad cramps and am spotting as if I am going to start my period which I already finished my cycle last week I never had break thru bleeding or spotting like this a few days after my period finished. I am having symptoms again


VAERS ID: 1463668 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 2 RA / IM

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

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

Write-up: patient received 2nd dose on day 61 of the vaccine series


VAERS ID: 1463672 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 2 LA / IM

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

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

Write-up: patient received 2nd dose on day 43 of vaccine series


VAERS ID: 1463746 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-01
Onset:2021-07-09
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diplopia
SMQs:, Ocular motility disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lantus and Novalog (since the age of 12)
Current Illness: Type 1 diabetic childhood diagnosis, mother with hyperthyroidism ( shouldn''t this have been asked BEFORE being vaccinated?) Neuropathy, other stuff but about to tunesout
Preexisting Conditions: Diabetes
Allergies: Xanax
Diagnostic Lab Data: None ....already know no one will care
CDC Split Type:

Write-up: Double vision,can no longer see with both eyes open- I realize this will be written off as a diabetic thing but no, this has never happened before


VAERS ID: 1463751 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-07-08
Onset:2021-07-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood urine present, Dysuria, Urine analysis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage 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: Wellbutrin
Current Illness: None
Preexisting Conditions: Depression
Allergies: No
Diagnostic Lab Data: Urinalysis 7/11/21
CDC Split Type:

Write-up: Pain while urinating, blood in urine,


VAERS ID: 1463775 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Heart rate increased, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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:
Current Illness:
Preexisting Conditions: Pcos
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Elevated heart rate, chest pain, fever


VAERS ID: 1463904 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-02
Onset:2021-07-09
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939676 / 1 LA / IM

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

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

Write-up: Site: Bruising at Injection Site-Mild, Site: Itching at Injection Site-Medium, Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Mild, Site: Swelling at Injection Site-Medium


VAERS ID: 1463959 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-07-08
Onset:2021-07-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 1 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Tinnitus
SMQs:, Hearing impairment (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: Multi vitamins
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Very loud ringing in the ears


VAERS ID: 1463987 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 1 RA / IM

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

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

Write-up: Patient had no known adverse effects after injection. Patient was underage but authorization from legal guardian was granted.


VAERS ID: 1463988 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 1 RA / IM

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

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

Write-up: Patient had no known adverse effects after injection. Patient was underage, however authorization from legal guardian was given.


VAERS ID: 1464002 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B1A / 2 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: no
Preexisting Conditions: asthma
Allergies: Penicillin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: About 25-30 minutes after receiving the vaccine she broke out in hives, starting on face, chest, and arms. The hives eventually covered her from head to toe. She immediately returned to ED and was treated with Solumedrol 125mg IM and sent home on medrol dose pack.


VAERS ID: 1464004 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-07-01
Onset:2021-07-09
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Chills, Fatigue, Gait disturbance, Headache, Mobility decreased, Pain, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Duloxetine, methotrexate, folic acid, vitamin d, vitamin b-12, lisinopril.
Current Illness: None
Preexisting Conditions: Lupus, rheumatoid arthritis, depression, anxiety, headaches
Allergies: Penicillin and sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme sore arm?unable to use, Chills Achy all over Extreme fatigue Lower back pain causing difficult to bend, move, walk Headache


VAERS ID: 1464017 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Feeling hot, Pruritus
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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine 125 Mg daily, HCTZ 12.5 mg daily., Aleve 220 mg, 2 caps daily, Colace 100 mg PRN, Acetaminophen 650 mg PRN
Current Illness: None
Preexisting Conditions: Hx Thyroid Cancer, Anxiety/depression, IBS. Shingles. Allergic rhinitis., Diverticulitis of large intenstine, Osteopenia, Hypothyroidsim, Arthritis.
Allergies: Eucalyptus oil, Adhesive tape, Amoxicillin, Latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: At approximately the 30 minute mark, patient began complaining of hot and itchy palms. Palms and fingers developed redness and there were faint red areas bilaterally on both arms. Patient''s PCP consulted and 25 mg of Benadryl was given. PCP saw patient and determined she was safe to go home.


VAERS ID: 1464024 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-09
Onset:2021-07-09
   Days after vaccination:91
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood test normal, Chills, Computerised tomogram normal, Headache, Loss of personal independence in daily activities, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: 0
Current Illness: 0
Preexisting Conditions: 0
Allergies: mushroom allergy
Diagnostic Lab Data: CT scan and full blood panel to rule out CVST or other serious issues - all looked perfect by general standards. Appointment scheduled with a neurologist for further exploration.
CDC Split Type:

Write-up: Initial symptoms were as expected and quite intense - strong fever, chills, headache, and nausea starting 6 hours after injection and lasting for 24-48 hours. Lingering side-effect has been headaches. Dull general headaches at least 4 days a week that last much of the day and are cause to disengage from normal activity. I HAVE NEVER HAD REGULAR HEADACHES IN MY LIFE AND HAVE NEVER HAD A MIGRAINE. This is ONGOING TODAY (July 12).


VAERS ID: 1464036 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-07-07
Onset:2021-07-09
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Dyspnoea, Sleep disorder
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PATIENT STATES HE HAS HIGH BLOOD PRESSURE AND POSSIBLE ANXIETY.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT CALLED TO INFORM OF SHORTNESS OF BREATH IN THE MIDDLE OF THE NIGHT BEGINNING A FEW DAYS POST-VACCINATION AND CONTINUING EVERY NIGHT SINCE (ABOUT 3 DAYS SO FAR). IT WAKES HIM UP IN THE MIDDLE OF THE NIGHT AROUND 2 AND 3AM EVERY NIGHT. PATIENT STATES HE DOES HAVE HIGH BLOOD PRESSURE AND EXPERIENCING SOME ANXIETY LATELY. I INFORMED HIM TO ALSO CONTACT HIS PHYSICIAN FOR FURTHER REVIEW.


VAERS ID: 1464053 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-26
Onset:2021-07-09
   Days after vaccination:44
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Condition aggravated, Diverticulitis, Hospitalisation, SARS-CoV-2 test positive
SMQs:, Gastrointestinal nonspecific inflammation (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Humira, Vitamin D3, Cymbalta, synthroid, toprol xl, topamax,
Current Illness: COVID (+) 2/2/21, Palpitations, Inappropriate sinus tachycardia, SOB
Preexisting Conditions: Anklosing spondylitis, Anxiety, Arthritis, Chronic pain, hypothyroid, diverticulosis, fibromyalgia, GERD, migraine,
Allergies: Aspirin, hydromorphone, ibuprofen, meperidine, morphine, naproxen, walnuts
Diagnostic Lab Data: Nasopharyngeal Swab Sars-cov-2 using Xpert Xpress SARS-CoV-2 RT-PCR Cepheid assay ont eh GeneXpert Dx platform
CDC Split Type:

Write-up: Patient has COVID (+) 2/2/21, COVID vaccine given 5/26/21. Patient admitted on 7/9/21 for diverticulitis and found to be COVID (+) during routine admission testing. Only symptoms are GI related to diverticulitis.


VAERS ID: 1464062 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-20
Onset:2021-07-09
   Days after vaccination:50
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Herpes zoster
SMQs:, Opportunistic infections (broad)

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

Write-up: Shingles (Herpes Zoster) diagnosed on July 11, 2021. Prescribed Valacyclovir 1000mg. Still taking today (it''s second day of treatment. Rash started on July 9th, 2001. NOTE: I did donate blood on March 20th, 2021, about a month before my first dose (4/27/21) of the covid vaccine. Some research shows that there is a temporary drop in certain immune cells after donating blood (serum protein & antibodies). This should perhaps be looked into.


VAERS ID: 1464086 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Vomiting X1 (2 days prior)
Preexisting Conditions: None
Allergies: No known Allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Vaccine was given to patient who is 16 years old. Current EUA is for 18 years and older.


VAERS ID: 1464092 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-08
Onset:2021-07-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Diarrhoea, Headache, Myalgia, Nausea, Pain, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lyrical 75mg 3xs a day, Cymbalta 120mg daily, Metformin 500mg 2xs a day, Hydroxychlor 200mg 2xs a day, Prolea 1 injection 2xs a year, Lipitor 10mg daily, Zanaflex 4mg as needed, Hyaluronic Acid 120mg daily, Omega 3 1200mg daily, Calcium 600
Current Illness: no
Preexisting Conditions: fibromyalgia, diabetisis, rheumatoid arthritis, osteoporosis, neuropathies
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: By noon the next day her arm was on fire, bad headache and body aches, joints began to hurt and painful, had chills muscle pains, nausea, and diarrhea


VAERS ID: 1464102 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood glucose normal, Cold sweat, Fall, Pallor, Presyncope
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (narrow), 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: na
Preexisting Conditions: na
Allergies: na
Diagnostic Lab Data: na
CDC Split Type:

Write-up: After vaccination LPN called me into room, pt had unassisted fall to the floor, NP arrived to room and pt was left lateral position of the floor, vitals instantly grabbed at 1620 pt BP was 98/56 with a HR of 62, pt was pale and clammy, pt states no LOS, pt talking to us the whole time, pt and significant other denies any BS issues, BS taken was 109, pt then starting to have color return to the face, BP now 1625 104/60 HR 84, pt able to stand up and denies hitting head, on examination nothing seen, per significant other and pt this is the first vaccine he has received since pediatric vaccination, at this time appears to be vasovagal response, pt is ambulating and talking to significant other in waiting room, neurologically intact, PERRLA on both eyes, strength equal in all extremities, no bony tenderness on spine, neck supple no sign of injury, head is atraumatic and free from injury, pt vitals WNL and can go home, education gave on syncopal episodes.


VAERS ID: 1464117 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Posture abnormal
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), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: While sitting on a chair in front of the pharmacy after the shot, patient briefly lost consciousness as he slipped down the chair before his girl friend caught him, thereby preventing him from falling to the floor


VAERS ID: 1464123 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-12
Onset:2021-07-09
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Angiogram abnormal, Cerebral haemorrhage, Cerebral mass effect, Cerebral venous sinus thrombosis, Computerised tomogram abnormal, Computerised tomogram head, Haematoma, Haemorrhagic transformation stroke, Magnetic resonance imaging abnormal, Transverse sinus thrombosis, Vasogenic cerebral oedema, Venogram abnormal, Venous haemorrhage, Venous thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: NA
Preexisting Conditions: none
Allergies: nka
Diagnostic Lab Data: 7/9 CT without contrast - left parancymal hemorrage moderate amount of surrounding vasogenic edema with mass effect. 7/9 MRI/ MRA / MRV brain - left temporal actue intraparencytmal hematoma - temporanl vasogenic edema, likely venous infarct given moderatedly extensive DVT involving left sinus, sigmoid sinus and left IJ vein. No intracranial mass effect. 7/10 CT head without contrast - unchanged.
CDC Split Type:

Write-up: Admitted 7/9 with left temporal ICH with vasogenic edema and mass effect. Found to have hemorrhagic conversion of a venous infarct due to thormbosis of the left transverse sinus sigmoid sinus, left IJ vein and several left temporal draining cortical veins.


VAERS ID: 1464137 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 - / -

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

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

Write-up: Vaccine given at 3:00PM and it had an expiry time of 2:25 PM. stored in less than 42 degrees until time given.


VAERS ID: 1464138 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-01-24
Onset:2021-07-09
   Days after vaccination:166
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL33002 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0149 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: aspirin, albuterol, MVI
Current Illness: N/A
Preexisting Conditions: mitral valve disease, liver lesion, arthritis
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient tested positive for COVID and presented to the ED for monoclonal antibody infusion roughly 6 months after receiving both doses of Pfizer vaccine.


VAERS ID: 1464139 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-02
Onset:2021-07-09
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: COVID19, SARS-CoV-2; Positive
CDC Split Type:

Write-up: Symptomatic, started on 7/9/21 with cough, runny nose, nasal congestion, & fever.


VAERS ID: 1464147 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-23
Onset:2021-07-09
   Days after vaccination:136
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: COVID19, SARS-CoV-2; Positive
CDC Split Type:

Write-up: Symptomatic, started on 7/9/21 with cough, runny nose, nasal congestion, and fever


VAERS ID: 1464149 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-07-08
Onset:2021-07-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039C21A / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Axillary pain, Dizziness, Fatigue, Headache, Oedema peripheral, Pain in extremity, Pyrexia, Rash, Rash erythematous, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (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: Losartan; Metoprolol; Aspirin; Multivitamins
Current Illness: No
Preexisting Conditions: Elevated Blood Pressure
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever (40 degrees), headache, tiredness, weakness, dizziness. Arm area red with rash, hot to the touch, with pain. Swollen and sore armpit.


VAERS ID: 1464189 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

Administered by: Pharmacy       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? 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: Homebound patient. dose was drawn up in pharmacy and transported via syringe by a CDC qualified packout container in with a home RN to administer. Data logger and external thermometer in qualified packout were verified upon return. Data logger reads that it reach greater than 25 degrees C at 1:41pm. Upon reviewing off label stability data provided by Pfizer, doses drawn in synringes are good at 2-30 degrees C for 6 hours. This excursion did not affect the validity of this patient''s dose but does allow us to change policies with home visits to help prevent future excursions.


VAERS ID: 1464221 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 RA / IM

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

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

Write-up: Vaccine administration error. 17 year old patient walked in to vaccination site with father around 2:35pm. We were running Moderna at that time but still had a few doses of Pfizer left from the morning session so we registered patient for COVID-19 vaccine. During registration there was miscommunication due to language barrier and the father was registered instead of the 17 year old son. Moderna vaccine was administered when it should have been Pfizer. I as the clinical lead realized an administration error had been made when the wayfinder handed me a blue prevax form for Pfizer and there was no Pfizer on the floor (they were locked in the med room). We immediately brought the 17 year old patient and the father to an exam room and informed them about the error (wrong patient was registered and Moderna was given instead of Pfizer). They were both very understanding and did not have questions or concerns.


VAERS ID: 1464231 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-07-07
Onset:2021-07-09
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Neck pain, Pain, Troponin increased
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), 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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: NKA
Diagnostic Lab Data: Troponin elevated-initially 0.21 on 7/10, peaked at 4.42 on 7/11 at 1738, then downtrending to 2.76 at time of discharge on 7/12
CDC Split Type:

Write-up: right sided chest pain with radiation to right side of neck with walking. Denies shortness of breath, nausea, vomiting, palpitations, dizziness


VAERS ID: 1464245 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-25
Onset:2021-07-09
   Days after vaccination:106
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 2 LA / IM

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

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

Write-up: SARS-CoV-2 RNA Resp Ql NAA+probe~2019 Coronavirus SARS-CoV-2 test performed for patient on 07/09/2021 and came back positive. Case investigation interview with case has not been performed at time of this note.


VAERS ID: 1464269 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-08
Onset:2021-07-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Phentermine Hair skin and nails
Current Illness: None
Preexisting Conditions: Allergy to own sweat and water, I break out in hives when sweaty or wet Pcos Pre diabetic
Allergies: Oral allergy to all fruit Allergy to own sweat and water, I break out in hives when sweaty or wet
Diagnostic Lab Data: None that im aware of?
CDC Split Type:

Write-up: First the injection site swelled big and red and itches and hurts like no other. Then a body rash that hurts and itches appeared on Friday the day after getting the shot and today is Monday and its still spreading slowing and its just itches more than my shingles did


VAERS ID: 1464306 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-08
Onset:2021-07-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Headache, Restless legs syndrome
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: none
Current Illness: none
Preexisting Conditions: none
Allergies: mango allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: headache for 2 days then resolved, restless leg syndrome for 3 days then resolved, yellow oily diarrhea on day 4 with no change to diet


VAERS ID: 1464314 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011021A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Benzoyl Peroxide (10%) soap; Adapalene Gel (.1%) topical:
Current Illness: None
Preexisting Conditions: None
Allergies: None known
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Moderna Vaccine administered to an adolescent (13 Years old)


VAERS ID: 1464321 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-08
Onset:2021-07-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aphthous ulcer, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient reported a high fever (104 degrees F) followed by Aphthous ulcers (canker sores) all over her mouth. She saw a dentist on 7/12/21 and will be seeing her PCP on 7/15/21. She said that she is treating the canker sores with salt water rinses.


VAERS ID: 1464338 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-20
Onset:2021-07-09
   Days after vaccination:111
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 LA / IM

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

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

Write-up: SARS-CoV-2 RNA Resp Ql NAA+probe~2019 Coronavirus SARS-CoV-2 performed on 07/09/2021 and came back positive. Case investigation interview with patient has not been conducted at the time of this note.


VAERS ID: 1464345 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-06-18
Onset:2021-07-09
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Echocardiogram, Electrocardiogram, Electrocardiogram ST segment elevation, Immunoglobulin therapy, Myocarditis, Troponin increased
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Focalin, Clonidine, Melatonin, Albuterol
Current Illness: none
Preexisting Conditions: pectus excavatum
Allergies: Erythromycin, Prednisone
Diagnostic Lab Data: 7/9-7/13: EKG, ECHO, Troponin, myocarditis workup
CDC Split Type:

Write-up: myocarditis with noted chest pain, diffuse ST elevation, and troponin $g50. Received IVIG and IV steroids


VAERS ID: 1464352 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-18
Onset:2021-07-09
   Days after vaccination:141
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Dyspnoea exertional, SARS-CoV-2 test positive
SMQs:, Pulmonary hypertension (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: Patient received Pfizer vaccines on 1/28/21 and 2/18/21, tested positive for COVID by PCR on 7/9/21. Admitted to hospital due to dyspnea on exertion on 7/9/21 and diagnosed w/ presumed COVID-19 pneumonia, received remdesivir. Patient has underlying h/o of relapsed CLL and lives in an assisted living community.


VAERS ID: 1464364 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2020-12-19
Onset:2021-07-09
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK57330 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Respiratory disorder, SARS-CoV-2 test positive
SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data: 07/09/21 2129 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 07/09/21 1309 | Final result | Specimen: Swab from Nasopharynx COVID-19 SARS-CoV-2 Overall Result DetectedCritical
CDC Split Type:

Write-up: respiratory disorder


VAERS ID: 1464411 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-11
Onset:2021-07-09
   Days after vaccination:120
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A-2 / 2 LA / SYR

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

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

Write-up: Received Moderna vaccines on 2/11/21 and 3/11/21. Tested positive for COVID-19 by PCR on 7/9/2021. Will received monoclonal antibody therapy.


VAERS ID: 1464433 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-11
Onset:2021-07-09
   Days after vaccination:59
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Delivery, Exposure during pregnancy, SARS-CoV-2 test positive
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Normal pregnancy conditions and outcomes (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received Moderna vaccines on 4/13/21 and 5/11/21 while pregnant. Tested positive for COVID-19 by PCR on 7/9/21 on hospital admission screening to labor and delivery unit. Delivered infant on 7/9/21. History of COVID-19 positive by PCR on 12/13/20. Unknown if symptomatic.


VAERS ID: 1464446 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-05
Onset:2021-07-09
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 2 LA / SYR

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

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

Write-up: Patient tested positive for COVID-19 by PCR on 7/9/21. Unknown if symptomatic. Received Pfizer vaccines on 1/5/21, 2/5/21.


VAERS ID: 1464451 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-08
Onset:2021-07-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Hives: tetanus vaccine, flu vaccine. Age 15 and 20s.
Other Medications: Tamoxifen 20mg Losinapril Magnesium 250mg Aspirin 80mg
Current Illness: None
Preexisting Conditions: Sarcoidosis
Allergies: Bees Penicillin Tetanus vaccine Flu vaccine Demerol Sulpha drugs
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 25 hours after shot?Extreme Fatigue, chills, fever, body aches, headache. Symptoms subsided approximately 30 hours later


VAERS ID: 1464459 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Interchange of vaccine products, No adverse event
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: methylphenidate 18mg ER once daily, women''s multivitamin once daily, tri-sprintec tablet once daily
Current Illness: none
Preexisting Conditions: none
Allergies: NKDA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: none, she had received the pfizer after receiving the Johnson and Johnson vaccine 4/5/2021


VAERS ID: 1464468 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pruritus
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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Taking Omeprazole 20 MG Capsule Delayed Release 1 capsule Orally Once a day, Taking Zyrtec Allergy 10 MG Tablet 1 tablet Orally Once a day, Taking Aspirin 81 MG Tablet Chewable 1 tablet Orally Once a day, Taking Fluticasone Propionate 50 MC
Current Illness:
Preexisting Conditions:
Allergies: Haloperidol, Codeine Sulfate
Diagnostic Lab Data:
CDC Split Type:

Write-up: 30 min after patient received #2 COVID Pfizer Vaccine patient began to itch on arms, legs and chest. Patient was seen by a medical provider and given Benadryl 50mg. Shortly after that patient was discharged to go home.


VAERS ID: 1464483 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D tablet
Current Illness:
Preexisting Conditions:
Allergies: Tramadol
Diagnostic Lab Data: Office visit 07/12/2021
CDC Split Type:

Write-up: Skin rash


VAERS ID: 1464500 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-02
Onset:2021-07-09
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Peripheral swelling, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, fenofibrate, duloxetin, topiramate,simvastatin, losartan, quetiapine,vitamina d3.
Current Illness: High blood pressure, diabetes 2, depression, cervical hernias, arthritis, high cholesterol.
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Redness, swelling in the arm and fever.


VAERS ID: 1464506 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-07-01
Onset:2021-07-09
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Injection site induration, Injection site pruritus, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: montelukast 10mg
Current Illness:
Preexisting Conditions: hashimotos autoimmune disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hard bump under skin, red itchy spot on arm at injection site, warm to the touch, swollen. Visible for about 48 hours.


VAERS ID: 1464614 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-25
Onset:2021-07-09
   Days after vaccination:106
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Pt admitted to the hospital for COVID 19 post vaccination


VAERS ID: 1464698 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-06
Onset:2021-07-09
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037A21B / 2 UN / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Cough, Headache, Influenza, Influenza B virus test positive, Pain, Rhinorrhoea, SARS-CoV-2 test positive, Sneezing
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Insulin via pump; centroid; medicine for Adison''s disease; vitamin C; vitamin D3; vitamin biotin; calcium; colatin
Current Illness: None
Preexisting Conditions: Addison''s disease; asthma; type one diabetes; gastro paresis
Allergies: A certain med, can''t remember the name; sulfa drugs
Diagnostic Lab Data: Covid test, positive. Influenza B, positive.
CDC Split Type: vsafe

Write-up: I started sneezing and got a really runny nose. I had body aches and headaches. I have a cough. I was tested for COVID on 7/09/2021 and tested positive, and also tested positive for Influenza B.


VAERS ID: 1464726 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-07
Onset:2021-07-09
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiocardiogram, Cardiac imaging procedure abnormal, Echocardiogram, Myocarditis, Troponin increased
SMQs:, Myocardial infarction (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Asthma, mild, well controlled
Preexisting Conditions: None
Allergies: nkda
Diagnostic Lab Data: Echocardiogram, cardiac MRI, coronary angiography, troponin test 7-2021
CDC Split Type:

Write-up: Myocarditis, with troponin elevation, verified on cardiac MRI


VAERS ID: 1464739 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-07-08
Onset:2021-07-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chronic obstructive pulmonary disease, Condition aggravated, Dyspnoea, Pyrexia, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ipratropium/albuterol neb soln, cetirizine, lisinopril, omeprazole, metformin, mirtazapine, prednisone, Trelegy
Current Illness: Asthma and brochitis
Preexisting Conditions: COPD, diabetes
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: The day following the second Moderna imz, pt went to ER due to high fever, weakness and exacerbation of COPD with wheezing and difficulty breathing


VAERS ID: 1464741 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Chills, Dizziness, Eye pain, Fatigue, Headache, Hypoaesthesia, Muscular weakness, Paraesthesia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Nuts and peaches
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills, fever, headache, fatigue. Muscle weakness and eye pain within 24 hours Continued headache with fatigue and eye pain. New symptoms include back pain, dizziness, Numbing and tingling of arms, legs, and faces within 72 hours


VAERS ID: 1464807 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: nkda
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: ABOUT ONE-FORTH OF THE DOSE LEAKED OUT OF THE SYRINGE WHETER THE NEEDLE ATTACHES WHILE BEING ADMINISTERED TO THE PT


VAERS ID: 1465092 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-06-28
Onset:2021-07-09
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site erythema, Injection site rash
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)

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

Write-up: About a week and a half after my first shot I developed a red rash around my injection site. It was circular and painless, about the size of a quarter. I have had no other issues, but wanted to report this because I was not asked about it on my latest v-safe check in. The rash is disappearing and it was never itchy or painful.


VAERS ID: 1465369 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C211A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Injection site swelling, Injection site warmth, Pyrexia
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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ProAir aerosol/albuterol - as needed Losartan (50mcg)
Current Illness: high blood pressure
Preexisting Conditions: Asthma
Allergies: no known
Diagnostic Lab Data: primary doc, prescribed cephalexin 500mg oral tablet and said to continue with Iburprofen as necessary.
CDC Split Type:

Write-up: After dose 1 - normal stiffness, feeling of semi-fatigue After dose 2 - approx 13 hours. site of injection started to feel warm and swelling started; next day w/in 24 hours, strong fatigue, fever 101.6, and the swelling had spread it was about palmsize , raised, warm to touch and swollen. Today is day 3 since vaccine and swelling is still there. Fever comes in /out (low grade of 99-100).


VAERS ID: 1465387 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-08
Onset:2021-07-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site erythema, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline 50mg
Current Illness:
Preexisting Conditions:
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Large red swollen area that was warm to the touch where shot was administered. Started day after shot improving 4 days later. Headache for 2 days after shot and fatigue for one day after shot.


VAERS ID: 1465675 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Kansas  
Vaccinated:0000-00-00
Onset:2021-07-09
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Non-smoker
Preexisting Conditions: Comments: The patient had no known allergies.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210722813

Write-up: POOR QUALITY VACCINE ADMINISTERED; INCORRECT PRODUCT STORAGE; This spontaneous report received from a pharmacist concerned a 76 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included non smoker, and other pre-existing medical conditions included the patient had no known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 1820096, expiry: 06-SEP-2021) .5 ml, administered on 09-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 09-JUL-2021, the subject experienced poor quality vaccine administered. On 09-JUL-2021, the subject experienced incorrect product storage. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the poor quality vaccine administered and incorrect product storage was not reported. This report was non-serious. This case, from the same reporter is linked to 20210722914.


VAERS ID: 1465676 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Missouri  
Vaccinated:0000-00-00
Onset:2021-07-09
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / UNK - / -

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: Comments: The patient had no known drug allergies. The patient was not pregnant at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210722854

Write-up: INAPPROPRIATE DOSE OF VACCINE ADMINISTERED; This spontaneous report received from a pharmacist concerned a 65 year old female. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included the patient had no known drug allergies. the patient was not pregnant at the time of vaccination.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 1808978, expiry: 28-JUL-2021) dose was not reported, administered on 09-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 09-JUL-2021, the subject experienced inappropriate dose of vaccine administered. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of inappropriate dose of vaccine administered was not reported. This report was non-serious.


VAERS ID: 1465678 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Kansas  
Vaccinated:0000-00-00
Onset:2021-07-09
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820096 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Non-smoker
Preexisting Conditions: Comments: The patient had no known allergies and had no medical conditions.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210722914

Write-up: ADMINISTRATION OF EXPIRED VACCINE; INCORRECT PRODUCT STORAGE; This spontaneous report received from a pharmacist concerned a 65 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included non smoker, and other pre-existing medical conditions included the patient had no known allergies and had no medical conditions.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 1820096, expiry: 06-SEP-2021) .5 ml, administered on 09-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 09-JUL-2021, the subject experienced administration of expired vaccine. On 09-JUL-2021, the subject experienced incorrect product storage. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the administration of expired vaccine and incorrect product storage was not reported. This report was non-serious. This case, from the same reporter is linked to 20210722813.


VAERS ID: 1465679 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-07-09
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Body temperature, Feeling drunk, Inappropriate affect, Oropharyngeal pain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic 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: NAPROXEN 500 MG
Current Illness: Allergy to chemicals; Hand injury (Naproxen 500 mg (generic for Naproysn) for an injury to my hand prior to being vaccinated which I was instructed to stop taking 24 hours before and 6 hours after vaccination. I waited as long as I could and took the Naproxen 10 hours later.)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210709; Test Name: Body temperature; Result Unstructured Data: 98.8
CDC Split Type: USJNJFOC20210722964

Write-up: SEVERE BODY ACHE; GIGGLES; HIGH ANXIETY; FEELING DRUNK; LOW GRADE FEVER; MILD AND DRY SORE THROAT; This spontaneous report received from a patient concerned a 48 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included allergic to some topical polyethylene glycol (peg), and hand injury. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 09-JUL-2021 for prophylactic vaccination. The batch number was not reported and has been requested. Concomitant medications included naproxen for hand injury. On 09-JUL-2021, the subject experienced mild and dry sore throat. On 09-JUL-2021, the subject experienced giggles. On 09-JUL-2021, the subject experienced high anxiety. On 09-JUL-2021, the subject experienced feeling drunk. On 09-JUL-2021, the subject experienced low grade fever. Laboratory data included: Body temperature (NR: not provided) 98.8. On 10-JUL-2021, the subject experienced severe body ache. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from mild and dry sore throat, severe body ache, low grade fever, feeling drunk, giggles, and high anxiety. This report was non-serious.


VAERS ID: 1465760 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Adverse reaction, Erythema, Inflammation, Testicular swelling
SMQs:, Anaphylactic reaction (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Advair 50/250 Albuterol
Current Illness: None
Preexisting Conditions: Asthma
Allergies: None
Diagnostic Lab Data: I was examined by Dr on 07/12/21. The doctor ordered a urinalysis and ultrasound test.
CDC Split Type:

Write-up: Adverse Reaction: Eight hours after receiving the injection I felt a burning sensation in the groin and scrotum. The scrotum turned bright red in color and the testicles swelled. The inflammation and swelling continued overnight until 07/10/21 when it later subsided. The scrotum and testicles remained sensitive but without inflammation until 07/11/21. Additional symptoms: In addition to the adverse reaction I experienced a fever of 101 degrees from 07/09/21 through 07/11/21. I experienced an extreme headache, nausea, dizziness, fatigue, muscle pain, and swelling of the injected arm which started 3 hours after the injection until the end of the day on 07/11/21.


VAERS ID: 1465763 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Erythema, Hypertension, Pruritus
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Hypertension (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: Pt reported redness and ichness on his face, abdomen, bilateral arm. PT denied difficulty of breathing nor dizziness. Consulted on-call Dr and requested to assess pt; IM Diphenhydramine 1mg BP 147/101, HR 89, O2 100% at 320 pm. Pt reported decrease of itchiness at 325 pm. 500ml Oral fluid given. BP 143/101, HR 92, O2 100% at 330 pm. BP 144/98, HR 83, O2 100% at 335 pm. Advised to consult with primary care about his high Blood pressure.


VAERS ID: 1466002 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-08
Onset:2021-07-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain, 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Head cold 2 weeks before
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: By the following day after getting shot 1 in the covid series Pfizer, she started breaking out in a rash all over her body that itches and hurts. We went to the Dr and she was given hydrocortisone that doesn''t help. Its been 4 days and the rash is still slowly spreading


VAERS ID: 1466436 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-05
Onset:2021-07-09
   Days after vaccination:65
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 031B21A / UNK - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 031A21A / UNK - / IM

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

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

Write-up: Admitted to the hospital after full vaccination.


VAERS ID: 1466444 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-08
Onset:2021-07-09
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 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? Yes
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: NO KNOWN ALLERGIES
Diagnostic Lab Data:
CDC Split Type:

Write-up: REPORTING ERROR ONLY BECAUSE PATIENT IS UNDER FDA APPROVED AGE FOR MODERNA (18+) PATIENT WAS 16 YEARS AT THE TIME OF VACCINATION NO ADVIRSE REACTIONS


VAERS ID: 1466448 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Choking, Dysphagia, Pharyngeal swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
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: Throat swelling caused choking when attempt to swallow. Food was lodged in tbroat and choking occurred for appx one minute before food was dislodged preventing severe circumstance


VAERS ID: 1466530 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW 0178 / 2 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Arthralgia, Dry skin, Oral herpes, Pruritus, Rhinorrhoea, Skin exfoliation
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Oropharyngeal infections (narrow), Hypersensitivity (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Thyroid supplement "Soothe", prenatal vitamins
Current Illness: none
Preexisting Conditions: Hashimoto''s Thyroiditis, psoriasis
Allergies: none known
Diagnostic Lab Data: No tests or labs performed at this juncture.
CDC Split Type:

Write-up: On the night of the second injection (7/9/2021) I began to experience moderate joint pain. The following morning (7/10/2021) I took 400 mg ibuprofen and the pain subsided and has not returned. On the third day post injection (7-11-2021) I developed a herpes simplex sore on my upper lip and have taken 6 doses of 400 mg of acyclovir, the sore is slowly healing. On the fourth day post injection (7/12/2021) I developed allergy symptoms: itchy eyes, nose, ears, scalp, runny nose, drier facial skin. I have taken two doses of OTC Zyrtec and none of the symptoms have lessened and are ongoing (7/13/2021). Also, the skin between and under my breasts and my right thumb peeled off like a sunburn had occurred, but the skin had not been exposed to any sunlight. No more signs of this symptom at this time. (7/13/2021).


VAERS ID: 1466584 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-07-08
Onset:2021-07-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Chest discomfort, Chest pain, Electrocardiogram normal, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), 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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: Booster MRI-August 2019 he exp lightheadedness, passed out due to needle not vaccine.
Other Medications: Prozac 20 mg
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: EKG(results normal)
CDC Split Type: vsafe

Write-up: On Friday he stayed in bed all day with body aches, joints pains, fever 102. Then on Saturday he got up out of bed with complaints of chest discomfort (felt as if someone had punched him in the chest). On Sunday around 12:30 am he was still exp chest pain he was taken to Hospital. He got EKG around 1:45 am by that time he wasn''t exp chest pains. Since early Sunday morning he hasn''t had any chest pains starting to gradually feel better. On Monday he was able to do he normal routine.


VAERS ID: 1466591 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-08
Onset:2021-07-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ROSUVASTATIN, TIZANIDINE, LOSARTAN, VITAMIN C, B12, D2, MULTIVITAMIN, BENADRYL, TYLENOL
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: MY FIRST DOSE WAS ON 12 JUNE 2021. ONLY HAD A RIGHT SORE ARM/SHOULDER. SECOND DOSE WAS AT PHARMACY SYMPTOMS STARTED AFTER 14 HOURS OF RECEIVING DOSE. FEVER OF 100, CHILLS, HEADACHE. LASTED FOR ABOUT 6 HRS. TYLENOL, FIREBALL AND GATORAID WAS MY TREATMENT. STARTED TREATMENT AS SOON AS 1 HR AFTER DOSE. (I KNOW FIREBALL IS NOT RECOMMENDED). I DID NOT FEEL THE NEED TO GO TO A DOCTOR. I FEEL GREAT NOW.


VAERS ID: 1466596 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-08
Onset:2021-07-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Computerised tomogram, Dyspnoea, Electrocardiogram, Ultrasound scan
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: Blood Tests 07/10/2021 EKG 07/10/2021 Cat-Scan 07/10/2021 Ultrasound 07/10/2021
CDC Split Type:

Write-up: Pt.''s mother states after receiving the 2nd dose of Phizer 07/08/2021, starting experiencing shortness of breath the following day 07/09/2021. Urgent Care visit 07/10/2021 gave steroid shot, follow-up with Cardiologist. Worsened 07/11/2021 ER visit, Colchicine prescribed 2 weeks with follow-up with Cardiologist. Still experiencing shortness of breath.


VAERS ID: 1466603 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-07
Onset:2021-07-09
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Pruritus
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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pruritis


VAERS ID: 1466687 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / UNK RA / IM

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

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

Write-up: Vaccination given in error. Pt was not 18 years old at the time of administration.


VAERS ID: 1466733 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-01
Onset:2021-07-09
   Days after vaccination:69
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Intensive care, Pneumonia, Respiratory failure, SARS-CoV-2 RNA, SARS-CoV-2 antibody test, 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), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: No
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: SARS CoV-2 RNA, RT- PCR: Positive July-10-2021 Anti-SARS-CoV-2: Reactive July-9-2021
CDC Split Type:

Write-up: Patient developed severe bilateral pneumonia with respiratory failure requiring ICU Admission. SARS CoV-2 RNA, RT- PCR tested positive


VAERS ID: 1466749 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-09
Onset:2021-07-09
   Days after vaccination:91
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Dehydration, Gastroenteritis
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Noninfectious diarrhoea (broad), Dehydration (narrow)

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

Write-up: gastroenteritis, dehydration


VAERS ID: 1466757 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-08
Onset:2021-07-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Chest pain, Computerised tomogram, Electrocardiogram, Scan with contrast, Tachycardia, Thyroid function test
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft- 100 mg , Strattera 40 mg
Current Illness: none
Preexisting Conditions: ADHD, Aspergers
Allergies: none
Diagnostic Lab Data: Fluids given, EKG, Chest X-Ray, CT with Contrast, Checked Thyroid, various other blood tests.
CDC Split Type:

Write-up: Chest Pain, Tachycardia, Resting heart rate stayed around 130 for the approx 11 hours we were in the emergency room.


VAERS ID: 1466765 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-07-07
Onset:2021-07-09
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Ear pain, Headache, Increased upper airway secretion, Nasal congestion, Oropharyngeal pain
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: Vitamin D
Current Illness:
Preexisting Conditions:
Allergies: Bananas
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore throat, congested throat and nose, coughing, headache and ear ache


VAERS ID: 1466771 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-02
Onset:2021-07-09
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046821A / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, Fenofibrate, Losartan, Duloxetine, Topiramate, Quetiapine, Simvastatin, Vit D.
Current Illness:
Preexisting Conditions: HTN, DM, Fibromyalgia, Hyperlipidemia
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Redness, swelling and pain in left arm Doxycycline 100 mg Po BID x 10 days


VAERS ID: 1466815 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009021A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: FLU VACCINE IN 2008 (?) EXPERIENCED HIVES AND HIGH FEVER. AGE 58. BRAND NAME UNKN
Other Medications: METFORMIN, LISINOPRIL, HYDROCHLOROTHIAZIDE, LEVOTHYROXINE, JARDIANCE, OMEPRAZOLE
Current Illness: NONE
Preexisting Conditions: TYPE II DIABETES
Allergies: COMPAZINE, POMAGRANATES
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: 8 HOURS AFTER THE INJECTION I NOTICED REDNESS, TENDERNESS, HEAT AND KNOTS AT THE INJECTION SITE. THE FOLLOWING MORNING THE IRRITATION HAD INCREASED AND GROWN IN SIZE AND INCREASED THROUGHOUT THE DAY AND INTO THE NEXT DAY. THE FINAL SIZE WAS THAT OF A LARGE SOFTBALL. BY THE FIFTH DAY (7/13/21) THE REDNESS ETC IS DISSIPATING AND OTHER SYMPTOMS ARE FADING. TREATMENT WAS BENADRYL AT BEDTIME AND IBUPROFEN DURING THE DAY. NO DR OFFICE VISIT NEEDED, BUT I DID NOTIFY THEM OF THE REACTION SO IT COULD BE NOTED IN MY MEDICAL RECORDS.


VAERS ID: 1466822 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-01-25
Onset:2021-07-09
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Ageusia, Anosmia, Cough, Ear pain, Fatigue, Headache, Myalgia, Nasal congestion, Oropharyngeal pain, Pyrexia, Rhinorrhoea, SARS-CoV-2 RNA
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: SARS CORONAVIRUS-2 RNA, V; Detected
CDC Split Type:

Write-up: Symptomatic, started on 7/9/21 with cough, runny nose, muscles aches, nausea, loss of smell & taste, sore throat, nasal congestion, fever, headache, fatigue abdominal pain, & ear ache.


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