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

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

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 140 out of 10,493

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VAERS ID: 1988643 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-12-16
Onset:2021-12-27
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014J21A / 3 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Erythema multiforme, Mechanical urticaria, Pain, Pruritus, Sensitive skin, Skin irritation, Skin lesion
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Hypersensitivity (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations: Patient experienced minor ?Covid arm? rash after second vaccine on 5/7/21
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Dog hair and dust mite
Diagnostic Lab Data:
CDC Split Type:

Write-up: Erythema multiforme developed on Monday 12/27 and worsened significantly on the evening of 12/28. Lesions began less than an inch across and grew to 3-4 inches at present. Spots are extremely itchy and intermittently painful under pressure, and continue to grow. Lesions are most frequent on extremities but continue to develop in new locations. Significant dermatographia is also observed. After diagnosis by an ER doctor, patient has been taking Benadryl and Tylenol, and will apply a topical steroid and take cetirizine. Treatment thus far has failed to mitigate irritation, skin sensitivity, or lesion growth.


VAERS ID: 1988653 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Chills, Exposure during pregnancy, Fatigue, Headache, Myalgia, Oedema peripheral, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (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: Omeprazole and pre-natal vitamins
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Currently pregnant at 17 weeks. I had a headache, fever, chills, fatigue, muscle aches (these 5 side effects last about 24 hours) but the one that is still lingering two days later is swelling and pain in my left armpit, same side that I had the injection.


VAERS ID: 1988656 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Headache, Hypoaesthesia, Hypoaesthesia eye, Myalgia, Pain, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (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: Moderna 2 on 2/26/21 same, filed report with VAERS
Other Medications: Aspirin 81, eliquis, amlodopine, losartan, lopressor, metoprolol, crestor, synthroid. Vit D-3,
Current Illness: HAIT, CAD, Hypertension, CKD 3a, Fibromyalgia, MCTD, Migraine, NASH
Preexisting Conditions: Same as above
Allergies: Sulfa, possibly PEG, latex, wool, gluten, dairy, mold
Diagnostic Lab Data: None but I have allergy testing scheduled in Feb?22. Suspect PEG since had adverse affects from Moderna 2 and also from Miralax and Angio seal plug groin which is a polymer. I have many chemical sensitivities.
CDC Split Type:

Write-up: Due to past Moderna 2nd shot reaction was on stretcher for shot. No reaction after 30 minutes. After 45 minutes scalp numbness occurred. After an hour scalp, head, side face and eye area was numb and tingly. Slight headache. This continued for 6 hours and began to subside. 8 hours after shot no longer had numbness. Fatigue, muscle aches and pain began after 12 hours from shit and lasted 24 hours total. All symptoms gone after 24 hours.


VAERS ID: 1988661 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-11
Onset:2021-12-27
   Days after vaccination:260
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Dyspnoea, Intensive care, Peripheral swelling, Positive airway pressure therapy, Pulmonary oedema, SARS-CoV-2 test positive, Wheezing
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Renal CA, HTN, Afib, HLD, CKD, CHF and hypothyroidism
Allergies: No Known Allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: 12/27/21: Patient brought to the ED via EMS complaining of SOB. He stated his symptoms started 2 days ago and progressively got worse. He also stated his doctor had recently given him diuretics for BLE swelling. When EMS arrived, his O2sat was 81% on room air. They placed him on CPAP 100% and gave him DuoNeb and methylprednisolone for wheezing. In the ED, he was switched to BiPAP 20/12/100%. He was found to be COVID-19 positive. His chest x-ray showed pulmonary edema. He was diuresed with furosemide 40 mg IVP. He will be admitted to the ICU for further monitoring.


VAERS ID: 1988662 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-12-15
Onset:2021-12-27
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / UNK - / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: I had the flu three weeks before my booster shot.
Preexisting Conditions: I have no chronic or long-standing health conditions.
Allergies: No known allergies.
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Beginning around 4pm on December 27th, I experienced itches around the back and scalp. These continued throughout the night and into the 28th. Ice helped to distract from the itching and alleviate symptoms for the time. Around 3pm on the 28th my thumbs began to feel sore and by 7pm both had swelled. The wrist and other fingers began to feel sore around this time too and by 9 there was slight tightness in my chest. Around 9:30 I took two aspirin. The itching persisted although it felt less severe than earlier. Around 10:30 pm I took a shower and took one tab of Benadryl. The next morning the swelling had not subsided in the thumbs and some swelling appeared in the feet. At the advice of a nurse I am taking Benadryl every four hours and Claritin every twelve. I am still monitoring the swelling as well as the chest tightness. For the most part the itching has subsided, though hives have appeared on the hands and feet.


VAERS ID: 1988670 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-12-01
Onset:2021-12-27
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angiogram, Anticoagulant therapy, Atrial fibrillation, Chest X-ray, Chest pain, Computerised tomogram thorax, Cough, Dyspnoea, Fibrin D dimer increased, Inflammation, Influenza virus test negative, Laboratory test, Metabolic function test, Procalcitonin, Pyrexia, Rash erythematous, Rash pruritic, SARS-CoV-2 test negative, Tachycardia, Urinary tract infection
SMQs:, Anaphylactic reaction (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: famotidine, probiotic, albuterol
Current Illness:
Preexisting Conditions:
Allergies: Elavil, Flagyl, Lopressor, Sulfa, Macrobid
Diagnostic Lab Data: CXR, CT angio, cardiac markers, procalcitonin, CMP
CDC Split Type:

Write-up: The patient is here with complaints of a fever, cough and shortness of breath. She said is been going on since last Tuesday. She was tested for Covid and influenza in the clinic which came back negative. She was instructed this is a viral illness and needs to pass on its own. She stated that she has been using her inhaler and her daughter''s nebulizer without much relief. She also complains of right lower chest pain. She denies any swelling in any of her extremities. Her last fever was this morning. She stated that the shortness of breath just comes and goes at times. Patient was treated for UTI last Monday and was on Macrobid. She noticed over the past couple of days she had had a reddened flat rash on her bilateral lower extremities. She stated is very itchy Atrial fibrillation with RVR I48.91 The patient is not ill-appearing or toxic upon arrival to the emergency room. Her heart rate is tachycardic in the low 100s. It is sinus rhythm upon arrival. She did have clear lung sounds. Patient does have a history of asthma which she feels like is not very controlled at this time. Patient is moving air well, oxygen levels remain in the mid to upper 90s with room air. Patient''s D-dimer did come back elevated at about 1700. We did do a CT of the chest to rule out a PE. There is no acute PEs noted but possible inflammation or metastasis to the bilateral lymph nodes in the hilar area. We will treat the patient with Augmentin for 10 days to see if we can help decrease the inflammation and have her rescan at that point by her primary care doctor to rule out any suspicious lesions. While she was in CAT scan and when she came back, the patient was in A. fib with RVR. She states she never had any issues like this before in the past and her shortness of breath does get worse with the faster heart rate. Otherwise she is asymptomatic. The patient was given a bolus of Cardizem and an oral dose of Cardizem with minimal relief of the elevated heart rate. I did go from the 170s/180s to the 130/140s and still in atrial fibrillation. I did contact the cardiologist and he recommended avoiding Cardizem due to lack of evidence that it will be beneficial for her in the outpatient setting and starting her on 400 mg of amiodarone twice daily for 2 weeks and then decreasing to 400 mg of amiodarone daily after the initial 2 weeks and to follow-up with him in 2 to 3 weeks for an echo and reevaluation. The patient will be started on VTE prophylaxis with Eliquis. The patient stated that she has been on this before and is unsure why. She said that she was on it when I thought she had Covid because I thought her blood looked thick. Denies any history of abnormal heart rhythms though. Her CAT scan results as well as the plan of care were discussed with the patient as well as her primary care provider. They are agreeable with the plan of care. Her PCP was comfortable with not further treating her heart rate more than what the cardiologist said due to lack of being symptomatic. The patient was instructed that she is at risk for stroke due to the atrial fibrillation and that we are trying to prevent that with the blood thinner. She verbalized understanding is agreeable. The cardiologist denied any further intervention needed. We will put her in the hospital for observation on telemetry. Patient denies any further concerns. The Doctor notified a plan of care and is agreeable. I do suspect that the patient''s rash on her bilateral lower extremities is due to a medication reaction. We will continue to keep an eye on that. Chads Vasc 2 score: 1 point, 0.6% stroke risk per year


VAERS ID: 1988673 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-01
Onset:2021-12-27
   Days after vaccination:270
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Dyspnoea, Oropharyngeal pain, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: From history and physical on 12/27/21: Patient is a 51 y.o. male with a history of chronic low back pain and anxiety who presents to ED for complaint of shortness of breath. He states it began on 12/25/21 but got worse yesterday. Admits to a persistent dry cough and subjective fever/chills. Denies chest pain, palpitations, abdominal pain, nausea or vomiting. Denies change in taste or smell. Reports sore throat. He admits he tested positive for Covid when symptoms began. He was about to check his O2 sat at home and saw that it was low (89%). He then called his PCP, and was advised to go to the ED. Denies any known sick contacts. He states he had received both doses of the Covid vaccine, but had not received the booster.


VAERS ID: 1988694 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-12-08
Onset:2021-12-27
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012H21B / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute kidney injury, Aggression, Anaemia, Asthenia, Back pain, Bacterial test, Bladder catheterisation, Blood creatinine increased, Blood glucose decreased, Blood pressure decreased, Blood test abnormal, Blood thyroid stimulating hormone, Computerised tomogram abdomen abnormal, Computerised tomogram head normal, Confusional state, Dyspnoea, Glycosylated haemoglobin, Haemoglobin decreased, Hypervolaemia, Hypophagia, Mental status changes, Metabolic function test, Nephrolithiasis, Red blood cells urine positive, Restlessness, Ureterolithiasis, Urinary tract obstruction, Urine analysis abnormal, Urine output decreased, White blood cells urine positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Akathisia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (narrow), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: multivitamin; ascorbic acid; ibuprofen
Current Illness:
Preexisting Conditions: Rheumatoid arthritis
Allergies: Morphine
Diagnostic Lab Data: UA, CMP, TSH, Hgb A1c, CT abdomen, CT head
CDC Split Type:

Write-up: Patient presents the emergency room with a 2-day history of increasing confusion not eating much or drinking much. She was confused when she came in not doing well. Blood sugar in the ambulance was 46 upon entering the emergency room it was 14. Initially upon entering the emergency room we are unable to do a review of systems secondary to her mentation. Once we got the IV finally started start some fluids her mentation did come around. Initially she was complaining quite a bit of back pain confusion weakness. Apparently has been going on for couple of days. Talking with her husband on the phone and the only medication she taken is some tramadol and ibuprofen. Initial physical exam sure to be quite confused somewhat resistant to our cares. She had to be reminded again and again to hold still. 3 attempts were made at starting IVs all unable to get there. She was supposed to get D50 secondary to her low blood sugar but we are unable to do that she did drink a container of orange juice which did perk her up a little bit. Anesthesia was called in to get her IV started. In the meantime the lab drew very little blood but again enough to see that she was in acute renal failure her blood sugar was back up to 38. Her hemoglobin was at 8.8. Multiple examinations were done while she was in the emergency room the final exam is the one that will be documented here. Initially HEENT is fine other dry mucous membranes her heart was regular lungs were clear abdominal exam was benign no complaints of pain to palpation. Later on that changed and she was having some back pain. Patient is confused she has had low blood sugars her blood pressure continues to drop she is in acute renal failure as far as we know for sure renal failure. She is anemic. We have very little history on her as she is unable to give us much history and there is nothing in the hospital. I need to admit the patient get a hydrate her to get her blood pressure up order to monitor her blood sugars I will recheck her kidney function and hemoglobin in the morning. In the meantime we will get the monitor her oxygen saturations her blood pressure pulse and her blood sugars as they continue to drop. I still have some lab pending we will follow up that closely. Patient is extremely confused this morning. During the night we are trying to hydrate her with a creatinine of 5.2 there was no change this morning. She started to fluid overload so we stopped the IVs try to give her Lasix again basically no urine output. As far as we know she has not taken anything at home other than Toradol and ibuprofen. My fear she took too much but were unsure still why her blood sugars are bottoming out and why she is so confused. This morning we will do a CT of her head and do a CT of her abdomen and I will follow up with these. Will need more lab work and wait till after the CAT scans to see if there is something else we need to order. Plans are to try to transfer her to a nephrologist depending on her findings. We need the CAT scans first. Patient''s renal failure is no better. She has huge calculus in the ureters which is obstructing the patient''s urine flow she is getting no fluid output she is in dire straits at this time. In the emergency room patient sensation would clear then should be confused again. Blood work was okay other than her blood sugars continue to stay low. We initially gave her D50 a couple times. It was difficult due to the fact that it took for 5 attempts at starting IVs to get 1 that would work. When I did start working we started hydrating the patient significantly due to her low blood sugars her blood pressure and such. Has a picture started to clear she started to become more confused. She would have moments of normal sensorium and then she would be quite confused again. Again her blood sugars were staying low so we did start her on D5. After she had a couple liters and it was noted that she was having difficulty breathing and her urine output had been next to nothing. We did float a Foley initially so we could monitor this. We did eventually have to stop the IVs but her blood sugars continued to stay low so we started her on D10 at 250 eventually moving it down to 125. Her vital signs remained somewhat stable. She had some problems with oxygenation early on but we did give her oxygen which did bring it up into the normal range. Eventually confused as to why her blood sugar stayed low I did a CT of her head which was essentially normal and a CT of her abdomen which showed enormous renal calculi which was causing obstruction which is why she was getting no urine output. We had noted that her creatinine was 5.2 the next day it had not improved probably from obstruction. At this point time her mentation was not clearing she was staying confused the whole time somewhat combative or at least restless. We have given her Ativan some Haldol to keep her from tearing out her IVs and the nurses and such. We then attempted to transfer the patient where she can get a higher level of care and we can take care of the renal stones. We had excepting physician but his Institute had no availability. We then called approximately 50 hospitals in the 6 state area and had no facility that would take our patient. We continue to monitor her maintaining her blood sugars her blood pressure then bottomed out and Levophed had to be started. It is currently running at 34 mics but had been much higher to maintain blood pressure. Again very little urine output it was noted that the urine she did have out was full of bacteria whites and reds. We started her on Rocephin. We did get an opening at the hospital 40 miles away with an accepting physician who states that he can go when and stent her kidneys. We are currently working on that transfer and as soon as we get acceptance patient will be discharged and transferred to another hospital. Patient is in and will remain in very guarded condition.


VAERS ID: 1988698 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-10-26
Onset:2021-12-27
   Days after vaccination:62
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 - / IM
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood creatinine increased, Brain natriuretic peptide normal, COVID-19, Cardiac stress test normal, Chest pain, Condition aggravated, Cough, Dyspnoea, Electrocardiogram abnormal, Left ventricular hypertrophy, Pneumonia, SARS-CoV-2 test positive, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amLODIPine 5 mg PO qDay aspirin 81 mg PO qDay Vitamin D3 50 mcg PO qDay GlipiZIDE XL 2.5 mg PO qDay Levemir - TI 25 units Subcutaneous BID Epivir 150 mg PO qDay losartan 25 mg PO qDay simvastatin-TI 10 mg PO at bedtim
Current Illness:
Preexisting Conditions: CHF, DM, HIV, HTN, CAD,CKD
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: 12/27/21: He presented with complaints of shortness of breath and cough for several days. He also endorses atypical chest pain which has been ongoing for years. He is unable to elaboarte on this more but notes it is not worse with exertion. Sometimes worse with laying supine or coughing. He does follow with a cardiologist but is unable to recall whom. Notes he did see them recently and has had full work up with NST and this was unremarkable. Further work up on admission revealed BP of 200/73, EKG SR with LVH and RL pneumonia. COVId19 positive. He is fully vaccinated. BNP WNL. Troponin 54 and 51. Cr 1.51. Records indicate echo in 2020 EF 65% with no significant structural abnormalities. Patient received first dose J&J vaccine on 3/26/21/2021 Lot # 1808609 and the second dose on 10/26/2021 Lot # 1822811


VAERS ID: 1988702 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33130BA / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Erythema, Fatigue, Injection site swelling, Nausea, Pain, Skin warm
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Redness, warmth, swelling at injection site. Body aches, fatigue, chills, nausea


VAERS ID: 1988714 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-02-25
Onset:2021-12-27
   Days after vaccination:305
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 022M20A / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 006B21A / 2 - / SC

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein increased, Decreased appetite, Dyspnoea, Fatigue
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? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen PRN, albuterol PRN, aspirin 81 mg daily, Symbicort BID, Vitamin D 2000 units daily, Jardiance daily, fludrocortisone 0.05 mg daily, gabapentin BID PRN, hydrocortisone 20 mg BID + 5 mg at lunch, Novolog, Tresiba 36 units daily,
Current Illness:
Preexisting Conditions: COPD, Type 2 Diabetes, lifelong tobacco use, addisons disease, sleep apnea, HTN, HLD
Allergies: bee venom, PCN, levaquin
Diagnostic Lab Data: On 5 L nasal oxygen at admission; now down to 1 L.
CDC Split Type:

Write-up: Presents to hospital on 12/27 for 2 days history of worsening shortness of breath, fatigues, decreased appetite CRP 2.05


VAERS ID: 1988724 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-12-14
Onset:2021-12-27
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 330308D / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Diarrhoea, Influenza like illness
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: Multi-Vitamins, Elderberry Supplements
Current Illness: N/A
Preexisting Conditions: High Cholesterol
Allergies: Motrin
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt. states that after receiving the 3rd dose of Phizer 12/14/2021 experienced flu-like symptoms lasting 12hrs, started experiencing symptoms 12/27/2021 of loose stool continuing through current. No noted Primary visit/communications.


VAERS ID: 1988726 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PFIZER FG3527 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD7218 / 2 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Decreased appetite, Hyperhidrosis, Injection site pain, Migraine
SMQs:, Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (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: Clarvis, Vitamin D, Birth Control
Current Illness: None
Preexisting Conditions: Cough
Allergies: Nut allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills, Sweating profusely, no appetite, migraine on and off for 2 days, burning at injection site 30 minutes after receiving vaccination.


VAERS ID: 1988778 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-12-21
Onset:2021-12-27
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 331308A / 3 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID positive test 12/28/21
CDC Split Type:

Write-up: COVID breakthrough vaccine


VAERS ID: 1988797 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-14
Onset:2021-12-27
   Days after vaccination:257
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018B21A / 2 - / -

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

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

Write-up: COVID vaccine breakthrough case


VAERS ID: 1988817 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045J21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diplopia, Interchange of vaccine products
SMQs:, Ocular motility disorders (broad), Medication errors (broad), Hypoglycaemia (broad)

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

Write-up: This was his 1st dose of Moderna, but his booster dose. He received Janssen in April 2021. Patient began experiencing double vision approximately 7-8 hours after receiving the vaccine


VAERS ID: 1988822 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / 4 LA / SYR

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

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

Write-up: I asked for a Flu vacine and was given COVID vacine in error at Pharmacy. I have now had 2, COVID boosters. Pharmacy would not add the second booster onto my Vacaine Card.


VAERS ID: 1988840 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-12-16
Onset:2021-12-27
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

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

Write-up: Heart palpitations


VAERS ID: 1988868 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-09-03
Onset:2021-12-27
   Days after vaccination:115
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: COVID-19, Influenza, 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: SEPTEMBER 1961 ADENO VIRUS, 19 YRS OLD, ANAPHALACTIC
Other Medications: VIT D 3, VIT C
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: FENATYL
Diagnostic Lab Data: TWO RAPID TESTS ON 27TH AND 29TH BOTH POSITIVE. STILL EXPERIEMCING MILD TO MODERATE FLU SYSTEMS
CDC Split Type:

Write-up: DECEMBER 27TH TESTED POSTIVE WITH RAPID ANTIGEN KIT. COVID 19 SYMPTOMATIC. MODERATE FLU SYMPTOMS.


VAERS ID: 1988879 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: 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: Expired vaccine given. Lot 013F21A expired on 12/24/21 based on date & time removed from freezer to refrigerator storage.


VAERS ID: 1988883 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 3 - / -

Administered by: Private       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: Expired vaccine given. Lot 013F21A expired on 12/24/21 based on date & time removed from freezer to refrigerator storage.


VAERS ID: 1988900 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-02
Onset:2021-12-27
   Days after vaccination:116
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 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: atorvastatin 20 mg, Trulicity 3 mg weekly, Jardiance 25 mg daily, glipizide 10 mg ER daily, prenatal vitamin, Icy Hot patches
Current Illness:
Preexisting Conditions: poorly controlled type II diabetes, elevated LFTs, sciatic neuropathy
Allergies: BBQ sauce, Sudafed
Diagnostic Lab Data: positive SARS-COV-2 by PCR on 12/27/2021
CDC Split Type:

Write-up: positive for COVID-19


VAERS ID: 1988920 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-12-01
Onset:2021-12-27
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Eye swelling
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: Unithoid
Current Illness: None
Preexisting Conditions:
Allergies: Nka
Diagnostic Lab Data:
CDC Split Type:

Write-up: Eyes swelled shut


VAERS ID: 1988937 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-01-21
Onset:2021-12-27
   Days after vaccination:340
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: fully vax tested positive 12/27. dose 1 12/29/21 dose 2 1/21/21


VAERS ID: 1988965 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-02
Onset:2021-12-27
   Days after vaccination:269
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Oropharyngeal pain, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient here at hospital since 12/15,started to develop sore throat, started getting worse, then developed a runny nose, tested for COVId and came back positive


VAERS ID: 1988973 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-02-12
Onset:2021-12-27
   Days after vaccination:318
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 UN / 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: Fully vaccinated adult tested positive for COVID-19


VAERS ID: 1988989 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041J21A / 3 LA / IM

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

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

Write-up: Patient presented to clinic for booster dose of Moderna, Patient had previously received a primary dose of Janssen on 3/9/2021 and booster dose of Moderna 10/27/2021. Patient received an additional 0.25 booster dose of Moderna on 12/27/2021 at our clinic.


VAERS ID: 1989004 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-12-26
Onset:2021-12-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Oropharyngeal pain, Rash
SMQs:, Anaphylactic reaction (broad), 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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: HPV vaccine (Gardasil); 12yo; October 2017. Adverse event report filed at the time.
Other Medications: Prozac; Singulair; Albuterol inhaler; QVar inhaler
Current Illness: None
Preexisting Conditions: POTS
Allergies: Penicillin and related drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash on arm (?COVID arm?) Sore throat


VAERS ID: 1989017 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-14
Onset:2021-12-27
   Days after vaccination:166
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose increased, Insulin therapy, Thirst, Type 1 diabetes mellitus
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Anticholinergic syndrome (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: 12/29/2021 blood glucose level over 700.
CDC Split Type:

Write-up: Patient Started getting very thirsty 4 months after the shot. He went into the hospital after it persisted for a few weeks of not being able to quench his thirst. Blood glucose level was over 700. He was diagnosed with Type 1 diabetes. Will need to take insulin now to regulate his blood sugar.


VAERS ID: 1989036 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-28
Onset:2021-12-27
   Days after vaccination:274
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Agonal respiration, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
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: found patient unresponsive with agonal respirations, episode lasted 1 minute, they provided rescue respirations with BVM, and patient returned to baseline then brought to emergency department and admitted


VAERS ID: 1989054 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Axillary pain, Chills, Incorrect product formulation administered, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Medication errors (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: ibuprofen 800 mg
Current Illness: FIBROMYALGIA
Preexisting Conditions: FIBROMYALGIA
Allergies: NKA
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: 12/27/2021 iNADVERENTLY MIXED VIAL OF PFIZER PEDIATRIC AND PFIZER ADULT TOGETHER AND ADMINISTERED .3 ML IM TO PATIENT. Patient was called and had no adverse events at 6pm a12/27/2021 - called am of the Dec.28th -c/o fever body aches chills . Pt.instructed she could take Tylenol /ibuprofen. Talked with pt. yesterday pm - feeling little better - continuing to take ibuprofen . 12/29/2021 - Pt. c/o soreness in axillary are - no fever - body aches better.


VAERS ID: 1989069 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-12-23
Onset:2021-12-27
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD7218 / 3 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cholecystitis acute, Computerised tomogram, SARS-CoV-2 test positive
SMQs:, Infectious biliary disorders (narrow), Gallbladder related disorders (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ascorbic acid, Aspirin 81mg, Atorvastatin 40mg QD, Wellbutrin XL 300mg QD, Calcium tablet, Tricor 145mg QD, Claritin D, Prilosec 20mg QD.
Current Illness: None
Preexisting Conditions: Chronic pain back ? Gastroesophageal reflux disease 11/22/2021 Controled with med. ? Hyperlipidemia ? Migraine ? Motion sickness 11/22/2021 Boat only
Allergies: Fish, Flaxseed, PCN
Diagnostic Lab Data: CT, Hospital admit for 3 days. Supportive care (ie fluids, pain meds, home meds), antibiotics.
CDC Split Type:

Write-up: Acute cholecystitis, non -toxic on overall appearance and exam. Plan for lap choley in AM 12/28/2021 was canceled due to Covid-19 PCR was also positive. Pt was moved to the isolation ward, OR was postponed. Conservative tx with supportive care and antibiotics help alleviate symptoms. Pt was discharged 12/29/2021 with plans to schedule surgery as an outpatient.


VAERS ID: 1989072 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-26
Onset:2021-12-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL8094 / 2 LA / IM

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

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

Write-up: Gave patient a pediatric Pfizer vaccine #2 that was potentially not as effective due to temperature excursion.


VAERS ID: 1989080 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-26
Onset:2021-12-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33030BD / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Headache, Musculoskeletal stiffness, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: The patient received the Pfizer booster on Sunday 12/26/21. She woke up on Monday 12/27/21 with a severe headache that was not alleviated with Ibuprofen. She also has had fever, chills, muscle aches, and a stiff neck. These symptoms have persisted since Monday morning.


VAERS ID: 1989085 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-26
Onset:2021-12-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL8094 / 2 LA / IM

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

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

Write-up: Temperature excursion happened to the pediatric Pfizer vaccine and pharmacist gave the patient the vaccine unknowingly. No harm was done but most likely less effective vaccine was given.


VAERS ID: 1989095 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-16
Onset:2021-12-27
   Days after vaccination:133
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 3 - / IM

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

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

Write-up: BREAKTHROUGH CASE : Pt. states that after receiving the 3rd dose of Moderna 08/16/2021 (Prior 1st and 2nd dose given) Covid + 12/27/2021


VAERS ID: 1989105 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-12-26
Onset:2021-12-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 068H21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Dizziness, Dyspnoea, Fatigue, Hypertension, Lethargy, Pain, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Systemic: Allergic: Difficulty Breathing-Severe, Systemic: Body Aches Generalized-Severe, Systemic: Chest Tightness / Heaviness / Pain-Severe, Systemic: Dizziness / Lightheadness-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: Hypertension-Severe, Systemic: Tachycardia-Severe


VAERS ID: 1989106 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL8094 / 1 AR / SC

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Pediatric Pfizer vaccine was left out at room temperature for more than 36 hours / temperature excursion happened the previous day. However, vaccine was placed back in the fridge by accident and the following day a second pharmacist gave a dose of the vaccine to the patient not knowing that the vaccine might have been spoiled previously. Patient was not harmed however a less effective vaccine was given to patient. Market director contacted the parents for revaccination and to re-assure the no harm is done for the child who received the vaccine.


VAERS ID: 1989116 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 068H21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Flushing, Hyperhidrosis, Loss of consciousness, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Mild, Additional Details: Patient received Moderna booster. RN gave the vaccine and reported the patient fainted and was unconcious for around 2 seconds. Rescue was called. Patient was cleared to go home


VAERS ID: 1989128 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

Administered by: Other       Purchased by: ?
Symptoms: Anion gap, Basophil percentage decreased, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood potassium normal, Blood prolactin, Blood sodium decreased, Blood urea normal, Carbon dioxide normal, Differential white blood cell count, Dizziness, Dyspnoea, Electrocardiogram, Eosinophil percentage decreased, Epigastric discomfort, Feeling hot, Glomerular filtration rate normal, Haematocrit normal, Haemoglobin normal, Immature granulocyte count, Lymphocyte percentage decreased, Mean cell volume normal, Monocyte percentage increased, Nausea, Neutrophil count increased, Neutrophil percentage increased, Nucleated red cells, Platelet count normal, Presyncope, Pruritus, Red blood cell count normal, Red cell distribution width normal, SARS-CoV-2 test negative, Sleep disorder, Throat tightness, Urticaria, White blood cell count increased
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Haematopoietic leukopenia (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None known
Diagnostic Lab Data: Results for OH, TAE YEUN (MRN 110017744024) as of 12/29/2021 11:35 12/28/2021 11:00 NA: 133 (L) K: 4.0 CL: 100 CO2: 24 BUN: 14 CREAT: 0.94 ANION GAP4 SERPL: 9 GLUC: 132 GFR-AFRAM: $g60 GFR NONAFR AMER: $g60 12/28/2021 11:05 EKG 12 OR MORE LEADS W INT & RPT: Rpt HEART RATE: 91 PR: 165 QRS: 92 QT: 334 QT CORRECTED: 411 12/28/2021 12:15 WBC: 12.1 (H) RBC''S: 5.36 HGB: 16.8 HCT: 48.0 MCV: 90 RDW, RBC: 11.8 (L) PLT: 152 IMMAT GRANULO % AUTO: 1 NRBC: 0 NEUTROPHILS % AUTO: 84 (H) ANC: 10.2 (H) LYMPHS % AUTO: 6 (L) MONOS % AUTO: 9 EOS % AUTO: 0 BASO''S % AUTO: 0 12/28/2021 16:21 CORONAVIR PAN 2019-NCOV, NAA, QL: COVID NOT DETECTED SP SOURCE: NP/OP 12/29/2021 03:40 NA: 132 (L) K: 4.3 CL: 101 CO2: 25 BUN: 13 CREAT: 0.83 ANION GAP4 SERPL: 6 GLUC: 135 WBC: 9.1 RBC''S: 4.90 HGB: 15.0 HCT: 43.9 MCV: 90 RDW, RBC: 11.8 (L) PLT: 177 IMMAT GRANULO % AUTO: 1 NRBC: 0 NEUTROPHILS % AUTO: 86 (H) ANC: 7.8 LYMPHS % AUTO: 6 (L) MONOS % AUTO: 8 EOS % AUTO: 0 BASO''S % AUTO: 0 DIFF PANEL: AUTO DIF
CDC Split Type:

Write-up: Patient is a 28 year old male generally healthy,who presented to ER with complaints of lightheadedness,near syncope and hives after Moderna booster 12/27/2021 Previous 2 vaccinations have been Pfizer. Patient woke up at 3 AM secondary to pruritis and noted whole body hives,no oral lesions. He felt hot,did not check his temp. He felt that he will pass out. Patient took Benadryl 50 mg orally at about 5 AM today prior to presentation.. He complaints of nausea, mild shortness of breath. No vomiting. No diarrhea. No chest pain or abdominal pain. Per patient he had similar reaction to unknown meds 3 years ago -treated at MGH. ED COURSE: On arrival patient medicated with Benadryl 50 mg IV, Decadron 10 mg IV, famotidine, epinephrine IM x1 Recheck at 1310 hrs.: Urticaria resolved, patient feeling better, ambulatory without dizziness. Recheck at 1400 hrs.: Diffuse urticaria, patient reports tight sensation in throat and mid epigastric area. Voice normal. No respiratory distress. Will premedicate with additional epinephrine and add hydroxyzine.


VAERS ID: 1989135 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-05-01
Onset:2021-12-27
   Days after vaccination:240
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood creatine increased, C-reactive protein increased, COVID-19, Cough, Diarrhoea, Dyspnoea, Dyspnoea exertional, Fibrin D dimer increased, Fluid intake reduced, Hypoxia, Myalgia, Nausea, Procalcitonin increased, SARS-CoV-2 test positive, Vomiting, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Haemorrhage laboratory terms (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient will be admitted to hospitalist for hypoxia related to COVID-19 infection. Patient is a relatively healthy 60-year-old male normally seeks cares. has been vaccinated not yet received his booster. Complains of approximately 9-10 days of diffuse viral symptoms including myalgias, cough, nausea, vomiting, and diarrhea. Has not been keeping up with his fluids. The last 2-3 days he has noted increasing shortness of breath with activity. No abrupt changes. Denies chest pain, pleuritic pain, abdominal pain. On evaluation in the emergency department patient was found to be hypoxic requiring supplemental oxygen. Labs showed elevated CRP of 12.0, slightly increased creatinine at 1.36, mildly elated D-dimer of 1235, normal white blood cell count mildly elevated procalcitonin. COVID positive 12/27/2021. Patient was given dexamethasone and admitted for further cares.


VAERS ID: 1989139 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: New York  
Vaccinated:2021-12-23
Onset:2021-12-27
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PL3197 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Fatigue, Nausea, Oropharyngeal pain
SMQs:, Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Fatigue; 48;4/21/21; Pfizer
Other Medications: Wellbutrin, candisartin, Abilify, zanaflex, lamictal, Flonase, cbd tincture
Current Illness:
Preexisting Conditions: Cerebral palsy, asthma, bipolar disorder 2, migraines, anxiety, depression
Allergies: Latex, bananas, clatithromycin, phenothiazines, sulfa, topamax, amoxicillin, divalproex, nifedipine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe fatigue, nausea, sore throat


VAERS ID: 1989155 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-15
Onset:2021-12-27
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Metastases to central nervous system, Pyrexia, SARS-CoV-2 test, Small cell lung cancer extensive stage
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological malignant tumours (narrow), COVID-19 (broad)

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

Write-up: Stage IV small-cell lung cancer with brain mets, malignant receiving treatment spiked a fever and tested for COVID


VAERS ID: 1989180 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-06
Onset:2021-12-27
   Days after vaccination:265
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025821A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Lethargy, Mental status changes, Pyrexia, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HTN, HLS, dementia, CAD with stents
Allergies: NKA
Diagnostic Lab Data: SARS Cov 2 PCR Covid19- detected on 12/27/2021
CDC Split Type:

Write-up: Covid19 breakthrough. 1st Vaccine given 3/9/2021. Pt vaccinated per family and here visiting. Presents with AMS, profound lethargy, fever. Pt treated with IV steroids.


VAERS ID: 1989230 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: New York  
Vaccinated:2021-12-26
Onset:2021-12-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

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

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

Write-up: Started experience pain in the left armpit, same side as injection. Swollen lymph nodes, a few days later swelling has not subsided yet. Tender to the touch and physical activity is stressful and painful. OTC ibuprofen and acetaminophen have been used to attempt to reduce swelling. OTC medicine has not been very effective.


VAERS ID: 1989255 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Minnesota  
Vaccinated:0000-00-00
Onset:2021-12-27
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unable to add two vaccinated dates above. Received vaccine 12/17/2020 and 1/6/2021. Both Pfizer.
Current Illness: Hospitalized to transitional care unit for ongoing trach cares following management of incidental squamous cell carcinoma found at the L base of tongue.
Preexisting Conditions: Recent history of C1-C2 instability, tongue base mass- oropharyngeal carcinoma. Other hx includes: hypertension, obstructive sleep apnea, prior cutaneous SCC, hyperlipidemia, hx of tobacco use, hx of septic meningitis, hx of aortic root abscess s/p AVR, AV heart blood s/p pacemaker placement, diabetes mellitus type 2, peripheral arterial disease, alcohol abuse, secondary malginancy of lymph nodes, DVT, PE, s/p partial foot amputation with history of chronic diabetic wound.
Allergies:
Diagnostic Lab Data: 12/27/2021 asymptomatic COVID-19 PCR (NP)
CDC Split Type:

Write-up: Asymptomatic. Incidentally found to be positive during routine admission testing.


VAERS ID: 1989281 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-12-22
Onset:2021-12-27
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Diarrhoea, Gastrointestinal pain, Nausea
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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: Similar issue with shot 2 of moderna vaccine
Other Medications: Birth control
Current Illness: Had a cold in November
Preexisting Conditions: Hashimoto?s disease
Allergies: Penicillin, sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe intestinal cramping, diarrhea, nausea 5 days after shot. ~90% recovery next day (6 days after shot). After my second Moderna shot I had severe intestinal cramping and nausea 5 days after the shot, abut did not have diarrhea. 90-100% recovery next day (6 days after shot).


VAERS ID: 1989301 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-12-13
Onset:2021-12-27
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Blood glucose normal, Chest X-ray normal, Chest pain, Computerised tomogram thorax normal, Dyspnoea, Electrocardiogram, Fibrin D dimer, Full blood count normal, Metabolic function test normal, Myalgia, Pain, Scan with contrast, Sinus tachycardia, Troponin
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Same event with dose 2 and 3 of moderna covid vaccine
Other Medications: Albuterol Alprazolam 2mg prn bid Bupropion 150 mg XL daily Diazepam 10 mg prn hs Fluoxetine 20 mg Daily Folic acid 1 mg gabapentin 300 mg TID PRN Hydroxyzine 50 mg TID prn Levothyroxine 112 mcg
Current Illness: None
Preexisting Conditions: Hypothyroidism Adrenal incidentaloma Generalized anxiety disorder Major depressive disorder
Allergies:
Diagnostic Lab Data: Troponin <0.05 x 2 12/28/21 D-dimer 0.68 12/28/21 CMP normal other than glucose of 198 12/28/21 CBC normal 12/28/21 EKG normal sinus rhythm 12/28/21 EKG sinus tachycardia 12/28/21 CT Chest with contrast for PE: no evidence of PE 12/28/21 CXR normal 12/28/2021
CDC Split Type:

Write-up: Chest pain described as sharp and stab-like located in central chest with radiation to her back, worse with positional movements. Onset occurred around 10 days after dose 2 and 3 of moderna covid vaccine. Associated symptoms include shortness of breath and myalgia. Symptoms after second dose eventually subsided after a few days.


VAERS ID: 1989391 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-15
Onset:2021-12-27
   Days after vaccination:195
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 2 - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, Chest pain, Cough, Decreased appetite, Dyspnoea, Exposure to SARS-CoV-2, Headache, Oropharyngeal pain, Pain, Respiratory tract congestion, SARS-CoV-2 test positive, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Uk
Current Illness: Uk
Preexisting Conditions: UK
Allergies: Uk
Diagnostic Lab Data: BinaxNow Rapid Antigen test positive on 12/28.
CDC Split Type:

Write-up: Sore throat, SOB, vomiting, cough, body aches, chest pain, headache, loss of appetite, congestion. No thermometer so unknown if she has a fever. Onset 12/27 and tested positive 12/28. Exposure likely occurred at a gathering on 12/24.


VAERS ID: 1989400 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-17
Onset:2021-12-27
   Days after vaccination:285
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 1 LA / IM

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

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

Write-up: Patient admitted as observation on 12/27 due to encephalopathy, metabolic. Patient was tested for COVID-19 and was positive on 12/27.


VAERS ID: 1989402 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211D21A / 1 LA / IM

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

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

Write-up: A few minutes after administering the vaccine, patient slumped off of bench to floor then vomited a few minutes later. It appeared that she fainted but did not fully lose consciousness, she caught herself on hands and knees, and did not hit her head. She confirmed she did not eat before coming to the pharmacy for vaccine. She was monitored for 15-20 minutes after until all symptoms resolved. Recommended she report fainting history and eat before any future vaccines.


VAERS ID: 1989460 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3197 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Nervousness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Armour Thyroid 60mg
Current Illness: unknown
Preexisting Conditions: hypothyroidism
Allergies: KNA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client received the Booster COVID vaccine (Pfizer, Lot #FL3197) at approximately 1235. At 1238,Observation RN was alerted by client, that she was feeling lightheaded and warm. Client was moved to anti-gravity chair and provided snacks and water. Co-lead was requested by Observation RN. At 1241, vitals assessed (BP 123/71, P 67, color wnl). Client reports feeling nervous and a little lightheaded. Client also reports she had not eaten anything recently. At 1256 vitals assessed (BP 125/86, P 68, color wnl). Client reports that she is feeling better. Client continues to eat snacks and drink water. Client has hypothyroidism and currently taking 60mg armour thyroid daily. No known Allergies. At 1303 client reports feeling good and feels ready to leave. Vitals assessed (BP 127/88, P 69, color wnl). Client educated on signs/symptoms when to seek medical care and to follow-up with primary care provider. Client left with steady gait and with husband present.


VAERS ID: 1989478 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Injection site inflammation, Injection site warmth, Pain in extremity, Skin warm, Sleep disorder
SMQs:, Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: atorvastatin, clonazepam, dextroamphetamine, ergocalciferol, ketoconazole, lamotrigine, melatonin, metoprolol, montelukast, olanzapine, oxybutynin, PreserVision AREDS 2
Current Illness: None
Preexisting Conditions: Depression
Allergies: sulfa drugs
Diagnostic Lab Data: When I saw my doctor today, she reported my blood pressure was normal. my breathing was good, my ears looked good inside, but that my upper left arm (where I had received both my COVID booster shot and flu vaccine was warm and a bit inflamed.
CDC Split Type:

Write-up: About two hours after my COVID Moderna booster shot and flu shot, I began experiencing severe pain in my upper left arm, far worse and far earlier than after my first two regular COVID Moderna vaccines. The next morning, I woke up with a mild headache that got progressively worse during the day until it was nearly unbearable in the evening. It was as severe a headache as I have ever had, and I have had full-body migraines. This definitely was not a migraine. I went to bed early without any dinner, and the headache began to diminish around 4:00 and 5:00 AM, so I got very little sleep. Today the headache is gone, but my left arm remains sore, and my doctor reported it is also warm. I have never before had any adverse reaction to a vaccine besides slight pain at the injection site.


VAERS ID: 1989492 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 060H21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Blood test normal, Dysstasia, Feeling abnormal, Pyrexia, Urine analysis, Vaccination complication
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: gabapentin, trajenta, metformin er, dexilant, calcium plus d, vitamin c, hydrocodone/apap 5/325, tamsulosin, b complex
Current Illness: none
Preexisting Conditions: stage 1 cirrhosis
Allergies: codeine
Diagnostic Lab Data: wife did not elaborate on tests. she stated that they did a bunch of blood tests and checked for uti. patient was seen at hospital.
CDC Split Type:

Write-up: patient started feeling bad in the evening. wife states she thinks he was vaccinated around 11am on 12/27. he started running a fever around 10 or 11pm. over night he progressed and got worse. patient needed to get up and use the restroom and was so weak he could not stand. took him to the er on 12/28. they gave him fluids and an antibiotic. wife states they did all sorts of blood work and checked for uti. nothing came back abnormal and they told her he had just had a severe reaction to the vaccine and to call pharmacy and have them report it. speaking to wife today, 12/29, patient is much better but still a little weak.


VAERS ID: 1989543 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 070H21A / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Dizziness, Feeling cold, Nervousness, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid 44mg
Current Illness: n/a
Preexisting Conditions: hypothyroidsim
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client received the Booster COVID vaccine (Moderna, Lot #070H21A, exp 4/7/2022) at approximately 1220. At 1259, re-entered the observation room after leaving notifying Observation RN, and Co-Lead that when she left the building she started feeling dizzy and having some blurry vision. At 1300 Client was seated in the anti-gravity chair and vitals assessed (BP 122/67, P 60, color wnl). Client reports she had not eaten breakfast or lunch today. Client was provided water and snacks. Client has hypothyroidism and takes 44 mg synthroid daily. Client denies any allergies. At 1309 Client states she''s feeling shaky/chills and lightheaded but no longer experiencing blurry vision. Client provided juice and tolerating. At 1317 vitals assessed (BP 114/77, P 62, color wnl). Client feels cold but no other symptoms at this time. At 1327 Client reports feeling better and ready to leave. Vitals assessed (BP116/69, P 63, color wnl). Client educated on signs/symptoms when to seek medical care and to follow-up with primary care provider. Client left with steady gait and with mother present.


VAERS ID: 1989553 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Fatigue, Injection site pain, Lymphadenopathy, Myalgia, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer COVID-19 vax, similar but less severe to current report
Other Medications:
Current Illness:
Preexisting Conditions: Chronic lymphocytic leukemia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Soreness at injection site- 6 hours Severe swollen axiliary lymph node, armpit on same arm as vax-10 hours Fatigue- 10 hours Myalgia-12 hours Fever 101.5F- 34 hours Vomit-40 hours


VAERS ID: 1989557 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-12-23
Onset:2021-12-27
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213021A / 2 LA / SC

Administered by: Pharmacy       Purchased by: ?
Symptoms: Nausea, Oropharyngeal pain, SARS-CoV-2 test, Vomiting
SMQs:, Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), COVID-19 (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: Fenofibrate 160mg
Current Illness: None
Preexisting Conditions: Hypertriglyceridemia
Allergies: Heparin, laytex
Diagnostic Lab Data: Covid rapid test
CDC Split Type:

Write-up: Severe nausea followed by violent vomiting. Must have been the lunch I ate 2 hrs prior to this. My throat was very sore and hurting for the next 36 hrs.


VAERS ID: 1989713 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 RA / IM

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

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

Write-up: No Adverse reaction but patient was outside of the age range for vaccine. I called mom and informed as soon as I was informed that I gave the wrong vaccine.


VAERS ID: 1989852 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-12-26
Onset:2021-12-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Headache, Myalgia, Nausea, Night sweats, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vyvanse 30mg
Current Illness:
Preexisting Conditions:
Allergies: Sulfa Drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, chills, night sweats, full body muscle pain, nausea, headache, dizziness. Resolved after 48 hours, ibuprofen helped relieve symptoms.


VAERS ID: 1989860 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: New York  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Injection site pruritus
SMQs:

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

Write-up: I was in the health center for my booster COVID shot but empty syringe was conducted to me at first time. The nurse noticed the syringe was empty after she injected it. And then she gave me another shot with vaccine. Obviously, there was a serious human error/misconduct there as there should not be any empty syringe at all at the to-be-injected area. I was not sure whether it was saline or air or something else that was injected to me, or the syringe was totally empty which means the plunger was at the bottom of the syringe (but there would be a very obvious difference as soon as the nurse picked up the syringe in this case) So far, there is no serious adverse symptom except itch in the injection area but the possible consequences that may occur in the future remain unknown. I request an incident report from the health center including what exactly happened and risk evaluation. In addition, I reserve the right to be held accountable in the future. I hope more strict procedures are imposed in the COVID vaccine preparation and injection process to prevent those incidents from happening again in the future.


VAERS ID: 1989867 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Chills, Headache, Myalgia, Neck pain, Pain in extremity, Vaccination site erythema, Vaccination site pain, Vaccination site swelling, Vaccination site warmth
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Chills, Muscle and Joint aches/pains, headaches, neck pain, vaccine site..pain,swelling,red,warm x 2 days


VAERS ID: 1989868 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-28
Onset:2021-12-27
   Days after vaccination:60
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / UNK LA / IM

Administered by: Pharmacy       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: Herpes Zoster (Shingles) on torso/trunk


VAERS ID: 1989869 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-02-01
Onset:2021-12-27
   Days after vaccination:329
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Drug ineffective, SARS-CoV-2 test positive
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Slynd, vitamin C, vitamin d, lexapro
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Positive for COVID on 12/27
CDC Split Type:

Write-up: Lack of efficacy


VAERS ID: 1991110 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Headache, Lymph node pain, Lymphadenopathy, Vaccination site bruising
SMQs:, Haemorrhage terms (excl laboratory terms) (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: 44, Covid vaccine Pfizer, swollen lymph node.
Other Medications: Protonix, Sertraline, metformin XR, loratadine, famotidine
Current Illness: None
Preexisting Conditions: PCOS, obesity, GERD, allergies
Allergies: Penicillin, Zetia, Cephlasporin, seasonal allergies, environmental allergies, Bisphosphonates
Diagnostic Lab Data:
CDC Split Type:

Write-up: Large sore bruise at vaccination site, swollen sore lymph node near left shoulder, headache for about 36 hours afterwards,


VAERS ID: 1991117 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066H21A / 3 LA / IM

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

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

Write-up: Pt has Latex allergy, and was given the Moderna Booster. She had a reaction to the band aid used, which was latex free. Pt still has some itching 3 days later, nothing has been applied to the allergy site.


VAERS ID: 1991642 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:2021-12-27
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: SARS-CoV-2 test, Suspected COVID-19, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20211225; Test Name: SARS-CoV-2 rapid diagnostic test; Result Unstructured Data: Negative; Test Date: 20211226; Test Name: SARS-CoV-2 rapid diagnostic test; Result Unstructured Data: Negative; Test Date: 20211227; Test Name: SARS-CoV-2 rapid diagnostic test; Result Unstructured Data: Positive
CDC Split Type: USJNJFOC20211258883

Write-up: SUSPECTED CLINICAL VACCINATION FAILURE; SUSPECTED COVID-19 INFECTION; This spontaneous report received from a patient concerned a 54 year male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (dose number in series 1) (suspension for injection, route of administration not reported, batch number: 211A21A, expiry: UNKNOWN) dose was not reported, 1 total, administered at left arm on 05-OCT-2021 for prophylactic vaccination. No concomitant medications were reported. On 25-DEC-2021, patient has been testing negative Saturday and Sunday with the rapid test since he was exposed to his wife who tested positive on Saturday 25-DEC-2021. Laboratory data included: SARS-CoV-2 rapid diagnostic test (NR: not provided) Negative. On 26-DEC-2021, Laboratory data included: SARS-CoV-2 rapid diagnostic test (NR: not provided) Negative. On 27-DEC-2021, the patient tested positive with a rapid home kit test for COVID-19 (suspected clinical vaccination failure, and suspected covid-19 infection), patient reports a little bit of joint and muscle fatigue and some tightness in chest and reports being relatively well. Laboratory data included: SARS-CoV-2 rapid diagnostic test (NR: not provided) Positive. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from suspected covid-19 infection, and the outcome of suspected clinical vaccination failure was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0: 20211258883-COVID-19 VACCINE AD26.COV2.S- suspected covid-19 infection. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s). 20211258883-COVID-19 VACCINE AD26.COV2.S- suspected clinical vaccination failure. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS


VAERS ID: 1991674 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 3 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20214

Write-up: Six patients received expired Moderna vaccine booster shots after 30-day Use by Date; This spontaneous case was reported by a nurse and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Six patients received expired Moderna vaccine booster shots after 30-day Use by Date) in a 73-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 022C21A) for COVID-19 vaccination. No Medical History information was reported. On 27-Dec-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 27-Dec-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Six patients received expired Moderna vaccine booster shots after 30-day Use by Date). On 27-Dec-2021, EXPIRED PRODUCT ADMINISTERED (Six patients received expired Moderna vaccine booster shots after 30-day Use by Date) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No Concomitant product use was reported. The patient received expired Moderna vaccine booster shot on 27-Dec-2021 after 30 day use by date after manufacturer date of expiry. The vaccine''s expiration date was 23-Dec-2021. The date the vial was initially stored in the refrigerator was unknown. Reportedly, the vial didn''t undergo any temperature excursions. No treatment information was provided. This case was linked to MOD-2021-429306 (Patient Link).


VAERS ID: 1991879 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-12-26
Onset:2021-12-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028K21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chest discomfort, Chest pain, Dizziness, Fatigue, Flushing, Headache, Hyperhidrosis, Hypertension, Injection site pain, Insomnia, Lethargy, Lymphadenopathy, Nausea, Pain, Paraesthesia, Tachycardia, Tinnitus, Tremor
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Site: Pain at Injection Site-Medium, Systemic: Body Aches Generalized-Medium, Systemic: Chest Tightness / Heaviness / Pain-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: Flushed / Sweating-Mild, Systemic: Headache-Medium, Systemic: Hypertension-Medium, Systemic: Joint Pain-Medium, Systemic: Lymph Node Swelling-Medium, Systemic: Nausea-Medium, Systemic: Shakiness-Medium, Systemic: Tachycardia-Severe, Systemic: Tingling (specify: facial area, extemities)-Mild, Systemic: Tinnitus-Mild, Systemic: Unable to Sleep-Mild


VAERS ID: 1991903 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 07H21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site erythema, Injection site pain, 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-Severe, Site: Pain at Injection Site-Severe, Site: Redness at Injection Site-Severe, Site: Swelling at Injection Site-Severe


VAERS ID: 1991908 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA FLR5618 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Decreased appetite, Diarrhoea, Laboratory test, Pain, Product administered to patient of inappropriate age, Pyrexia, Tremor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Medication errors (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Nine
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Medical tests and laboratories results pending.
CDC Split Type:

Write-up: Vomits, diarrhea, fever, body ache, shaking chills, lost of appetite for 3 days and counting.


VAERS ID: 1992037 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 069H219 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Headache, Nausea, Pain, Sensitive skin, Tinnitus
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna Shot Series #2. Age of Vaccination 30, Date :02/05/2021. Same Symptoms Described For Booster. Course Time 12 Hours. Mil
Other Medications: None
Current Illness: None
Preexisting Conditions: Scoliosis; Irritable Bowel Syndrome
Allergies: Penicillin
Diagnostic Lab Data: None- No Options To Come Into Employee Health Provided By Place Of Employment, No Primary Care Appointment Available By Primary Care Physician Until January 3rd.
CDC Split Type:

Write-up: Severe Headache Severe Body Aches Severe Skin Hypersensitivity Tinnitus Nausea Vaccination Completed 12/27- Time Course 72 Hours


VAERS ID: 1992051 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 625417 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Disturbance in attention, Fatigue, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: J&J/Jannsen Covid-19, age 68, 1 week delayed appearance of bruising 4 inches from injection site
Other Medications: lisinopril 10mg qd, repatha 140mg monthly, chlorthalidone 25mg qd, levothyroxine 88 mmg qd
Current Illness: none
Preexisting Conditions: hypertension
Allergies: bananas, chicken meat but not eggs
Diagnostic Lab Data: This Moderna vaccine was used as booster. Pt. tested positive for covid Jan 13, 2021, recovered. Had Johnson & Johnson covid vaccine March 2021
CDC Split Type:

Write-up: Severe chills and shivering with fever over 103F despite aspirin, Fever declining to 102.5 40 hours after injection, mild fever 99F at 70 hours after injection (pt normal is 97.6F) Other symptoms included fatigue, inability to concentrate for 72 hours after injection.


VAERS ID: 1992052 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Headache, Nausea, Night sweats, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna Covid shot #2, fever, chills, April 15, 2021
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, severe chills, nausea, vomiting, headache, night sweats on 3rd night


VAERS ID: 1992060 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: New York  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3198 / 3 LA / IM

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

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

Write-up: Guidelines states that people 16 years of age or older should receive a booster vaccine; however the above patient who is 13 years of age inadvertently received a booster vaccine/3rd dose of COVID19 vaccine. There were no symptoms reported by the patient or parent.


VAERS ID: 1992082 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3198 / 3 LA / IM

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

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

Write-up: Client given booster at age 13. Clinician made aware of mistake and follow-up done.


VAERS ID: 1992152 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-08
Onset:2021-12-27
   Days after vaccination:110
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asymptomatic COVID-19, Caesarean section, SARS-CoV-2 test positive
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fully vaccinated, not eligible for booster yet. Asymptomatic COVID + in prep for planned full term C section (39 w gestation) Baby born. Baby Wt no documented yet Apgar 9/9. All stable.


VAERS ID: 1992160 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

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

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

Write-up: Broke out in hives.


VAERS ID: 1992185 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Feeling abnormal, Injection site swelling, Lethargy, Paraesthesia, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Lethargy, tingling in cheeks and head, injection site swelling, and fuzziness from day 1-2. Slight fever day two through day 4 increasing to 102 with ibuprofen. Tiredness.


VAERS ID: 1992210 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-12-10
Onset:2021-12-27
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8757 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Feeling hot, Pain
SMQs:, Arthritis (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: Patient stated she takes Vitamin D3 and suppose to be taking Iron but has not in a while. Patient also takes multivitamins starting last week.
Current Illness: Patient had a pap smear done one month prior and was diagnosed with chlamydia and took azithromycin and threw up immediately after taking this. Patient also took doxycycline.
Preexisting Conditions: Patient had asthma as a child but now it is controlled. Other than that period exceeded three weeks. November 4th-26th, October 2nd-24th, Sept 15th-21st, August 13th-19th, then June 1st-28th (those are examples of how long her periods last) She stopped taking birth control as per now.
Allergies: Patient has allergy to amoxicillin
Diagnostic Lab Data: None but encouraged patient to contract PCP
CDC Split Type:

Write-up: Patient experiencing pain on one side of the body starting this past Monday from her foot all the way to her injection site. Explains she feels extremely hot and achy in all of her joints, but mainly on one side of the body.


VAERS ID: 1992251 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-12-26
Onset:2021-12-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028K21A / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache
SMQs:

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

Write-up: very frequent headache on random sides of head all over since a day after booster shot.


VAERS ID: 1992333 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-12-26
Onset:2021-12-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 1330258D / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adverse reaction, Chills, Headache, Lethargy, Pain
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, Atorvastatin, Propecia
Current Illness: None
Preexisting Conditions: Hypothyroid, Mitral valve prolapse, high cholesterol
Allergies: Erthromycin, Sulfa, Scopolamine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Expected adverse reactions after approximately 24 hours including lethargy, body aches, fever (100.1), chills, and headache. The headaches are continuing 4 days post vaccine, although, not as severe. They do respond to Tylenol. My doctor said this should be reported due to the longevity of the symptoms.


VAERS ID: 1992337 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-11-27
Onset:2021-12-27
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3197 / 3 LA / -

Administered by: Public       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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Booster administered too early


VAERS ID: 1992345 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site swelling, Pruritus, Vaccine positive rechallenge
SMQs:, Anaphylactic reaction (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Covid arm after the first and second dose of Moderna
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin. Aspirin. Latex.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Extremely swollen area on the injection site the next day of the third Moderna vaccine. Itchy. Have been applying hydrocortisone topically for 2 days with no improvement. Also taking Zyrtec by mouth. Still not resolved. Seems to be getting bigger. Also got them same reaction with the first and second dose of Moderna, but this time it seems more aggressive.


VAERS ID: 1992347 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3197 / 3 LA / IM

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

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

Write-up: The site got swollen, red, and itchy. It also hurt a lot to move the arm or touch the area. The red mark was about 2 by 2 and a half inches in an oval shape. This whole thing was swollen. The itchiness started two days later but is persistent.


VAERS ID: 1992352 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-16
Onset:2021-12-27
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 LL / IM

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

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

Write-up: Persistent hives. Currently 4 days in. Started on day 10 after vaccine. Reacting over all parts of the body. Appearing for an hour at a time, disappearing, reappearing in different places


VAERS ID: 1992378 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33025BD / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Interchange of vaccine products
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Medications: Mirena IUD
Current Illness:
Preexisting Conditions: PMH: ? Abnormal Pap smear ? Anemia ? Anxiety state ? Gall bladder disease ? GERD (gastroesophageal reflux disease) ? Hypothyroid ? Obesity ? OSA (obstructive sleep apnea)
Allergies: Allergies: Morphine (anaphylaxis), PCN (Rash), Iopamidol (hives)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna Primary Series , Pfizer Booster


VAERS ID: 1992395 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 331308A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Hypoaesthesia, Muscle spasms, Paraesthesia, Product administered at inappropriate site
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Drug abuse and dependence (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Medication errors (narrow), Sexual dysfunction (broad)

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

Write-up: Incorrect positioning of the vaccine given. Per the medical staff she spoke with it was given to low. She has tingling in her hands, feets and legs. Muscle spasms in her legs and also numbness. She has balance issues. She told the pharmacist it was to low. She called and spoke with her doctor and she sent him pictures and he stated that she could possibly have nerve damage.


VAERS ID: 1992400 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-12-19
Onset:2021-12-27
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33030BD / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Fatigue, Headache, Influenza virus test negative, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: Flu test, Covid-19 test
CDC Split Type: vsafe

Write-up: I was fatigue, headache, and cough. These symptoms lasted for about a week. I went to medical facility about. They checked me for the flu and exam me. I did a at home Covid-19 test, negative results.


VAERS ID: 1992413 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059H21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Injection site erythema, Injection site pain, Lymphadenopathy, Sinus disorder
SMQs:, Extravasation events (injections, infusions and implants) (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: septra, penicillins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient states that she began to feel tired 12/27/21 evening. She noticed redness and pain at the site a few hours after immunization as well. Swelling in her armpit started 12/28/21 and had not gotten better as of 12/29/21. She was also having sinus drainage.


VAERS ID: 1992466 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041J21A / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Fatigue, Myalgia, Nausea, Pyrexia, Vaccine positive rechallenge
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 2nd Moderna Shot. Same adverse effects but only moderate
Other Medications: Prescription: Levothyroxine Supplements: D3, Fish Oil, B12, Turmeric, Calcium
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 2 Days: Severe fatigue, chills, and muscle aches. 100 degree plus fever and mild nausea. 3rd Day: Same symptoms - less severe


VAERS ID: 1992469 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 RA / IM

Administered by: Public       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: denies
Current Illness: denies
Preexisting Conditions: denies
Allergies: denies
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient received Booster dose and does not meet age requirement for Booster dosing


VAERS ID: 1992475 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-29
Onset:2021-12-27
   Days after vaccination:332
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / UNK RA / IM

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

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

Write-up: Hospitalization 12/27/21 2nd Pfizer covid vaccine: 2/19/21, EL9267, IM, R arm


VAERS ID: 1992526 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-05
Onset:2021-12-27
   Days after vaccination:266
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Hypoxia, Productive cough, SARS-CoV-2 test positive
SMQs:, Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized with productive cough and hypoxia 20 days after initial COVID + test.


VAERS ID: 1992528 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-23
Onset:2021-12-27
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Diarrhoea, Feeling abnormal, Gait disturbance, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

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

Write-up: ADMISSION: 75-year-old male with PMH of hypertension, gout, CAD status post triple bypass surgery presents with 2 day history of diarrhea and progressive lower extremity weakness. Patient states that his diarrhea started 2 days ago and is brown watery in nature. No foul odors. In association to this he is feeling a bit abnormal. Patient states for the past 6 months he has had progressive lower extremity weakness bilaterally. He states that he is not able to ambulate well anymore. Upon investigation parents should states that he is diet of me and vegetables and admits to drinking at least 1 glass of alcohol per night. Patient denies headache, lightheadedness, dizziness, shortness of breath, chest


VAERS ID: 1992564 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-30
Onset:2021-12-27
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / 1 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anaemia, COVID-19, Dyspnoea, Fatigue, Haemoglobin decreased, SARS-CoV-2 test positive, Transfusion
SMQs:, Anaphylactic reaction (broad), Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: Unknown
Preexisting Conditions: Iron Deficiency Anemia, HTN, Hx RUL Pulmonary Nodule (now resolved), Emphysema/Respiratory Bronchiolitis, Chronic LBP w/Bilateral Sciatica, Tobacco Dependence and EtOH Abuse
Allergies: Enalapril
Diagnostic Lab Data: Covid-19 PCR + 12/27/2021. Hgb 3.8 and 3.2 on 12/27/21 with h/o iron deficiency anemia.
CDC Split Type:

Write-up: Pt admitted for symptomatic anemia (Hgb 3.8) and found to be COVID positive. Tested due to SOB and fatigue, which resolved after transfusion. Pt was otherwise asymptomatic. Received 1 dose of Moderna COVID vaccine, per System records, on 6/30/21. Tested positive for COVID-19 on 12/27/2021.


VAERS ID: 1992572 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-03
Onset:2021-12-27
   Days after vaccination:299
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Fatigue, Respiratory symptom, SARS-CoV-2 test positive
SMQs:, Guillain-Barre syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine (Norvasc) 10 Mg Oral Tablet Aspirin 81 Mg Oral Enteric Coated Tablet Atenolol (Tenormin) 100 Mg Oral Tablet Atorvastatin (Lipitor) 20 Mg Oral Tab Cefdinir (Omnicef) 300 Mg Oral Capsule Chlorthalidone
Current Illness:
Preexisting Conditions: Arthritis Diabetes Falls HTN (hypertension) Hyperlipidemia Metabolic encephalopathy T2DM (type 2 diabetes mellitus) Severe, refractory hypoglycemia Severe Hypokalemia Pneumonia Sepsis, unspecified organism UTI (urinary tract infection) Falls Generalized weakness Elevated lactic acid level PAST SURGICAL HISTORY: The patient has past surgeries of: Oophorectomy Abdominal/lower extremity angiography
Allergies: Hydrochlorothiazide Oseltamivir
Diagnostic Lab Data: POSITIVE COVID TEST 12/28/2021
CDC Split Type:

Write-up: WEAKNESS, FATIGURE, URI SYMPTOMS


VAERS ID: 1992583 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-12
Onset:2021-12-27
   Days after vaccination:45
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / 3 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anal incontinence, Asymptomatic COVID-19, Condition aggravated, Discomfort, Fibrin D dimer, Multiple sclerosis relapse, Muscular weakness, SARS-CoV-2 test positive, Urinary incontinence
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Optic nerve disorders (broad), Demyelination (narrow), Noninfectious diarrhoea (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: Unknown.
Preexisting Conditions: Relapsing remitting multiple sclerosis, GERD, arthritis, depression.
Allergies: Bactrim; Cipro; Erythromycin; Morphine.
Diagnostic Lab Data: Rapid COVID-19 test positive 12/28. Ddimer 22.7 on 12/29 (goal <0.5).
CDC Split Type:

Write-up: Pt received 3 doses of COVID-19 (Moderna) vaccine on 3/11/21, 4/8/21, & 11/12/21. These were confirmed. Pt presented to hospital on 12/27/21 with increased lower extremity weakness, a sensation of heaviness, and bowel/bladder incontinence. These symptoms are typical of her MS flares and she was started on therapy for such (high dose methylprednisolone IV). The patient tested positive for COVID-19 on 12/28/21, but was asymptomatic.


VAERS ID: 1992613 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 RA / IM

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

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

Write-up: Patient is inmunocompromised and received 0.25ml of moderna vaccine instead of 0.5ml.


VAERS ID: 1992619 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: After being vaccinated Tylenol, benadryl
Current Illness: Cold
Preexisting Conditions: Asthma Fatty liver disease Hyperlipidemia
Allergies: Naproxen, pcn shell fish
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 1st day (12.27.21) rash at injection site, rash progressing to arms and torso, headache, fatigue 2nd day (12.28.21)- headache, body aches, fatigue 3rd day (12.29)- milder headache, hives intensified 3th day (12.30)- intense hives, headache, body aches


VAERS ID: 1992656 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0321H2A / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Injection site erythema, Injection site pruritus, 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 2nd Moderna shot; tetanus.
Other Medications: Xarelto; Fish oil; D3; Cinnamon; Probiotic; Aller-Tec
Current Illness: None
Preexisting Conditions: Pulmonary embolisms; DVTs; back surgery
Allergies: Amoxicillin; Penicillin; Sulfa; Erythromycin; Eggs; Lilies
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: After shot given, warm feeling above injection shot area (warm-to-touch). Treated with ice pack and monitored. Had a doctor look at area. Next day: bump under injection site, warm-to-touch, itchy, headache, chills and slight temp around 7 pm. I was tired and slept. Wed: injection site red, warm, itchy, bump underneath, headache off/on and tired. Thurs: injection site red, warm, itchy, bump underneath and headache. Treatment: Tylenol as needed for headache. Monitored redness and bump by injection site.


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