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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 142 out of 10,493

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VAERS ID: 1999498 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Condition aggravated, Nausea, Restlessness, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

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

Write-up: Parents reported nausea/vomiting in parking lot, vomited phlegm/undigested rice - patient breathing unlabored, color even + good, no angioedema or other edema, no SOB. Parents reported hx of occasional N/V associated with emotional upset at times, restless behavior normal for autistic diagnosis Vitals: BP N/A, 88, 16 Patient discharged stable to home with parents, instructed to call 911 if any SOB, difficulty breathing, or other concerns


VAERS ID: 1999560 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Headache, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

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

Write-up: Pt reported vomiting, dizziness, and headache 9 minutes after vaccination Vitals: 101/56, 71, 18 Patient stable and released from vaccination site at 10:20AM


VAERS ID: 1999571 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Dizziness, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: arm pain initially, by nightfall developed chills, fever, and dizziness


VAERS ID: 1999620 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-08
Onset:2021-12-27
   Days after vaccination:294
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: positive test


VAERS ID: 1999647 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-19
Onset:2021-12-27
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ET7533 / 3 RA / -

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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: No
Preexisting Conditions: No
Allergies: Fiorinal; Wellbutrin
Diagnostic Lab Data: COVID test.
CDC Split Type: vsafe

Write-up: Tested positive for COVID after being fully vaccinated. I got the antibody infusion in April for the second COVID outbreak. Not for the third time.


VAERS ID: 1999697 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

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

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

Write-up: patient fainted while walking down the aisle shortly after receiving vaccine. ambulance was called and patient was feeling better before ambulance arrived. emergency personnel allowed patient to leave with parents. called patient 1/3/22 and she was feeling normal with no other adverse reactions since leaving the store.


VAERS ID: 1999736 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-03
Onset:2021-12-27
   Days after vaccination:115
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 2 - / -

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 + on 12/27/2021
CDC Split Type:

Write-up: Breakthrough Case


VAERS ID: 1999741 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-15
Onset:2021-12-27
   Days after vaccination:256
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Covid + on 12/27/2021
CDC Split Type:

Write-up: Breakthrough Case


VAERS ID: 1999751 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-08
Onset:2021-12-27
   Days after vaccination:294
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 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 + on 12/27/2021
CDC Split Type:

Write-up: Breakthrough Case


VAERS ID: 1999788 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-20
Onset:2021-12-27
   Days after vaccination:129
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 2 - / -

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 + on 12/27/2021
CDC Split Type:

Write-up: Breakthrough Case


VAERS ID: 1999795 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8757 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol PRN
Current Illness: none
Preexisting Conditions: No medical history on file
Allergies: No known drug allergies
Diagnostic Lab Data: none preformed
CDC Split Type:

Write-up: None stated by patient or mother.


VAERS ID: 1999796 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-16
Onset:2021-12-27
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 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 + on 12/27/2021
CDC Split Type:

Write-up: Breakthrough Case **Patient received 1st and 2nd vaccine doses at hospital


VAERS ID: 1999995 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-12-16
Onset:2021-12-27
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / N/A LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Joint swelling, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Armour thyroid Resveratrol Magnesium Broccoli extract Vitamin c
Current Illness:
Preexisting Conditions:
Allergies: Ketamine Pepcid Zantac Codeine
Diagnostic Lab Data: Ultrasound to be scheduled
CDC Split Type:

Write-up: My feet and ankles swelled tremendously for the first time ever. Will b getting an ultrasound to look for blood clots


VAERS ID: 2000041 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 331308A / 4 RA / IM

Administered by: Unknown       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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 4TH BOOSTER SHOT WAS GIVEN TO THE PATIENT.


VAERS ID: 2000192 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Michigan  
Vaccinated:0000-00-00
Onset:2021-12-27
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855835 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Anxiety, Dizziness, Dyspnoea, Heart rate increased, Influenza like illness, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (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: Abstains from alcohol; Non-smoker
Preexisting Conditions: Comments: The patient has no known allergies and does not abuse or illicit drug usage. The patient does not consume any birth control medication.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20220100961

Write-up: HEART RACING/RAPID HEART RATE; SHORTNESS OF BREATH; ANXIOUS FOR MAY BE GETTING A BLOOD CLOT; UNUSUAL ABDOMINAL PAIN; FEELING LIGHTHEADED; TINGLING SENSATION OF ARMS & LEGS; FLU-LIKE SYMPTOMS (CHILLS, FEELING FEVERISH, FATIGUE); This spontaneous report received from a patient concerned a 22 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: non-smoker, and non-alcohol user, and other pre-existing medical conditions included: The patient has no known allergies and does not abuse or illicit drug usage. The patient does not consume any birth control medication. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1855835, and batch number: 1855835 expiry: 27-APR-2022) dose was not reported, administered on 27-DEC-2021 for prophylactic vaccination. No concomitant medications were reported. On 27-DEC-2021, the patient experienced flu-like symptoms (chills, feeling feverish, fatigue). On 01-JAN-2022, the patient experienced heart racing/rapid heart rate, shortness of breath, anxious for may be getting a blood clot, unusual abdominal pain, feeling lightheaded, and tingling sensation of arms & legs. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from flu-like symptoms (chills, feeling feverish, fatigue) on 29-DEC-2021, and had not recovered from heart racing/rapid heart rate, shortness of breath, anxious for may be getting a blood clot, unusual abdominal pain, tingling sensation of arms & legs, and feeling lightheaded. This report was non-serious.


VAERS ID: 2000650 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-12-16
Onset:2021-12-27
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test normal, Computerised tomogram, Disorientation, Dizziness, Electrocardiogram, Fall, Loss of consciousness, Myalgia
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? Yes
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: NA
Current Illness: NA
Preexisting Conditions: Slightly elevated cholesterol level
Allergies: NA
Diagnostic Lab Data: CT scan EKG Blood drawn to test for any sign of stroke- negative result
CDC Split Type:

Write-up: Passed out while crossing the street. Hit the concrete on the road when I lost consciousness. Had to be transported to the ER. Disoriented upon awakening. Continue to experience dizzy spells and back neck muscles ache.


VAERS ID: 2000751 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-10-13
Onset:2021-12-27
   Days after vaccination:75
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 2 RA / IM

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

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

Write-up: Tested positive for COVID-19.


VAERS ID: 2001055 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / 3 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure systolic increased, Dizziness, Dyspnoea, Rash, Rash erythematous, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: 1 Aleve 220 Mg Caplet SIG: As needed 2 Amlodipine-valsartan 5-320 Mg SIG: nightly 3 Benadryl Allergy 25 Mg Ultratb SIG: As needed 4 Carvedilol 25 Mg Tablet SIG: twice daily 5 Claritin 10 Mg Tablet SIG: daily (alternate with zyrtec) 6 E
Current Illness:
Preexisting Conditions: Allergic Rhinitis HTN Bipolar. Prior surgeries: C3-5 diskectomy R lumpectomy 2/2 breast cancer Hysterectomy R hip replacement. She was hospitalized in the past (R hip). Gastroesophageal reflux.
Allergies: amoxicillin trihydrate, azithromycin, Betalactams, COVID-19 (SARS-CoV-2) vaccine, Ad26 (Sputnik), erythromycin base, Fish Containing Products, Macrolide Antibiotics, nut - unspecified, Penicillins
Diagnostic Lab Data:
CDC Split Type:

Write-up: She was at pharmacy had her 3rd Pfizer booster 3 days ago. She denies problems with the first 2 doses She got her booster and was walking around shopping, and within 15 min she got dizzy. Her dizziness got worse in an hour later. She went home and ate dinner, then 30 min later she felt even worse with severe dizziness and sob, but no angioedema. She called EMS and her Systolic BP was 200s. She got epinephrine and benadryl IV. The EMT noted that she had a bright red rash on her chest. By the time she arrived to the hospital she was feeling better. Arrived to hospital at 1720 with VS: Temp 98.1, HR 110, Resp 18, BP 177/99, O2 98 She was observed in the ED and was feeling better with improving urticarial rash.


VAERS ID: 2001097 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-06-09
Onset:2021-12-27
   Days after vaccination:201
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 2 RA / IM

Administered by: Other       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: AMLODIPINE
Current Illness: NONE
Preexisting Conditions: SEASONAL ALLERGY, TOBACCO DEPENDENCE, DEPRESSION, HTN
Allergies: ASPIRIN
Diagnostic Lab Data: 12/27/21: POSITIVE SARS-COV-2 RNA
CDC Split Type:

Write-up: UNKNOWN


VAERS ID: 2001137 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-12-20
Onset:2021-12-27
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lymphadenopathy, Pain
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: rapid a-fib after the second vaccine
Other Medications: metoprolol ( after the second dose I went into Rapid A-fib)
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: N/A for this booter side effect.
CDC Split Type:

Write-up: Swollen lymph node jaw/face , as large as a tangerine. heating pad and hot cloth decrease the size and thobbing. I''ve never been in the ER, hospital (except as an RRT), never an EKG or anything until after the 2nd vaccine. I ended up in ICU with rapid a-fib. ( $g200 bpm) and spent 3 days in ICU. So, there has to be a connection. I''m 66 and have NEVER been ill. I walk 5 miles a day and now I''m leery of being out walking alone. What''s UP ? Now swollen lymph (without tooth pain). HELP


VAERS ID: 2001146 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-12-03
Onset:2021-12-27
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Hemiplegia, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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: Advil, Tylenol, zicam, Zyrtec, Claritin
Current Illness: None other than allergies.
Preexisting Conditions: None
Allergies: Aspirin, combination allergies with food such as strawberries or pineapple, mountain cedar
Diagnostic Lab Data: None
CDC Split Type:

Write-up: None at the time. Approximately three weeks after I develop headache behind my ear. I developed a fever on 12/22/21 which lasted 2 days. And now I have left side paralysis with started on 12/27/2021.


VAERS ID: 2001200 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Injection site swelling, Nausea, Oedema peripheral
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: Influenza 15+yrs (Flu-like symptoms lasting 30days)
Other Medications: Prilosec, Adelaide, Vitamin B, Vitamin D, Synthroid, Procaidxl
Current Illness: N/A
Preexisting Conditions: HBP
Allergies: Sulfa, Latex, Surgical Adhesives
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt. states that after receiving the 3rd dose of Phizer 12/27/2021, started experiencing symptoms that evening of round swelling at the injection site, moved to the Left under arm area, chills, and nausea. No noted Primary visit/communications. Still experiencing symptoms .


VAERS ID: 2001212 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066H21A / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Eating disorder, Feeling cold, Hyperhidrosis, Mouth ulceration, Pyrexia
SMQs:, Severe cutaneous adverse reactions (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: 11/23/2021 COVID, neg; dry cough, congestion, low grade fever 11/30/2021 Dr. prescribed a cough medicine (presently still have lingering cough)
Preexisting Conditions: Asthma; GERD
Allergies: Biaxin; Bees
Diagnostic Lab Data: n/a
CDC Split Type: vsafe

Write-up: 12/27/2021 @ 10:30 vaccination. 08:00PM I started to overall low grade fever, chills, sweats, I couldn''t get warm enough. 12/28/2021 102 temperature. I stayed home. 12/30/2021 Mouth ulcerations started to appear. I woke up and they were all over my mouth. 1/1/2022 ER, Dr. stated it was due to the booster vaccination and that they would go away on their own. Visual observations. Prescribed numbing medication. I never took as pharmacy was closed due to the holiday. I used orgel and mouthwash. Presently, 1/4/2022, significantly better. Still on roof of mouth. I was able to eat some solid food starting yesterday. 12/23/2021 - shot of steroids for the ongoing cough from 11/2021.


VAERS ID: 2001275 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059H21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Dizziness, Fatigue, Oropharyngeal pain, Pain in extremity, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu shot 17 yrs ago
Other Medications: Paroxetine
Current Illness: N/a
Preexisting Conditions:
Allergies: Sulfur
Diagnostic Lab Data:
CDC Split Type:

Write-up: Diarrhea vomiting dizzy fatigue arm pain sore throat....last for 5 days


VAERS ID: 2001292 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-02
Onset:2021-12-27
   Days after vaccination:328
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3012BA / 3 RA / IM

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

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

Write-up: Tested Positive for Covid.


VAERS ID: 2001321 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-09
Onset:2021-12-27
   Days after vaccination:321
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M200 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Covid positive contact unknown


VAERS ID: 2001328 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-02-07
Onset:2021-12-27
   Days after vaccination:323
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Communication disorder, Cough, Fatigue
SMQs:, Anaphylactic reaction (broad)

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

Write-up: cough, fatigue, not communicating well


VAERS ID: 2001343 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-23
Onset:2021-12-27
   Days after vaccination:95
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Pollakiuria, SARS-CoV-2 test positive, Thirst, Treatment noncompliance, Vaccine breakthrough infection
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Infective pneumonia (broad), Dehydration (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: Diabetes Type 2
Allergies: No known allergies
Diagnostic Lab Data: SARS CoV office-Positive 12/27/2021.
CDC Split Type:

Write-up: Covid19 breakthrough. 1st Vaccine received on 09/02/2021. Pt presented to the ER with c/o excessive thirst and urination and feeling like his blood sugars are uncontrolled. Pt has not been taking his diabetic medications due to lack of insurance. Pt had a positive Covid test at MD office.


VAERS ID: 2001383 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-26
Onset:2021-12-27
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A - NOT ADMIN / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A - NOT ADMIN / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Positive COVID-19 PCR on 12/27/2021
CDC Split Type:

Write-up: Per MCIR, patient received 2 doses of Pfizer COVID-19 vaccines on 7/26/2021 and 8/16/2021 and was subsequently diagnosed with COVID-19 at our hospital on 12/27/2021


VAERS ID: 2001421 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-20
Onset:2021-12-27
   Days after vaccination:221
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C12A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Covid positive contact unknown


VAERS ID: 2001448 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-12-26
Onset:2021-12-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028K21A / 3 RA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT7424LA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood urine present, Creatinine urine, Metabolic function test, Protein urine, Urine abnormality, Urine analysis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Proteinuria (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Visible blood in urine following second COVID vaccination (Moderna ). 5/4/2021
Other Medications: Cozaar (Losartan) Foliromin (Ferrous citrate sodium) Fish oil
Current Illness:
Preexisting Conditions: Chronic kidney disease (IgA Nephropathy, stage 2/3)
Allergies: None
Diagnostic Lab Data: 12/29/2021: Urinalysis (microscopic) Protein random urine Creatinine random urine Basic metabolic panel I do not have the results of these tests, but they are available from my nephrologist.
CDC Split Type:

Write-up: The morning following my vaccination, I noticed visible blood in my urine. By the third day after vaccination, the color of my urine was dark red (red wine color) when I first urinated in the morning. The color of my urine had returned to normal by the following Saturday (1/1/2022). My urine also became noticeably frothier after my vaccination and has remained so (as of 1/4/2022). I sought treatment from both my primary care doctor and nephrologist. They both did a urinalysis and bloodwork.


VAERS ID: 2001455 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-06-10
Onset:2021-12-27
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Covid positive through work contact


VAERS ID: 2001677 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-24
Onset:2021-12-27
   Days after vaccination:94
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 31035BA / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Exposure to SARS-CoV-2, 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: Covid positive through family contact


VAERS ID: 2001685 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-10-20
Onset:2021-12-27
   Days after vaccination:68
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Occupational exposure to SARS-CoV-2, 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: Covid positive through work contact


VAERS ID: 2001697 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-01
Onset:2021-12-27
   Days after vaccination:117
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051E21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Exposure to SARS-CoV-2, 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: Covid positive through family contact


VAERS ID: 2001699 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-16
Onset:2021-12-27
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 069F21A / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Angioedema, Lip swelling, Pruritus, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (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: Yerba Prima Daily Fiber Caps
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Starting 11 days later (December 27), experienced intense itching in armpits and groin on both sides of body. Within hours, developed large raised areas of hives that persist for days. Additional hive outbreaks appear daily, always bilateral in different areas of body (shoulders, armpits, hips, calves, feet, inner elbows, etc.). Occasional low-grade fever. One incident of Angioedema (lip swelling). After 3 days on high dosage over-the-counter antihistamines (Zyrtec, Pepcid AC, Benadryl) with no relief, started 6-day Prednisone course. Prednisone removed hives within 12 hours of first dose, but hives gradually returned over the course and were fully present again at its end. Symptoms still unresolved after 7 days.


VAERS ID: 2001716 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-09-01
Onset:2021-12-27
   Days after vaccination:117
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051E21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Exposure to SARS-CoV-2, 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: Covid positive due to community contact


VAERS ID: 2001821 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Electric shock sensation, Headache, Impaired work ability, Lethargy, Muscle twitching, Sensory disturbance, Sleep disorder, Tremor
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cymbalta; Vitamins
Current Illness: Clogged ears
Preexisting Conditions: Migraines; asthma
Allergies: Dilaudid
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Muscle tremors and shaking jolt me awake. Feels like backside is electrified lying in bed. Pulse throbbing throughout body. Started the night I received shot. Horrid lethargy and headache. I rested two days off work. Continual jolting and twitching at night.


VAERS ID: 2001897 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-12-17
Onset:2021-12-27
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 060H21A / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Allergy test, Angioedema, Erythema, Pruritus, Sensation of foreign body, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Maybe Zyrtec for seasonal allergies, patient unsure.
Current Illness: None
Preexisting Conditions: High cholesterol.
Allergies: None
Diagnostic Lab Data: Physical examination given in the ER (12/29/2021) with results normal Allergy test for reactions to fish and shellfish (1/4/2022)
CDC Split Type:

Write-up: Ten days after the vaccination, patient began feeling itchy around scalp at 10:30 PM. Awoke at 2:30 AM with hives on torso and right leg. Hives were raised, red, and extremely itchy. Treated with calamine lotion and later Zyrtec, which calmed symptoms. Hives persisted throughout day. Patient awoke at 2 AM the next morning with the feeling of a lump in the throat, similar to indigestion or a pill caught in the back of the throat. Patient did not have trouble breathing, fever, or other symptoms of anaphylaxis. Went to the ER where vital signs were normal. Pill caught in throat feeling persisted for approximately 24 hours before subsiding, possibly with the help of Pepcid A/C. Hives persisted over the next week and were joined by periods of angioedema in the feet and hands. Angioedema episodes coincided with periods of physical activity, hot showers, and alcohol consumption. Hives and angioedema have slowly started to subside beginning on January 2. Both respond well to Zyrtec and Pepcid. Hives remain. Interesting other factor is that the patient''s mother displayed similar symptoms approximately 10 days after receiving the Moderna vaccine. Her symptoms are also ongoing.


VAERS ID: 2001927 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: 1. Vomiting after vaccination PLAN Discharge Medication List as of 12/28/2021 12:24 PM COURSE & MEDICAL DECISION MAKING Pt with h/o abdominal surgery, but no SBO Relays feeling unwell after covid booster yesterday No rooms available in ER, given PO zofran Feels much improved and wishes discharge but will return if vomiting returns Given take home pack Discharge Instructions Please return if you are feeling unwell or continue to vomit Discharge References/Attachments Vomiting (Adult)


VAERS ID: 2002098 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-12
Onset:2021-12-27
   Days after vaccination:259
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038A21A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, Dyspnoea, Malaise, Peripheral swelling, SARS-CoV-2 test positive
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Advair Diskus 100 mcg-50 mcg inhalation powder, 1 Puff, Inhalation, Daily allopurinol 100 mg oral tablet, 100 mg= 1 TAB, PO, Daily atorvastatin 40 mg oral tablet, 40 mg= 1 TAB, PO, QPM (Every evening) furosemide 20 mg oral tablet, 20 mg=
Current Illness:
Preexisting Conditions: Acute on chronic respiratory failure with hypoxemia Anemia At risk for venous thromboembolism (VTE) Chronic renal failure, stage 4 (severe) COPD with emphysema Decreased strength, endurance, and mobility Dysphagia Impaired activities of daily living Moderate aortic stenosis Mycobacterium avium complex Presence of permanent cardiac pacemaker Unspecified severe protein-calorie malnutrition
Allergies: dilaudid and morphine
Diagnostic Lab Data: 12/27/2021 COVID 19 rapid test is positive
CDC Split Type:

Write-up: Patient arrived to the ED on 12/27/2021 with shortness of breath and bilateral leg swelling +COVID Generalized malaise and weakness, shortness of breath , mild cough . O2sat 89% on room air


VAERS ID: 2002103 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-17
Onset:2021-12-27
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939909 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Pruritus, Skin warm, 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: Multi-vitamin, Vitamin D, Fish Oil, Tumeric, Probiotic
Current Illness: None
Preexisting Conditions: None
Allergies: Almonds, pollen, grasses
Diagnostic Lab Data: None. I notified my primary care doc, she advised to take antihistamines.
CDC Split Type:

Write-up: 10 days after my Moderna booster I became extremely itchy and my body started breaking out in hives. The hives look like wide paint strokes, my skin turns a dark pink/red when the hives appear. They appear in 2-3 areas at a time, last for about 30 minutes and move to a new area. They are hot and itchy. The hives comes in waves throughout the day, get worse at night. This is now Day 9 and they have been consistent for the past 9 days.


VAERS ID: 2002146 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-12-16
Onset:2021-12-27
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058H21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperaesthesia, Mechanical urticaria, Pruritus, Swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Oral Allergy Syndrome - mouth itchiness with raw carrots and celery. Seasonal grass pollen allergies.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 11 days after receiving the booster I began having intense itching and hives on my body. No other allergic factors could be identified (e.g. change in diet, detergent, pets, etc.). The hives have continued daily, and do not seem to respond to regular antihistamine use (Benadryl). The hives are highly reactive to touch (dermatographic) and can even be spontaneously generated - raised welts will appear after gently scratching an otherwise calm area of skin. First and second dose of the vaccines were also Moderna, without this reaction. Medical literature is very sparse on this condition, but I was surprised to find in social media community of 1300+ members reporting very similar symptoms to mine (delayed chronic urticaria after COVID vaccines).


VAERS ID: 2002393 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-12-05
Onset:2021-12-27
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027H21B / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adverse event, Penile abscess, Penile swelling, Testicular swelling
SMQs:, Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)

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

Write-up: Pt came to pharmacy and presented a medical report from an urgent care where pt complaint was penile and testicular swelling as well as an abscess in that area. Pt states had been experiencing the swelling and then the abscess for around week''s time and received the moderna vaccine on 12/5 and states he thinks it''s possible this adverse event was from the vaccine.


VAERS ID: 2002921 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-03
Onset:2021-12-27
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Adult failure to thrive, Arthralgia, Back pain, Blood culture, Blood glucose normal, Blood phosphorus decreased, Blood potassium normal, COVID-19, Chest X-ray abnormal, Condition aggravated, Dysphagia, Fall, Hypoaesthesia, Hypokalaemia, Hypomagnesaemia, Hypophagia, Hypophosphataemia, Hypoxia, Ketosis, Lung infiltration, Malnutrition, Musculoskeletal chest pain, Nausea, Neck pain, Neurological examination normal, Pneumonia, Procalcitonin increased, Productive cough, Regurgitation, SARS-CoV-2 test positive, Syncope, Tenderness, Vomiting, Weight decreased, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Hypokalaemia (narrow), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow), 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? Yes
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amLODIPine (NORVASC) 5 MG tablet ascorbic acid (VITAMIN C) 500 MG tablet Blood Glucose Monitoring Suppl (BLOOD GLUCOSE MONITOR SYSTEM) w/Device KIT cholecalciferol (VITAMIN D3) 25 MCG (1000 UT) capsule cyanocobalamin 1000 MCG tablet folic a
Current Illness: 12.3.21: ED visit - Patient is a 59-year-old male with history of hypertension, alcohol abuse, type 2 diabetes who presents emergency department for evaluation after mechanical ground level fall. He is living at a motel in presented to emergency department via EMS; states that this fall occurred approximately 1 hour prior to arrival. He was ambulatory on scene per EMS report. Reports neck pain, left-sided rib pain, right shoulder pain, right hip pain. Tenderness to palpation noted on evaluation overall the sites but no significant deformities noted. Normal neuro examination however patient had tenderness to palpation on cervical spine. C-collar was in place upon arrival to emergency department which I kept in place. He has a chronic history of neck pain but states that this is new when attending went to evaluate him. Does not meet criteria for head CT via the Canadian head CT rules as he denies any head trauma loss of consciousness. Patient is a poor historian but is oriented to everything aside from year; he states that his 2012 and per chart review he has stated that it is is 2012 in multiple previous encounters in the emergency department. Per chart review he is seen for falls and electrolyte abnormalities on a relatively frequent basis.
Preexisting Conditions: Cervical neck pain with evidence of disc disease Low back pain Primary osteoarthritis of left knee Osteoarthritis of multiple joints Spinal stenosis of cervical region Weakness Cognitive and behavioral changes Closed fracture of multiple ribs, initial encounter Falls frequently Hypokalemia Protein-calorie malnutrition, severe (HCC) HAP (hospital-acquired pneumonia) Tobacco use Essential hypertension Type 2 diabetes mellitus without complication, without long-term current use of insulin (HCC) Severe alcohol abuse disorder with alcohol dependence Intractable vomiting with nausea
Allergies: TalwinConfusion MetforminOther Talwin [Naloxone]Anxiety Zanaflex [Tizanidine]Nausea and Vomiting
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized (12.26.21); COVID-19 positive (12.27.21); fully vaccinated Admission Date: 12/26/2021 Discharge Date: 01/03/2022 Admitting Diagnoses: Hypokalemia Details of Hospital Stay PRESENTING PROBLEM: Hypokalemia [E87.6] Hypomagnesemia [E83.42] Ketosis (HCC) [E88.89] Failure to thrive in adult [R62.7] Syncope, unspecified syncope type [R55] Vomiting, intractability of vomiting not specified, presence of nausea not specified, unspecified vomiting type [R11.10] COVID-19 [U07.1] HOSPITAL COURSE: * Hypokalemia Assessment & Plan Potassium levels stable. Monitor daily. Continue IV fluids with potassium supplements. COVID-19 Assessment & Plan: - stable and in no respiratory distress, sating 100% on room air - Unclear symptom onset, likely $g2 weeks ago - Continue mucinex for sputum production - Supportive care - If becomes hypoxic would add decadron Type 2 diabetes mellitus without complication, without long-term current use of insulin (HCC) Assessment & Plan: Blood sugars have been stable without insulin coverage because of his poor intake. Now that he is unable to keep anything down we will continue serial Accu-Cheks but once he is being fed via G-tube this will need to be readdressed. Falls frequently Assessment & Plan: - PT/OT eval - Currently recommending SAR placement Hypophosphatemia Assessment & Plan: Stabilizing; Phosphorus up to 1.7; Will re-dose Sodium phosphate 40 meq x 1 recheck phos in am Essential hypertension Assessment & Plan: Patient''s blood pressure is stable off antihypertensives; - Hold lisinopril and norvasc HAP (hospital-acquired pneumonia) Assessment & Plan Patient developed a marked increase in his white count up to 14,000 and a procalcitonin was elevated at 0.65. He developed hypoxia last night requiring up to 3.5 L but that has been weaned to room air today. Two-view chest x-ray showed a left lower lobe infiltrate and he was started empirically on cefepime due to this being his 7th day in the hospital. He has been afebrile and has not been coughing or hypoxic since last night. Blood cultures were taken prior to antibiotic therapy and RT was requested to induce a sputum if possible. Ketosis (HCC) Assessment & Plan: Resolved. Related to malnutrition and possibly alcoholic ketosis - Supportive care, encourage continued ETOH cessation Intractable vomiting with nausea Assessment & Plan Patient continues with intractable vomiting. Not much nausea at this point more regurgitation due to inability to swallow. Plan consultation with General surgery/Interventional Radiology on Monday for options for feeding tube placement Protein-calorie malnutrition, severe (HCC) Assessment & Plan: Reports 40 pound weight loss over the past year. Has difficulty with swallow, large pills need to be crushed. Reports history of esophageal dilitation. Reports epigastric pain with swallow. RN noted patient chewing food and spitting it out. If this does not improve plan pursue of PEG tube placement - Dietitian consult - Ensure clear with meals (patient preference over milk based ensure) - dental soft diet - up in chair for meals - speech therapy recommendations: Impressions/Recommendations Swallow Diagnosis: pharyngoesophageal phase dysphagia,other (see comments) (suspected esophageal dysphagia) Diet Recommendations: thin liquids, liquids via cup and straw Strategies required for safe oral intake: upright for 60+ following meals,other (comment),small bites,small sips,slow rate (GERD Precautions), self fed, patient is independent, no specific recommendations,provide 6 smaller meals throughout day, patient independent Medication Intake Recommendation: Crushed in puree,Per patient preference Patient unable to keep anything down at this point. He had improved somewhat yesterday and the hope was that he could stabilize enough for discharge but that does not appear likely at this point. Plan consultation general surgery/Interventional Radiology Monday to explore placement of a feeding tube. Severe alcohol abuse disorder with alcohol dependence Assessment & Plan: No evidence of withdrawal at this point; Convert to a Flintstones chewable daily Hypomagnesemia Assessment & Plan: Magnesium level stabilizing. Continue to monitor serially; 1.8 this morning Weakness Assessment & Plan: See plan under frequent falls. Complicated by chronic back pain and intermittent leg numbness. Opioid type dependence, continuous (HCC) Assessment & Plan: Unable to keep even Hycet down due to regurgitation. Morphine 2 mg q.4 hours p.r.n. added IV - lidocaine patch for left rib pain has been effective


VAERS ID: 2002930 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211021A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Burning sensation, Headache, Rash macular
SMQs:, Peripheral neuropathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Armor thyroid 60mg
Current Illness: None
Preexisting Conditions: None
Allergies: None known
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Intense headache the first night, splotchy rash and burning feeling from head-to-toes.


VAERS ID: 2002942 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Body temperature increased, Headache, Nervousness, Respiratory rate increased, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Patient (Date of Birth: 8/18/2013) is an 8-year-old female patient vaccinated at 12:23pm 1st dose Child Pfizer 5-11 (Lot #FK5618) by, LPN in her Left Deltoid. Per patient''s Spanish speaking father who communicated with staff via Language Line Spanish video interpreter, the patient completed her post-vaccination observation period at 12:47pm and was fine when she left the clinic without issues. Patient''s father stated that his daughter was doing good when she left the clinic after observation and was playing outside the Outlet mall in the snow. She then started complaining of a headache while playing in the snow and he brought the patient back to our clinic door around 1:17pm. He did not report any injuries while she was playing in the snow. He did not have her vaccine card with him at the time. With the Spanish interpreter (video) it was communicated by 8-year-old that she had a headache. Assessed by this Charge RN the patient appeared very anxious and nervous. Patient and her father both stated she was nervous and anxious before coming for vaccine that day. Patient and father reported to staff that the vaccinated minor did not have much to eat the day of vaccination and only ate some bacon for breakfast. Offered and accepted apple juice with parent''s permission. Patient drank juice without issue. This RN began a verbal assessment, patient reports she was nervous for the vaccine. As this RN continued to assess the patient, she appeared to become even more anxious and nervous, with visible increase in her respirations, and this RN could visibly see the patient shaking her hands and arms. Patient denied she was having difficulty breathing, she did not know why she was shaking, and she was able to continue to speak in complete sentences via video Spanish interpretation. To further assess and evaluate, the guest and her father were safely escorted to the medical area via wheelchair. At this time the patient''s father called the other family members around 1:30pm for the patient''s vaccine card. Patient''s mother (Spanish-speaking only), and other family members who both spoke English: (the patient''s uncle) and (patient''s Cousin), all arrived around 1:40pm. The mother and uncle began to attempt to calm the patient down encouraging her to breathe slowly in through her nose and out through her mouth as educated by RN staff. Patient appeared to be very anxious, shaking her arms and hands, but she was alert, conscious, and oriented. She spoke with complete coherent sentences via interpreter. Ice pack was provided with parent consent. Parents were informed via video Spanish interpreter that EMS/911 was activated for patient per Site Supervisor. Patient''s parents both agreed. Fire and Rescue/EMS Team- (Run # AF2114331) that his Spanish speaking EMS team member/partner would continue the assessment of the patient and Spanish video interpretation ended once they arrived. Parents agreed. EMS assessed the patient, and they reported the following patient vitals 132/20, HR 100, O2 Sat 99%, Temp 101.3F, Respiration Rate 20, MAP 5. The EMS team also reported that the mother told them that she was a nurse in Mexico. The mother said the patient has no history of seizures or taking any other medications. Patient eventually began to calm down and was no longer shaking. The patient stated that her breathing was getting better and that she was feeling better. However, her hands and arms were still shaking intermittently. EMS offered and encouraged the parents to allow them to call an aid car to take the patient to the emergency room for further follow-up. Both the parents refused EMS. This writer and the EMS team discussed with the parents the risks of declining transport for further assessment of their minor child. Parents understood education and still declined. The patient began to breathe normally, and following patient parent refusal of aid transport, the patient was stable, and EMS ended their clinical encounter and departed the facility. As the family was leaving, the parents asked this RN to call the firefighters/EMS back to take her to the hospital as they had changed their mind. This writer went and relayed the parents request to the EMS went to retrieve firefighters/EMS but when the EMS team returned the patient Uncle listed above stated that the parents had left the vaccination facility to go to the mall restrooms. The Uncle escorted the firefighters with him to assess the patient. The firefighters/EMS then as they were walking by the vaccination clinic returning to their fire truck stated that the parents refused transport again when they were found at Outlet Mall public restrooms. Vaccination Site Nurse Supervisor aware.


VAERS ID: 2003174 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-03
Onset:2021-12-27
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027H21B / 1 LA / -

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

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

Write-up: Itchy skin, hives, redness and welts on back of my head, Rash on my forearms, chest, stomach, back, neck and legs


VAERS ID: 2004238 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3197 / 3 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR UJ773AC / N/A RA / IM
VARZOS: ZOSTER (SHINGRIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, No adverse event, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT WAS RECEIVING THREE VACCINES. COVID-19 VACCINE WAS ADMINISTERED FIRST AND THEN THE FLUZONE FOLLOWED IN THE SAME ARM. SHE WAS THEN TO RECEIVE THE ZOSTER VACCINE IN THE OTHER ARM. AS THE PHARMACIST WAS SPEAKING TO THE PATIENT HE DIDN''T NOTICE THAT HE GRABBED ANOTHER COVID-19 VACCINE. A SECOND COVID-19 VACCINE WAS ADMINISTERED DURING THE SAME VISIT. AFTER REALIZING WHAT HAPPENED THE PHARMACIST ADMINISTERED THE ZOSTER VACCINE AND HAD THE PATIENT WAIT 15 MINUTES. THERE WERE NO ADVERSE EFFECTS REPORTED BY THE PAITENT. THE PATIENT RECEIVED A THIRD AND FOURTH DOSE OF COVID-19 VACCINE AT SAME VISIT BY ACCIDENT.


VAERS ID: 2005452 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-17
Onset:2021-12-27
   Days after vaccination:101
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 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: Depo-Provera
Current Illness: none
Preexisting Conditions: acne
Allergies: latex
Diagnostic Lab Data: Sars-Cov-2 RNA NAAT positive on 12/27/2021
CDC Split Type:

Write-up: positive COVID


VAERS ID: 2005487 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-19
Onset:2021-12-27
   Days after vaccination:130
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 3 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, Voltaren gel, empagliflozin 10 mg, folic acid, ibuprofen prn, glargine 30 U daily, lidocaine patches, metformin 1500 mg daily, methotrexate 50 mg daily, metoprolol 25 mg daily, paroxetine 40 mg daily, prednisone, aspiri
Current Illness: none
Preexisting Conditions: obesity BMI 45, diabetes mellitus with polyneuropathy, hypertension, rheumatoid arthritis, OSA on CPAP
Allergies: none
Diagnostic Lab Data: sars-cov-2 RNA NAAT positive on 12/27/2021
CDC Split Type:

Write-up: positive COVID


VAERS ID: 2005505 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-18
Onset:2021-12-27
   Days after vaccination:284
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001B21A / 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: gabapentin 300 mg TID, hydroxyzine 50 mg prn, albuterol
Current Illness: herniation with low back pain
Preexisting Conditions: exercise-induced asthma, low back pain, depression
Allergies: diclofenac
Diagnostic Lab Data: sars-cov-2 RNA NAAT positive on 12/27/2021
CDC Split Type:

Write-up: positive COVID


VAERS ID: 2005520 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-08-25
Onset:2021-12-27
   Days after vaccination:124
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 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: acetaminophen and ibuprofen prn
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: sars-cov-2 RNA positive on 12/27/2021
CDC Split Type:

Write-up: positive COVID


VAERS ID: 2005605 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 3 LA / IM

Administered by: Unknown       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: PATIENT RECEIVED AN EXPIRED DOSE OF THE PFIZER BOOSTER VACCINE.


VAERS ID: 2005614 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 3 LA / IM

Administered by: Unknown       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: PATIENT RECEIVED AN EXPIRED DOSE OF THE PFIZER BOOSTER VACCINE.


VAERS ID: 2005619 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 3 LA / IM

Administered by: Unknown       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: PATIENT RECEIVED AN EXPIRED DOSE OF THE PFIZER BOOSTER VACCINE.


VAERS ID: 2005628 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 3 LA / IM

Administered by: Unknown       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: PATIENT RECEIVED AN EXPIRED DOSE OF THE PFIZER BOOSTER VACCINE.


VAERS ID: 2005639 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 3 LA / IM

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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT RECEIVED AN EXPIRED DOSE OF THE PFIZER BOOSTER VACCINE.


VAERS ID: 2005649 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 3 LA / IM

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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT RECEIVED AN EXPIRED DOSE OF THE PFIZER BOOSTER VACCINE.


VAERS ID: 2005651 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 3 LA / IM

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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT RECEIVED AN EXPIRED DOSE OF THE PFIZER BOOSTER VACCINE.


VAERS ID: 2005655 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Dizziness, Flushing, Head discomfort, Heart rate increased, Immediate post-injection reaction, Pain in extremity, Palpitations, Paraesthesia, Pyrexia, Tremor
SMQs:, Anaphylactic reaction (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 encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: "Immediately following the injection, I had severe facial flushing and a fever. They kept me at the clinic for a while to monitor heart and blood pressure as my head also felt strange. My heart rate went high after a series of palpitations and light headedness. There were a few nurses involved contemplating sending me to the ER. Severe tremors also began after the heart issue. I am still dealing with the tremors today. I know the arm pain is to be expected, but has been extreme and into my chest. I have also been having tingling in my hand".


VAERS ID: 2005657 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 3 LA / IM

Administered by: Unknown       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: PATIENT RECEIVED AN EXPIRED DOSE OF THE PFIZER BOOSTER VACCINE.


VAERS ID: 2005843 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067H21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Gait disturbance, Headache, Mobility decreased, Muscle spasms, Myalgia, Nausea, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre 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), 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: 2nd Covid Vaccine, 5/7/2021, Moderna, age 50.
Other Medications:
Current Illness: None
Preexisting Conditions:
Allergies: Sulfa medications, Zofran, Acyclovir, Bees (anaphylaxis reaction)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe muscle spasms, severe headache, severe muscle pain, couldn''t move, needed assistance to walk, nausea, vomitting, slight fever (100.3) , extreme fatigue. Lasted 24 hours. Almost called ambulance.


VAERS ID: 2005937 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-12-15
Onset:2021-12-27
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi-vitamin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Diagnosis of Shingles approximately 2 weeks after booster shot of Moderna.


VAERS ID: 2005950 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-12
Onset:2021-12-27
   Days after vaccination:259
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 2 - / UN

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Chest X-ray abnormal, Chills, Cough, Decreased appetite, Intensive care, Lethargy, Lung opacity, Oxygen saturation decreased, Pyrexia, SARS-CoV-2 test positive, Sputum discoloured
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: CAD COPD Gout Hyperlipidemia GERD
Allergies: unknown
Diagnostic Lab Data: 12/27/2021: As per patient report, COVID positive. Not tested. Chest x-ray shows multifocal bilateral opacities.
CDC Split Type:

Write-up: 12/27/2021: Event occurred after 2nd vaccine. 82-year-old male with a past medical history of COPD not on home oxygen CAD and hypertension who presents to the ED with low oxygen level. Patient reports that he started having symptoms of 2 to 3 days ago including chills weakness lethargic cough which is productive for white sputum fever poor appetite and generalized weakness Today he went to go get monoclonal antibodies and his oxygen saturations were low so he was sent to the ED for evaluation. . Pt admitted to critical care. Remains in hospital- Jan 5 2022


VAERS ID: 2005985 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-15
Onset:2021-12-27
   Days after vaccination:195
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Anosmia, Atypical pneumonia, COVID-19, Chest X-ray abnormal, Chills, Cough, Diarrhoea, Dyspnoea, Pain, Pyrexia, SARS-CoV-2 test positive, Tachycardia, Tachypnoea
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (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), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (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? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin, atorvastatin, furosemide, gemfibrozil, ibuprofen PRN, levemir, metformin, metoprolol succinate, novolog, ozempic, potassium chloride
Current Illness:
Preexisting Conditions: Past Medical History Positives Diagnosis Date ? Diabetes mellitus ? Hyperlipemia ? Restless leg syndrome
Allergies: none
Diagnostic Lab Data: 12/23/21 COVID19: positive. 12/27/21 Chest xray: Multifocal atypical pneumonia concordant with history of COVID-19.
CDC Split Type:

Write-up: Presents to hospital ER on 12/27/21 with his wife with a 5 day history of cough, subjective fevers/chills, diarrhea, body aches, loss of sense of taste and smell, and shortness of breath. Patient received the Johnson and Johnson COVID vaccine on June 15, 2021. CXR appears to demonstrate rather diffuse atypical pneumonia. Currently on RA however is tachycardic and tachypnic in between sentences. Received IV dexamethasone and albuterol in the ED. Was admitted for further management following completion of ED workup. Found to be COVID positive. Started on dexamethasone and remdesivir and IV abx as he required 1L NC. Patient with improvement and ready to go home 12/29. Walk test, patient not requiring o2 at rest or on exertion. Discharged on 12/29/21


VAERS ID: 2006010 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-12-16
Onset:2021-12-27
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Anaphylactic reaction, Eye swelling, Joint swelling, Lip swelling, Peripheral swelling, Rash, Swelling face, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Anaphylactic/anaphylactoid shock conditions (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Soolantra cream for rosacea
Current Illness: Known
Preexisting Conditions: Roasacea
Allergies: None known
Diagnostic Lab Data: Visit to immunologist on 1/5/2021 confirm autoimmune response, no tests due to prescriptions at this time
CDC Split Type:

Write-up: Hives, rash, facial swelling, wrists swollen, mild anaphylaxis event with lips and eyes swelling on 12/27/21 ER visit, 2 epinephrine, 4 days of prednisone, claritin - 12/28/21 Foot swelling, continued facial swelling and intermittent hives on torso, back, wrists - 12/28/21 Urgent Care visit, tapering prednisone for 10 days - 12/29/21 Prednisone relieved swelling, still breakthrough rash from touching, food sensitivity Current dosing: 1 Claritin, 2 Pepcid daily, Tapered prednisone until further notice, 2 benadryl in evening


VAERS ID: 2006145 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-07
Onset:2021-12-27
   Days after vaccination:264
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Chest pain, Cough, Dyspnoea, Exposure to SARS-CoV-2, Fatigue, Hypoxia, Lung opacity, Nasal congestion, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (narrow), 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? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknonw
Current Illness: unknown
Preexisting Conditions: COPD, Asthma
Allergies: Bactrim, Effexor, penicillins, Talacen, Toradol, Wellbutrin
Diagnostic Lab Data: External COVID positive result. Not tested at this hospital
CDC Split Type:

Write-up: 12/27/2021-Event occurred after 2nd vaccine. 72-year-old female presenting due to hypoxia and Covid positive test from urgent care earlier today. Patient states 5 days ago she was around her Covid positive granddaughter and 3 days ago she started to notice cough, fatigue, nasal congestion, and shortness of breath. Has had constant nonradiating chest pain that occurs predominantly when she coughs of 3 days duration.. Chest x-ray showed bilateral opacities consistent with Covid pneumonia.


VAERS ID: 2006182 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-23
Onset:2021-12-27
   Days after vaccination:248
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Depressed level of consciousness, Hyporesponsive to stimuli, Loss of consciousness, Lung opacity, SARS-CoV-2 test positive, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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? Yes
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: ESRD, hypertension, diabetes
Allergies: Demerol
Diagnostic Lab Data: 12/27/2021- SARCOV2 positive. CXR; 12/27/2021- Bibasilar opacities are again noted, may represent atelectasis and/or airspace disease.
CDC Split Type:

Write-up: 12/27/2021: Event occurred after 2nd vaccine. Patient presents with decreased responsiveness. History obtained from EMS as patient is not responding to verbal stimuli right now, they were apparently called for a decreased level consciousness, mother unable to wake patient up, per the mother the patient did not have any equipment to measure her blood sugar at home so had just been taking ad lib. doses of her Lantus. 01/05/2022: remains in house.- day 10


VAERS ID: 2006217 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-03-22
Onset:2021-12-27
   Days after vaccination:280
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / UNK UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Balance disorder, Blood bicarbonate normal, Blood glucose normal, Blood pH normal, Blood sodium decreased, COVID-19, Carbon dioxide decreased, Cough, Dizziness, Dyspnoea, Headache, Hypoxia, Nausea, PO2 decreased, Pyrexia, SARS-CoV-2 test positive, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Chronic kidney disease (broad), Respiratory failure (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: 12/27/2021
CDC Split Type:

Write-up: Chief Complaint pt arrives to triage with HA, fever, cough, off balance states +covid on Monday. Patient is a 63 y/o female who presented with complaints of cough, fever, headache, and dizziness for the past week. Patient symptoms started on 12/26, she was diagnosed with COVID19 on 12/27. Patient reports persistent symptoms of dizziness, cough, and fevers 101.7 at home. She has had associated nausea and vomiting. She received 2 doses of the Pfizer vaccine in April, no booster. Due to persistent symptoms with no improvement she presented to the emergency department. Upon arrival patient was noted to be hypoxic with pulse ox in the 90s on room air. Routine lab work with Na 133, CO2 21, glucose 135. ABG pH 7.45, oCO2 35, pO251, HCO3 24.4 on room air. Patient has been placed on 2L O2 via NC. Hospitalist service asked to admit. Currently on COVID Stepdown unit (01/05/2021). Progress note of 01/05/2022: Subjective Feeling somewhat better, cough still bothersome. On 5L, unable to turn down to 4 without dropping. Energy level improving. Review of Systems Constitutional: Negative. Respiratory: Shortness of breath, Cough. Cardiovascular: Negative. Gastrointestinal: Negative. Genitourinary: Negative. Musculoskeletal: Negative. Integumentary: Negative. Neurologic: Negative. ROS reviewed as documented in chart Objective VS/Measurements Vital Signs( 01/03/22 11:55:56 to current ) VITAL SIGN LAST CHARTED MINIMUM MAXIMUM Blood Pressure 149/69 (01/04 11:11) 104/50 (01/04 05:00) 149/69 (01/04 11:11) Heart Rate 46 (01/04 11:40) 46 (01/04 11:40) 74 (01/03 15:15) Respirations 18 (01/04 11:40) 11 (01/04 08:00) 25 (01/03 17:16) Temperature 97.4 (01/04 08:15) 96.8 (01/04 05:00) 98.7 (01/03 17:16) SpO2 90 (01/04 11:40) 88 (01/04 00:00) 96 (01/04 10:00) Oxygen Flow Rate 5 (01/04 11:40) 4 (01/04 11:30) 6 (01/04 09:00) Weight 94.1 (01/04 11:29) 94.1 (01/04 11:29) 94.1 (01/04 11:29)


VAERS ID: 2006263 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-01-19
Onset:2021-12-27
   Days after vaccination:342
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Appendicitis, COVID-19, Fatigue, Respiratory tract congestion, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: hypothyroidism, polycystic kidney disease
Allergies: clarythromycin
Diagnostic Lab Data: SARS-COV-2 testing completed 12/28
CDC Split Type:

Write-up: Patient hospitalized with acute appendicitis on 1/4/2022. She was diagnosed with COVID on 12/28/2021. Patient reports mild symptoms of congestion an d fatigue starting on 12/27/2021. She did recieve outpatient monoclonal antibody treatment as well. In current hospitalization she is not being activly treated for COVID infection. Her primary diagnosis this admissio nis appendcitis.


VAERS ID: 2006287 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-20
Onset:2021-12-27
   Days after vaccination:251
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Cough, Fall, Fatigue, Lung infiltration, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: 12/27/2021- Sars COV 2- positive chest x-ray showed bilateral infiltrates consistent with Covid pneumonia
CDC Split Type:

Write-up: 12/27/2021 Event occurred after 2nd vaccine. 83-year-old male presenting for sudden onset weakness and chronic falls. he does have a fever of 101 today however he states he has not had fevers or chills but has felt progressively more fatigued over the past couple days and has had a cough which started yesterday.


VAERS ID: 2006320 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: New York  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL8095 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: The minor was vaccinated with her second dose of the Pfizer vaccine 2 days early.
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: NKDA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: None


VAERS ID: 2006338 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Mobility decreased, Pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: Entire right side of body swelled up and could hardly move, extreme body aches for 4 days and pain at injection site since injection.


VAERS ID: 2006430 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-10-05
Onset:2021-12-27
   Days after vaccination:83
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Exposure during pregnancy, Injection site pain, Injection site swelling, SARS-CoV-2 test positive
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cetirizine, Fluoxetine, prenatal vitamin, baby aspirin, levothyroxine, progesterone (oral and injection), omeprazole
Current Illness: None
Preexisting Conditions: mild hypertension, asthma, anxiety, depression, GERD, allergic rhinitis
Allergies: Ethyl oleate, nifedipine, wellbutrin, theophylline
Diagnostic Lab Data: Positive Covid test on 12/30/21
CDC Split Type:

Write-up: 19 weeks pregnant at time of administration (EDD 03/02/2022) of second dose on 10/5/21. Side effects after 1st dose 9/10 included body aches, shoulder pain, lethargy, increased allergy symptoms for 48 hours, irritation at previous injection sites (IM progesterone given days before) and headache (lasting 2 weeks). Symptoms after 2nd injection on 10/5 included swelling and soreness at injection site. Positive for covid on 12/30/2021 with symptoms starting on 12/27/21 (less than 3 months after vaccination)


VAERS ID: 2006503 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059H21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event
SMQs:

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

Write-up: Patient did not have any reaction or symptoms at all.


VAERS ID: 2006563 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-02-23
Onset:2021-12-27
   Days after vaccination:307
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Fatigue, Influenza A virus test negative, Influenza B virus test, Respiratory syncytial virus test negative, Rhinorrhoea, SARS-CoV-2 test positive, Sinus disorder
SMQs:, Anaphylactic reaction (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? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: DM type I
Allergies: MONOSODIUM GLUTAMATE OLIVES
Diagnostic Lab Data: Dec 27, 2021@14:40:38 FLU A (CEPHEID) NEGATIVE, FLU B (CEPHEID) NEGATIVE, RSV (CEPHEID) NEGATIVE SARS-CoV-2 POSITIVEA*
CDC Split Type:

Write-up: sinus, cough, tiredness, runny nose


VAERS ID: 2010266 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-09-29
Onset:2021-12-27
   Days after vaccination:89
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Covid positive contact unknown. Client did receive booster


VAERS ID: 2010347 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-17
Onset:2021-12-27
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046A21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 2 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027H21B / 3 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, COVID-19, Chest pain, Cough, Dyspnoea, Fatigue, Headache, Oropharyngeal pain, Pain, Pain in extremity, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ADVIL
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: 01/03/2022 Positive PCR test
CDC Split Type:

Write-up: Got the booster vaccine on December 17, I had side effects for 4 days (body ache, fatigue, arm pain), on December 27 I began to feel a sore throat, fatigue and body ache, I took acetaminophen. On December 30 I did a rapid test at home, I tested positive for COVID. I started to get a headache, shortness of breath, chest pain, dry cough, body aches, and tiredness. I got tested again on January 3 (my doctor asked for it) this time it was a PCR test and I tested positive. The symptoms I have now are chest pain, joint pain, and tiredness. My doctor prescribed an Albuterol, Acetaminophen, and Benzonatate inhaler. I have used the inhaler for 3 days and it has helped a little


VAERS ID: 2010348 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-01-29
Onset:2021-12-27
   Days after vaccination:332
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 - / -

Administered by: Work       Purchased by: ?
Symptoms: Abdominal pain, COVID-19, Discharge, Drain site complication, Flank pain, SARS-CoV-2 test positive
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 325 MG tablet aspirin (HALFPRIN) 81 MG tablet atenolol (TENORMIN) 25 MG tablet colestipol (COLESTID) 1 GM SR tablet famotidine (PEPCID) 20 MG tablet HYDROcodone-acetaminophen (NORCO) 5-325 MG tablet nitroGLYCER
Current Illness: none known
Preexisting Conditions: Hepatocellular carcinoma (HCC) 09/16/2019 CAD (coronary artery disease) 2012 Bell''s palsy Date Unknown Arthritis Date Unknown Essential hypertension, benign Date Unknown Glaucoma Date Unknown HTN (hypertension) Date Unknown MI (myocardial infarction) (HCC) Date Unknown Sensory disorder
Allergies: no known allergies
Diagnostic Lab Data: tested at Healthcare - covid-19 test positive on 10/29/21
CDC Split Type:

Write-up: patient presented to emergency dept on 10/27/21 for right flank pain and discharge from drain patient was admitted for further management of abdominal pain patient was found to be covid-19 positive on 10/29/21 patient did not require treatment for symptoms associated with covid-19 infection. patient was discharged to home on 10/31/21


VAERS ID: 2010481 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-26
Onset:2021-12-27
   Days after vaccination:276
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / UNK - / -

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: DM, Afib, HTN
Allergies:
Diagnostic Lab Data: + Abott
CDC Split Type:

Write-up: COVID


VAERS ID: 2010500 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 060HZ1A / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Diarrhoea, Dizziness, Gait disturbance, Headache, Hyperhidrosis, Limb discomfort, Pain, Pyrexia, Visual impairment, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: mesalamine e r 0.375 gm 4 in am / colesevelam 625 mg 3 at lunch / clonidine o.1mg 1 at bedtime insomnia / synthroid 75 mcg 1 during nite / calcium / daily vitamin/ vit c / vit d / zinc
Current Illness: diagnosed with microscopic colitis nov 2021
Preexisting Conditions: total thyroid removal 2010
Allergies: bactrim and macrobid
Diagnostic Lab Data:
CDC Split Type:

Write-up: second vaccine on 03-14-2021 I had a headache and diarrhea with body aches for about a week . I almost didnt get my booster but when I found out it was half dose figured I would do better .. After I got my booster on 12-27-2021 I started with a headache and dizziness about one hour later. That nite I started with chills and sweating and a fever of 101 . Worse headache of my life . legs felts like heavy weights and could hardly walk. hurt all over . threw up on the third day . Diarrhea also started on the third day. This continued for about 5 days after which I started feeling better and no fever but a headache and Diarrhea continued on for a couple more days. Headache was horrible . Couldnt move my head a inch or 2 without pain shooting thru.. Hurt all ever but around the eyes really bad.. Affected vision also . I saw my family dr on Jan 3 2022 and told her about it and she said I should not get any more covid vaccines .


VAERS ID: 2010509 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-12-09
Onset:2021-12-27
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Rash erythematous, Rash pruritic, 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: Sudafed, claritin, prilosec
Current Illness:
Preexisting Conditions: GERD, seasonal allergies
Allergies: Penicillin, lactose
Diagnostic Lab Data:
CDC Split Type:

Write-up: Red itchy rash and hives around knees, ankles, and upper arms. Treated with claritin, liquid Benadryl, skin cream with Benadryl and skin cream with 1% cortizone. Returned again each evening for 5 days. Never experienced this before. Happened over 2 weeks after receiving Moderna COVID19 booster.


VAERS ID: 2010749 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-22
Onset:2021-12-27
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067F21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Exposure during pregnancy, Nasal congestion, Oropharyngeal pain, Pregnancy, Pyrexia, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Normal pregnancy conditions and outcomes (narrow), 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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Daily Prenatal vitamin
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type: vsafe

Write-up: Pregnant. About 5 weeks after vx, she came down with nasal congestion, fever and sore throat. Two days after symptoms started she tested positive for COVID.


VAERS ID: 2010777 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-23
Onset:2021-12-27
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939909 / 3 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Blood test normal, Computerised tomogram, Dizziness, Ear discomfort
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

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

Write-up: Extreme dizziness when turn head from side-to-side. Ears feel that they are full and pulsing, no pain. Never had ear problems prior, not sick. Went to emergency room and had CAT scan and blood work. All normal. Doctor prescribed Meclizine. Patient did exercises to try to move ear crystals back into place. Recovered to 90% within 24hrs. Still experiencing some dizziness as of filing Jan 6th but not to the same extent. Ears still feel full.


VAERS ID: 2010800 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product administration 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was given a vaccine that did not have the vaccine in it but was drawn up with air. Once the needle was inserted and the plunger was pushed the pharmacist realized there was nothing in there and another Pfizer dose was drawn up and given to the patient.


VAERS ID: 2010861 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33025BD / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Muscle tightness, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (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: 6/7/2021 Pfizer EW0217.
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: N/A.
CDC Split Type:

Write-up: Back tightened within 2-3 hours of receiving the booster shot vaccination. Fever and chills within 24 hours of receiving the booster shot.


VAERS ID: 2011224 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-09
Onset:2021-12-27
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Inappropriate schedule of product administration, SARS-CoV-2 test positive
SMQs:, Medication errors (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, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: covid+


VAERS ID: 2013940 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-12-24
Onset:2021-12-27
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dermatitis, Dry skin, Mechanical urticaria, Pruritus, Skin abrasion
SMQs:, Anaphylactic reaction (broad), Accidents and injuries (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine 125 mcg daily Meloxicam 7.5 mg when necessary Omeprazole 20 mg daily, when necessary
Current Illness:
Preexisting Conditions: hypothyroid
Allergies: NKMA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Within 72 hours, the patient developed pruritus not associated with dermatitis at the vaccination site. Within 96 hours the patient had developed generalized pruritus on the upper extremities, especially the upper arms and the thighs. Dermatitis was only secondary to excoriation. No obvious angioedema or urticaria. Limited dermatographia. Skin is generally dry in the areas of pruritus. No other symptoms suggestive of systemic anaphylaxis. The patient does not have a history of previous urticaria, angioedema or atopic dermatitis.


VAERS ID: 2013963 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: New York  
Vaccinated:2021-12-16
Onset:2021-12-27
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Vitreous floaters
SMQs:, Retinal disorders (narrow)

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

Write-up: Persistent, recurrent "floaters" in visual field. Persistent every day for a week and then recurrent a few times a day until the date of this report.


VAERS ID: 2014140 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33030BD / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: No adverse event, Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: PFIZER BIONTECH COVID 19 VACCINE: ADMINISTRATION ERROR Vaccine vial was not diluted prior to giving dose resulting in error. Individual received 0.3ml of undiluted vaccine. No adverse effects reported.


VAERS ID: 2014182 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-12-26
Onset:2021-12-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD7218 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Eye pain, Fatigue, Feeling abnormal, Pain
SMQs:, Dementia (broad), Glaucoma (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Diabetes (controlling by diet, prescribed metformin 500 mg - wasn''t taking at the time of vaccination) Mild atrial valve regurgitation
Allergies: Penicillin, peanuts, Zithromax
Diagnostic Lab Data: I did not seek medical care - I just assumed it would eventually go away, and if it didn''t I would see my doctor.
CDC Split Type:

Write-up: Along with severe fatigue that started the day after the vaccine and lasted one full day, I also experienced SEVERE EYE PAIN in both left and right eyes that lasted 5 days. My eyeballs hurt! The first three days were torture when moving eyes left to right or up and down. It was better to just keep them closed. The fourth day was still painful, but the left eye was less painful than the right and by the fifth day, there was little to no pain toward the end of the day. There were no redness, itching, draining, or swelling just severe eye pain- I was very concerned that I would to end up with vision problems, or worse, blindness. It was just a miserable 5 days of eye pain- kind of like what eye pain you experience when you have the flu but intensified making you worry because it''s just so painful. On a scale of 1-10 with 10 being the worst, I would rate the pain over the first 2 days at a 9, the third day at a 7, the fourth day at a 5, and the fifth day started at a 3 or 4 and then went away at some point by the next morning.


VAERS ID: 2014192 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3197 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Electric shock sensation, Lip haemorrhage, Muscle twitching, Pharyngeal haemorrhage, Rash, Secretion discharge, Seizure, Sleep disorder, Tremor, Upper respiratory tract infection
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine- rash, upper respiratory congestion/high fever
Other Medications: Zinc 15 mg once daily Magnesium 500 mg once daiy Vitamin C 500 mg once daily
Current Illness: None
Preexisting Conditions: Meniere''s Disease
Allergies: Augment, Cipro, Flu Vaccine, Naproxen, MSG
Diagnostic Lab Data: I have a scheduled appointment with my doctor on 2/7/2022 for lab work and a referral to a neurologist. If the bleeding continues or the muscle twitching progress, I will go to urgent care. However, am in between jobs and do not have insurance until 2/1/2022.
CDC Split Type:

Write-up: I received the Pfizer vaccine on 12/27/2021, two hours after receiving the vaccine, my lip started bleeding and filled my mouth with blood and I had to apply pressure to the opening on my lip for 5 minutes to get it to stop bleeding. I did not cut my lip, it started bleeding without prior trauma. Over the next 2-5 days after the vaccine, I kept tasting blood in my mouth and looked at my throat with a flashlight and found an area in the back of my throat, a capillary bleeding. I drank cold water to have it stop bleeding. 7 days after the vaccine, I got an upper respiratory infection with lots of thick yellow/brown mucus produced over the next 4 days and still ongoing. On day 7 after the vaccine, I started experiencing muscle twitching throughout my body, a sensation of full body tremors, and electric current feeling in my body all day and night. When falling asleep and during sleep, the muscle twitching''s are quite large and wake me throughout the night and cause my entire lower body to convulse. I have also broke out in rashes throughout my body since the day of the injection. I had none of these symptoms prior to the vaccine.


VAERS ID: 2014222 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-12-22
Onset:2021-12-27
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3197 / 3 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD, rheumatoid arthritis, CKD
Allergies:
Diagnostic Lab Data: COVID+ 12/27/2021
CDC Split Type:

Write-up: COVID BREAKTHROUGH CASE


VAERS ID: 2014284 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3198 / 1 RA / IM

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

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

Write-up: Client reported they were 12 years olf when they were only 11. Adult dose of Pfizer was given incorrectly.


VAERS ID: 2014293 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-20
Onset:2021-12-27
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Exposure to SARS-CoV-2, Nasal congestion, 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: LORAZEPAM, OMEPRAZOLE, MECLIZINE, METPROLOL, LANSOPRAZOLE
Current Illness:
Preexisting Conditions: GERD
Allergies: AMOXICILLIN, BENZOYL PEROXIDE WASH
Diagnostic Lab Data: POSITIVE COVID TEST
CDC Split Type:

Write-up: NASAL CONGESTION POST COVID EXPOSURE


VAERS ID: 2014355 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 330308D / 3 LA / IM

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? 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: PFIZER vaccine that was stored in pharmacy refrigerator given outside of 31 day expiration. Vaccine received at hospital on 11/19/2021. Expiration date on vial 02/2022. NDC# 5926710000


VAERS ID: 2014357 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 330308D / 3 RA / IM

Administered by: Unknown       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: PFIZER vaccine that was stored in pharmacy refrigerator given outside of 31 day expiration. Vaccine received at hospital on 11/19/2021. Expiration date on vial 02/2022. NDC# 5926710000


VAERS ID: 2014370 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 330308D / 3 RA / IM

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? 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: PFIZER vaccine that was stored in pharmacy refrigerator given outside of 31 day expiration. Vaccine received at hospital on 11/19/2021. Expiration date on vial 02/2022. NDC# 5926710000


VAERS ID: 2014385 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-27
Onset:2021-12-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 330308D / 3 LA / IM

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? 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: PFIZER vaccine that was stored in pharmacy refrigerator given outside of 31 day expiration. Vaccine received at hospital on 11/19/2021. Expiration date on vial 02/2022. NDC# 5926710000.


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