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From the 9/10/2021 release of VAERS data:

Found 686,636 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 144 out of 6,867

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VAERS ID: 1574665 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Chest pain, Computerised tomogram, Cough, Dizziness, Headache, Nausea, Oropharyngeal pain, Pyrexia, SARS-CoV-2 test, Streptococcus test, Vision blurred, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Atenolol Cetirizine
Current Illness: Migraines/ hypertension
Preexisting Conditions: Recently rediagnoaed with hypertension and history of chronic migraines
Allergies: Rondec
Diagnostic Lab Data: As far as I was told all testing came back relatively normal and that It was probably just side effects from the vaccine to go home and sleep it off. Prescribed Phenergan for home nausea and to follow with pcp in 3 days
CDC Split Type:

Write-up: Fever, sore throat, vomiting. Nausea, dizziness, blurred vision, headache. Chest pain, cough Outpatient clinc and well as ER visit for treatment. Bloodwork, cheat xray, cat scan, strep test and covid swabbed


VAERS ID: 1574666 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Diarrhoea, Disturbance in attention, Fatigue, Headache, Nausea, Neck pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Arthritis (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Hypertension
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Head Ache, Neck Ache, Low Fever, Extreme Fatigue, Loss of Concentration, Diahreah , nausea for Friday, Saturday, Sunday, Monday


VAERS ID: 1575481 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-07
Onset:2021-08-13
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E211 / UNK LA / IM

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

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

Write-up: Pt reported swelling around the eye around 6 days after the 2nd covid vaccine was given. Pt stated that she called 911 and was instructed by EMT to use cold compress around the area. Per pt EMT staff confirmed that her breathing, heart, and blood pressure were normal. Pt informed the pharmacy about this event 3 days after the adverse reaction event.


VAERS ID: 1577512 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Ohio  
Vaccinated:0000-00-00
Onset:2021-08-13
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821281 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Limb mass
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Toxemia
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210827372

Write-up: LUMP IN UPPER RIGHT LEG; This spontaneous report received from a patient concerned a 53 year old female. The patient''s height, and weight were not reported. The patient''s past medical history included: toxemia when pregnant. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 1821281 expiry: UNKNOWN) dose was not reported, administered on 03-AUG-2021 for prophylactic vaccination. No concomitant medications were reported. On 13-AUG-2021, the patient experienced lump in upper right leg. The action taken with covid-19 vaccine was not applicable. The outcome of lump in upper right leg was not reported. This report was non-serious. This case is associated with Product Quality Complaint number: 90000189496


VAERS ID: 1577523 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Tennessee  
Vaccinated:0000-00-00
Onset:2021-08-13
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19; Comments: The patient had no known allergies.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210829073

Write-up: FEVER; This spontaneous report received from a patient concerned a 21 year old male. The patient''s height, and weight were not reported. The patient''s past medical history included: covid, and other pre-existing medical conditions included: The patient had no known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 202A21A, expiry: 21-SEP-2021) dose was not reported, administered on 12-AUG-2021 for prophylactic vaccination. No concomitant medications were reported. On 13-AUG-2021, the patient experienced fever. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from fever. This report was non-serious.


VAERS ID: 1577524 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:2021-08-13
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

Administered by: Military       Purchased by: ?
Symptoms: Fatigue, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Blood pressure high (that patient take medication)
Preexisting Conditions: Medical History/Concurrent Conditions: Appetite impaired; Comments: Patient had no known drug allergies.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210829164

Write-up: MORE TIRED THAN USUAL; MUSCLE ACHES; This spontaneous report received from a patient concerned a 52 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: high blood pressure, and not able to drink milk, and other pre-existing medical conditions included: Patient had no known drug allergies. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 204A21A, and expiry: UNKNOWN) dose was not reported, administered on 12-AUG-2021 for prophylactic vaccination. No concomitant medications were reported. On 13-AUG-2021, the patient experienced more tired than usual. On 13-AUG-2021, the patient experienced muscle aches. The action taken with covid-19 vaccine was not applicable. The outcome of the more tired than usual and muscle aches was not reported. This report was non-serious.


VAERS ID: 1577526 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-08-13
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210829226

Write-up: RASH; FEVER; This spontaneous report received from a consumer concerned a 26 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 12-AUG-2021 for prophylactic vaccination. The batch number was not reported. The company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On 13-AUG-2021, the patient experienced rash. On 13-AUG-2021, the patient experienced fever. The action taken with covid-19 vaccine was not applicable. The patient had not recovered from rash, and fever. This report was non-serious.


VAERS ID: 1577527 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:2021-08-13
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Poor quality product administered
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: No known allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210829279

Write-up: VACCINE WAS ADMINISTERED WHEN EXPIRED BY 45 MINUTES - 1 HOUR (PAST THE ALLOWED 6 HOURS AFTER FIRST PUNCTURE); This spontaneous report received from a pharmacist concerned a 39 year old male. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included: No known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1808986, expiry: 02-OCT-2021) dose was not reported, administered on 13-AUG-2021 for prophylactic vaccination. No concomitant medications were reported. On 13-AUG-2021, the patient experienced vaccine was administered when expired by 45 minutes - 1 hour (past the allowed 6 hours after first puncture). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of vaccine was administered when expired by 45 minutes - 1 hour (past the allowed 6 hours after first puncture) was not reported. This report was non-serious.


VAERS ID: 1577528 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:2021-08-13
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210829363

Write-up: LEG PAIN ON THE SIDE WHERE PATIENT RECEIVED THE VACCINE (LEFT SIDE); This spontaneous report received from a consumer concerned a 19 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 206A21A, expiry: UNKNOWN) dose was not reported, administered on 12-AUG-2021 16:00 for prophylactic vaccination. No concomitant medications were reported. On 13-AUG-2021, the patient experienced leg pain on the side where patient received the vaccine (left side). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from leg pain on the side where patient received the vaccine (left side). This report was non-serious.


VAERS ID: 1577533 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-08-13
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Heart rate, Heart rate increased, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ALBUTEROL [SALBUTAMOL]
Current Illness: Multiple allergies; Non-smoker; Social alcohol drinker (1-2 drinks once a month)
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 20210813; Test Name: Heart rate; Result Unstructured Data: 115 Beats per minute; Test Date: 20210813; Test Name: Heart rate; Result Unstructured Data: 90 Beats per minute; Test Name: Heart rate; Result Unstructured Data: 62 Beats per minute (normal)
CDC Split Type: USJNJFOC20210830353

Write-up: SORE ARM; INCREASED HEART RATE; SHORTNESS OF BREATH; DIZZINESS; This spontaneous report received from a patient concerned a 62 year old female. The patient''s weight was 165 pounds, and height was 65 inches. The patient''s concurrent conditions included: outdoor allergies, social alcohol drinker, and non-smoker. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 042A21A, expiry: UNKNOWN) dose was not reported, administered on 13-AUG-2021 11:00 for prophylactic vaccination. Concomitant medications included salbutamol. On 13-AUG-2021, the patient experienced increased heart rate. On 13-AUG-2021, the patient experienced shortness of breath. On 13-AUG-2021, the patient experienced dizziness. Laboratory data included: Heart rate (NR: not provided) 115 Beats per minute, 90 Beats per minute. On 14-AUG-2021, the patient experienced sore arm. Laboratory data (dates unspecified) included: Heart rate (NR: not provided) 62 Beats per minute (normal). The action taken with covid-19 vaccine was not applicable. The patient had not recovered from increased heart rate, shortness of breath, dizziness, and sore arm. This report was non-serious.


VAERS ID: 1577565 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

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

Write-up: Systemic: Patient compliant of numbness of the left face side starting about 3 to 4 hours after vaccine-Medium


VAERS ID: 1577627 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

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

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

Write-up: Systemic: Diarrhea-Medium, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Medium, Systemic: Nausea-Medium, Systemic: Vomiting-Medium, Additional Details: low blood pressure. was seen by family friend who is a provider. pt came around after having coffee.


VAERS ID: 1577851 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Agitation, Muscle spasms, Pain
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (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: Ativan PRN Vitamin B Vitamin D Multivitamin
Current Illness: Sinus infection 2 weeks prior to vaccination that was treated with Rocephin injection
Preexisting Conditions: Anxiety and depression, Alpha Gal
Allergies: Alpha Gal- allergic to beef and beef containing products
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Body aches that started on the day of injection that has since resolved; patient has been agitated and having muscle spasms in her neck that started the day after injection that are persistent.


VAERS ID: 1577870 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Dyspnoea, Hypertension, Respiratory distress
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Hypertension (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: no known allergies
Diagnostic Lab Data: Possible due to COVID-10 vaccine
CDC Split Type:

Write-up: On the second day after receiving Moderna vaccine, patient developed uncontrolled Blood Pressure and admitted to the ED at the Medical Center in area. His systolic BP was $g240, shortness of breath, respiratory distress, and acute kidney injury


VAERS ID: 1577871 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-04
Onset:2021-08-13
   Days after vaccination:101
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 AR / SYR

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

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

Write-up: n/a


VAERS ID: 1577884 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-07
Onset:2021-08-13
   Days after vaccination:128
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER0153 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lantus, Voltaren, Unifine, Synthroid, Vit D, Eliquis, Bumex, Flexeril, Zyloprim, Depakote, Multaq, Norco, Novolog, Toprol, Mirapex, Deltasone, Seroquel, Cymbalta
Current Illness:
Preexisting Conditions:
Allergies: Cefepime, Rocephin, Haloperidol, Atorvastatin, Daptacel, Gabapentin, HMG-coa-r inhibitors, hydrochlorothiazide, Indomethacin, Lisinopril, Lithium, Lithium, Nitrofurantoin, Tdap vaccine, adhesive tape, latex, methotrexate, metoclopramide, prochlorperazine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient developed symptoms of SOB and a cough on 08/06/2021. Presented to the ER on 08/13/2021 for these symptoms and tested positive for COVID-19 on 08/13/2021.


VAERS ID: 1577886 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-02-06
Onset:2021-08-13
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Dyspepsia, Fatigue, Nausea, Pain, SARS-CoV-2 test positive
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific dysfunction (narrow), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: humalog via pump, xalatan5% ,simbrinza, crestor 10 mg, miralax, carvedilol 3.123 2x day, clopidogrel 75mg, torsemide 20mg on non dialysis days, alprazolam 0.50 2x day, baby aspirin, sertraline 50mg, norvasc 2,5mg , dialyvite 800 multivitami
Current Illness: esrd, cad,
Preexisting Conditions: type 1 diabetes for 66 years
Allergies: infused iron
Diagnostic Lab Data: covid rapid test positive 8/16/2021
CDC Split Type:

Write-up: fatigue, nausea, indigestion, aches


VAERS ID: 1577896 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 RA / IM

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

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

Write-up: A patient received 3 different types of COVID- Vaccine injections. Patient received Moderna Vaccine 02/17/2021 @ Health Center, received Janssen on 05/08/2021 @ Emergency Center, and received Pfizer on 08/13/2021. No Adverse reactions noted. Patient called to schedule appointment with a physician at family health center, Patient has not responded to phone call.


VAERS ID: 1577898 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angioedema, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), 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? 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: Generalized rash beginning around 4pm - patient describes as hives. Angioedema begin about 11pm same day as vaccination and lasted to early next morning. Patient took Benadryl, Sudafed, Pepcid and Zyrtec. Rash gone in 2 days.


VAERS ID: 1577912 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-20
Onset:2021-08-13
   Days after vaccination:174
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest X-ray, Cough, Dizziness, Gastrointestinal disorder, Headache, Laboratory test, SARS-CoV-2 test positive, Sputum discoloured
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular 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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: COPD, HTN
Allergies: NKA
Diagnostic Lab Data: Chest xray x2, general labs
CDC Split Type:

Write-up: Moderna- 01/23/2021 C19 dose #1 Moderna- 02/20/2021 C19 dose #2 8/13/2021- Pt reported cough with green sputum, dizzy, positive test from 8/2/2021, constant headache and GI issues 8/15/2021- came to ED with same symptoms and worsening, no vomiting, known C19 positive from 8/2/2021 while visiting family in another location, no Covid testing in ED


VAERS ID: 1577945 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-03
Onset:2021-08-13
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu
Other Medications: Tylenol 650/ Lisinopril, Clopidogrel, Crestor, Vit B 12, Vit:D3
Current Illness:
Preexisting Conditions: No Spleen, have had several TIA''s
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: 10 days after vaccine started developing a rash and itching. The site was warm to touch. Today site is still red and slightly warm and spread almost entire upper arm.


VAERS ID: 1577952 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Dysstasia, Flank pain, Headache, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Gabapentin, Dilantin 100mg, Fludrocortisone 0.5mg, NP Thyroid 30mg twice a day, Zinc 22mg daily, Vitamin D 5000 units daily, Oxycodone 1 tablet 3x a day as needed.
Current Illness: None.
Preexisting Conditions: Addison''s disease, hashimoto''s disease, RSD in left arm.
Allergies: Penicillin, Sulfonamide antibiotics.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe headache, bilateral flank pain, severe muscle and joint paint, urgency, severe nausea no vomiting, blood pressure- 90/0, was unable to stand, extremely weak.


VAERS ID: 1577976 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-09
Onset:2021-08-13
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH CR5204 / 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: Covid19


VAERS ID: 1577983 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-02-08
Onset:2021-08-13
   Days after vaccination:186
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Headache, Muscle fatigue, Oropharyngeal pain, Pain, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test
SMQs:, Rhabdomyolysis/myopathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amphetamine-dextroamphetamine XR (ADDERALL XR) 10 mg 24 hr capsule(Expired) fluticasone propionate (FLONASE) 50 mcg/actuation nasal spray
Current Illness: None
Preexisting Conditions: Digestive Nonulcer dyspepsia Other Anxiety Depression Dysfunctional labor Insomnia ADHD (attention deficit hyperactivity disorder), combined type
Allergies: No Known Allergies
Diagnostic Lab Data: COVID-19 PCR
CDC Split Type:

Write-up: Fatigue Muscle or body aches Headache Sore throat Congestion or running nose


VAERS ID: 1577998 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-08-09
Onset:2021-08-13
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Erythema, Pruritus, Skin burning sensation, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), 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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PROZAC 40 MG, WELLBUTRIN XL 150 MG, CYANOCOBALAMIN 1,000 MCG, ALPRAZOLAM 0.5MG
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: PENICILLIN, CODEINE AND SULFA-DRUGS
Diagnostic Lab Data:
CDC Split Type:

Write-up: INTENSE HIVES, SEVERE ITCHING AND BURNING, ENTIRE BODY FEELS SUNBURNED - NO REDNESS AT INJECTION SITE, JUST ALL OVER UPPER BODY, TRUNK, BEHIND KNEES, ARMS, FACE, AND NECK


VAERS ID: 1578032 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-05
Onset:2021-08-13
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Malaise, 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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Benadryl
Diagnostic Lab Data: Positive COVID test.
CDC Split Type:

Write-up: Pt. tested positive for COVID-19 08/14/21 and started having symptoms 08/13/21.


VAERS ID: 1578044 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Flushing, Pain, Paraesthesia, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (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: Valium 5mg Lyrica Baclofen Wellbutrin
Current Illness:
Preexisting Conditions:
Allergies: Contrast dye
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client complained on left extremity feeling tingly, achiness, flushing, and wheezing. Client''s HR 130s and BP 150/90s. Pulse ox 98% RA. Client remained alert and oriented during event. Nurse noted mild wheezes in upper lung. Client stated she was feeling flushed off and on. Benadryl given to client. Ambulance arrived on scene at 1350 and pt refused transport. Went home with a family member.


VAERS ID: 1578060 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-27
Onset:2021-08-13
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Oxygen saturation decreased, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: No known home medications
Current Illness: unknown
Preexisting Conditions: Denies
Allergies: No known allergies
Diagnostic Lab Data: Patient initially tested positive for COVID infection on 08/05/21, per history, type/place unknown
CDC Split Type:

Write-up: The patient presents with shortness of breath. 56 year old male presents to ED complaining of sob, secondary to COVID-19 infection. Pt reports his O2 saturation drooped to 85% PTA. He discussed this concern with his PCP, who advised him to visit the ED. Pt is COVID-19 positive. PT PRESENTS TO ED FROM HOME VIA EMS FOR CO SHORTNESSOF BREATH. PT TESTED POSITIVE FOR COVID A WEEK AND A HALF AGO. PT WAS AT 87% ON RA UPON EMS ARRIVAL. when pt arrived to the ED he was placed on 4L NC and his sat was 88%.


VAERS ID: 1578061 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-01-14
Onset:2021-08-13
   Days after vaccination:211
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EL1283 / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EN5318 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Condition aggravated, Cough, Fall, Pain, Palpitations, SARS-CoV-2 test positive, Trunk injury
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Accidents and injuries (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine, Trental, Zocor, Lyrica, Plavix, Ativan Colace, Zinc, Multivitamin with minerals (Emerg-C), Dulera , Spiriva, Mysoline, probioticNitrostate
Current Illness: unknown illnesses, no vaccinations one month prior
Preexisting Conditions: CAD, HTN, HLD, AAA, MI, angina, COPD, CVA, enlarged prostate
Allergies: no known allergies
Diagnostic Lab Data: SARS COV2 Covid 19 PCR 08/13/2021
CDC Split Type:

Write-up: The patient presents with 77 year old male with history of CAD, HTN, HLD, AAA on Plavix, MI, angina, COPD, CVA, and enlarged prostate presents to ED with c/o weakness and multiple falls x1 week. Sts he woke up to use the restroom at 0400 and started leaning forward and got caught between the toilet and the wall. He c/o left sided trunk pain that''s exacerbated with coughing and palpation. EMS was called to assist the patient but he refused to be transported. Patient is on 2L oxygen at night secondary to COPD. Patient states he always has a decreased urinary stream. Also states he always has a cough.. The onset was 1 weeks ago. Incidental finding--Covid.


VAERS ID: 1578119 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-08-11
Onset:2021-08-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Herpes virus infection, Infection, Oral herpes, Oxygen saturation decreased, Pain in extremity, Vaginal disorder
SMQs:, Oropharyngeal infections (narrow), Acute central respiratory depression (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (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: Advil PM, Vit D, C, E, Zinc, Multi Vitamin,All Medications are PRN
Current Illness: None
Preexisting Conditions: Cancer 1987 Breast, 1998 Breast, 2014 Skin Basal, 2017 Skin Squamous
Allergies: Dairy, Wheat, Shellfish, Peanuts, Legumes All Antibiotics - Sipro, Penicillin, Sulfa, Tetracycline,Ampicillin, Erythromicin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Herpes break out severe and raw in vaginal and labia area - started taking PRN Valcyclovir for 3 days post breakout which started two days after vaccine. Severe fatigue four days after vaccine Sore arm day after vaccine Breathing SpO2 dropped to 84% four days after vaccine


VAERS ID: 1578168 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Peripheral swelling, Throat tightness
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad)

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

Write-up: Chest tightness, hand and foot swelling, throat tightness


VAERS ID: 1578186 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-02-15
Onset:2021-08-13
   Days after vaccination:179
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 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: diclofenac sodium (VOLTAREN GEL) 1 % gel fexofenadine (ALLEGRA) 180 mg tablet fluticasone propionate (FLONASE) 50 mcg/actuation nasal spray lisinopril-hydroCHLOROthiazide (ZESTORETIC) 10-12.5 mg per tablet metoprolol succinate XL (TOPROL-XL
Current Illness: None
Preexisting Conditions: Respiratory Allergic rhinitis Circulatory Essential hypertension Digestive History of hepatitis C virus infection Genitourinary Postmenopausal Endocrine/Metabolic Prediabetes Hypercholesterolemia Other Overweight(278.02) History of squamous cell carcinoma of skin
Allergies: None listed
Diagnostic Lab Data: COVID-19 (SARS CoV-2,RNA Molecular Amplification) COVID-19 PCR
CDC Split Type:

Write-up: Tested positive for COVID-19 Mild symptoms


VAERS ID: 1578191 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037A21A / UNK UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Eye movement disorder, Foaming at mouth, Nausea, Secretion discharge, Stridor
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Convulsions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ocular motility disorders (narrow), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad)

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

Write-up: 1. vaccine given approx 1310, approx one minute later she became nauseous and then was frothing at the mouth, no vomiting 2. assistance was requested by personnel in the command center 3. as she was frothing at the mouth, her eyes rolled back and she had respiratory stridor and secretions coming from her mouth, epinephrine given in her left deltoid muscle, she was slowly assisted to the floor and her airway was maintained by a jaw lift maneuver, secretions were removed from her mouth, after several minutes a crash cart and stretcher were brought and O2 via blow by at 15L placed, placed on code cart monitor and the emergency room staff came to take her to the ER. This is the sequence of events that led to patirnt going to the ED. Staff from vaccine team.


VAERS ID: 1578205 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Balance disorder, Chest pain, Fatigue, Injection site pain
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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: None.
Current Illness:
Preexisting Conditions: Asthma.
Allergies: seafood.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fatigue, chest pains, unbalanced, soreness at injection site, constant stomach pains.


VAERS ID: 1578210 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-08-05
Onset:2021-08-13
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 2 LA / SC

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Pulmonary thrombosis
SMQs:, Embolic and thrombotic events, venous (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: Metoprolol Simvastatin Folic Acid VD Desvenlafaxin B Complex Calcium with Mag and Zinc Methatrexate SQ weekly and Remacade infusion every 8weeks
Current Illness: Just Crohns
Preexisting Conditions:
Allergies: Sulfa Pcn
Diagnostic Lab Data:
CDC Split Type:

Write-up: Blood clots in lung admit to hospital started on blood thinners


VAERS ID: 1578219 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-06
Onset:2021-08-13
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipene, gout medication
Current Illness: None
Preexisting Conditions: None
Allergies: Reaction to mri contrast
Diagnostic Lab Data: Admitted to emergency room on Friday 13th
CDC Split Type:

Write-up: Uncontrollable shaking for hours. I continue to feel lightheaded and shaky


VAERS ID: 1578228 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / UNK RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Diarrhoea, Dizziness, Fatigue, Headache, Lymphadenopathy, Nausea, Pyrexia, Tremor, Vulvovaginal pain
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omeprazole, Venlafaxine, Colestipol HCL, Centrum Slver for Women, Calcium 600mg + D3 10mcg
Current Illness: None
Preexisting Conditions: Anxiety Disorder
Allergies: Asprin, E-myacin, Steroids, Lexapro, MSG
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme fatigue, extreme join paint, dizziness, headache, swollen lymph node in armpit of right arm, diarrhea, nausea, fever, tremors, painful vagina/clitoris Took Extra Strength Tylenol for 2 days. Symptoms lasted 4 days with lessening strength. As of writing this, the swollen lymph node and painful clitoris still continue.


VAERS ID: 1578233 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-03-03
Onset:2021-08-13
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: PCR COVID-19 test with a positive result
CDC Split Type:

Write-up: The patient received the Pfizer COVID-19 vaccine on 2/10/21 and 3/3/21, so was fully vaccinated when he tested positive for COVID-19 on 8/13/21.


VAERS ID: 1578234 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Virgin Islands  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039C21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Decreased appetite, Diarrhoea, Dizziness, Eye pain, Headache, Injection site pain, Injection site swelling, Lethargy, Malaise, Pain, Photophobia, Pyrexia, Visual impairment
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Corneal 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Standard Process Immune System Health Pack (Vegetarian) and Cod Liver Oil dietary supplements.
Current Illness: None known
Preexisting Conditions: Sciatic nerve pain and herniated disc
Allergies: Penicillin and environmental allergies
Diagnostic Lab Data: None taken
CDC Split Type:

Write-up: 1st Dose: Injections site pain, tenderness and swelling by the afternoon; slight light-headed/dizziness in the evening into the next day. Took two dose of Tylenol on the second day for the pain in the arm. The light-headed/dizziness was gone by the fourth day. 2nd Dose: Injection site swelling tenderness and body ache by the afternoon; fever, intense head ache, dizziness, light sensitivity eye pain vision impaired, lost of appetite lethargic state of not feeling well lasted for three days after the injection. Symptoms were treated with Tylenol every 4-hours, intake as much water, bush tea and home-made fish and onion soups that I could and slept/rest. On the third day the fever subsided about midday, but the headaches, eye sensitivity, lost of appetite, and lethargy continued, which continued to be treated with Tylenol, bush tea and soup. By the fourth day the head aches subsided, appetite still light, slight light-headed, some diarrhea and tenderness at the injection site continues. Symptoms were treated with bush tea and rest. Body achy feeling, eye sensitivity are not apparent.


VAERS ID: 1578258 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-04-22
Onset:2021-08-13
   Days after vaccination:113
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Sofia Antigen COVID-19 test with a positive result.
CDC Split Type:

Write-up: Patient received the Pfizer COVID-19 vaccine on 4/1/21 and 4/22/21, so was fully vaccinated when he tested positive for COVID-19 on 8/13/21.


VAERS ID: 1578296 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: New York  
Vaccinated:2020-08-13
Onset:2021-08-13
   Days after vaccination:365
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EC3180 / 1 LA / IM

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

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

Write-up: Site: Itching at Injection Site-Mild, Site: Redness at Injection Site-Mild, Systemic: Allergic: Rash (specify: facial area, extremeties)-Mild


VAERS ID: 1578304 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-10
Onset:2021-08-13
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Myocardial infarction, Pain, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: per patient - "08/13/2021 pressure in chest started throwing up and a lot of pressure. a log of sharp pains. went to hospital and was diagnosed as heartattack."


VAERS ID: 1578332 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Circumstance or information capable of leading to medication error, Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

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

Write-up: Patient''s mother used incorrect date of birth to obtain COVID vaccine for patient 11 years of age. The vaccine administered is for patients 12 years of age and older.


VAERS ID: 1578336 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-25
Onset:2021-08-13
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna on 1/25 and 2/18. Positive on 8/13 admitted on 8/13-current


VAERS ID: 1578338 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-09
Onset:2021-08-13
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Janssen on 3/9. Positive on 8/12 admitted 8/13-current


VAERS ID: 1578344 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Discomfort, Fatigue, Feeling abnormal, Headache, Injection site pain, Joint stiffness, Pain, Pain in extremity, Pyrexia, Sleep disorder
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Women''s Multi Vitamin, Airborne Tablets, Viactiv Chew
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Sulfa drugs, Amoxicillin, Cortizone injections
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Approximately 6 hours after the shot, the joints in my left and hand started to feel sore and tight. By midnight, I could not get comfortable and tossed and turned for several hours. Body ached and head hurt. It hurt to lay in any one position for any length of time. When I woke around 7:00 AM on 8/14, I felt tired but not too bad. Chose to stay in bed and rest. I took Advil for the headache. By noon, I was extremely achy and my head hurt so bad I couldn''t have the TV on or have any light or noise going on around me. It hurt to hold a cell phone in my hand. By 1:00 PM, I had a fever of 101 that peaked at 101.3. It lasted until 7:00 PM. I took Advil for it, but it seemed to do nothing. Then around 7:00 PM, everything seemed to disappear. I felt better, I ate and watched some TV. Sunday 8/15, I got up and went about my day as usual. I felt a little "off" and my joints in my hands and arms ached. Monday, 8/16, back to normal except for the lingering ache in my hands and arms. Tuesday, 8/17, all side effects seem to be one. Arm is still hurts some at the injection site.


VAERS ID: 1578346 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-11
Onset:2021-08-13
   Days after vaccination:214
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna on 1/11 and 2/4. Positive on 8/11 admitted on 8/13-current


VAERS ID: 1578371 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-19
Onset:2021-08-13
   Days after vaccination:116
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Colitis, Diarrhoea, SARS-CoV-2 test positive
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

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

Write-up: Hospitalized 8/13/21 with positive Covid test and Colitis, diarrhea. Patient did not have respiratory symptoms and never required supplemental oxygen. Discharged home the next day with antibiotics.


VAERS ID: 1578407 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-27
Onset:2021-08-13
   Days after vaccination:78
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asymptomatic COVID-19
SMQs:, 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: Pre-op COVID-19 positive test ; asymptomatic


VAERS ID: 1578420 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Day after vaccine patient had chills and muscle aches. They started to go away and then in the past couple of days they have come back and gotten worse


VAERS ID: 1578459 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood glucose normal, Condition aggravated, Dizziness, Electrocardiogram, Feeling hot, Hyperhidrosis, Hypoglycaemia, Nervousness, PO2 normal
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (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: Client denies taking any medications or supplements.
Current Illness: Client denies any illnesses or prior reactions to vaccinations
Preexisting Conditions: Client denies any health conditions
Allergies: Client denies any allergies
Diagnostic Lab Data: blood sugar of 50 (done by Paramedics) repeat blood sugar after oral glucose 60.
CDC Split Type:

Write-up: 7:15PM patient was accompanied by her aunt/guardian. Client?s aunt/guardian completed and signed the COVID-19 consent form. Client was given a Pfizer COVID-19 vaccine (lot #EW0168 expiration date 8/31/2021) in the right deltoid by RN. 7:25PM Client c/o feeling ?dizzy? and ?hot?. Client was noted leaning forward in the chair. Client denied any chest pain or difficulty swallowing or difficult respirations. 7:27PM client B/P was 80/50; pulse 76 strong and regular; client c/o increased dizziness and feeling ?shaky? with an increase in diaphoresis was noted. Client was placed in a supine position with feet elevated. 7:30PM 911 call was made by another RN and observation of client continued with no change in condition. 7:37PM Paramedics arrived: Paramedics ran an EKG strip and did a PO2 which was unremarkable. B/P by Paramedics 96/60. Paramedics continued to observe client and did a repeat B/P. 7:41PM Client reports feeling better. Paramedics helped client to a sitting position. Client sitting B/P 104/64 and blood sugar of 50 (done by Paramedics). Paramedics administered and oral glucose liquid to client. 7:46PM Repeat blood sugar 67 and standing B/P 134/85. Paramedics recommend client?s aunt follow-up with client?s doctor on client?s hypoglycemia. Client told Paramedics she is a dancer and she (client) had an episode of feeling ?dizzy? and ?shaky? last week. Client also reports she ate ?2 hotdogs? prior to coming for COVID 19 vaccine and additionally denies missing meals. RN


VAERS ID: 1578477 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Asthenia, Blood test normal, Computerised tomogram thorax normal, Laboratory test normal, Mobility decreased
SMQs:, Parkinson-like events (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi vitamin, Omeprazole 40mg 1 time a day, buspirone 15mg 2 times a day, escitalopram 20mg 1 a day, probiotic, magnesium 500mg daily, vitamin D3, vitamin C
Current Illness: N/a
Preexisting Conditions: N/a
Allergies: Dilaudid
Diagnostic Lab Data: 8/13/21 lad results CT scan came back normal
CDC Split Type:

Write-up: I woke up 8/13/21 fine as I was working I felt weak, went and sat down. Couldn''t move arms or legs, very weak. I went to ER got blood work and CT scan of chest (came back good). Had IV for fluids


VAERS ID: 1578519 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-04-07
Onset:2021-08-13
   Days after vaccination:128
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 LA / IM

Administered by: Work       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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BP, Thyroid, B12, Vit D, Fish Oil, Magnesium
Current Illness: None
Preexisting Conditions: Thyroid, HTN, Fibromyalgia, Arthritis
Allergies: Lots of environmental , food, Augmentin, Sulfate
Diagnostic Lab Data: Covid PCR test
CDC Split Type:

Write-up: 3/17/21 Pfizer Covid 4/7/21 Pfizer Covid 8/12-8/14/21 family gathering 8/13 exposure to family member 8/14 "allergy symptoms" 8/17 + Covid PCR 8/28/21 potential to RTW


VAERS ID: 1578599 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adverse drug reaction, Expired product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Submitted the clinical information we have on the vaccine and they are conducting a stability test
CDC Split Type:

Write-up: The expired vaccine from the day before was mixed with non expired vaccine mixed that day. We are unsure if patient received expired vaccine. I f/u with pt and let them know Pfizer was testing the stability and we could redoes them per CDC guideline...however he reported having a lot of side effects over the weekend so he felt confident the vaccine he received was active and didn''t want to repeat until his 2nd shot


VAERS ID: 1578619 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Clinical data was submitted to Pfizer so they can perform stability data
CDC Split Type:

Write-up: The expired vaccine from the day before was mixed with non expired vaccine mixed that day. We are unsure if patient received expired vaccine


VAERS ID: 1578631 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Submitted clinical data to Pfizer awaiting information that find out on stability data
CDC Split Type:

Write-up: The expired vaccine from the day before was mixed with non expired vaccine mixed that day. We are unsure if patient received expired vaccine


VAERS ID: 1578632 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-17
Onset:2021-08-13
   Days after vaccination:149
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Anosmia, Chest pain, Chills, Cough, Dyspnoea, Fatigue, Headache, Influenza A virus test, Influenza B virus test, Myalgia, Nausea, Pyrexia, Rhinorrhoea, SARS-CoV-2 test, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol inhaler
Current Illness: none
Preexisting Conditions: Schatzki Ring Esophagus, Asthma
Allergies: none
Diagnostic Lab Data: Influenza virus A and B and SARS_CoV-2 (covid-19) Ag panel -upper respiratory specimen by rapid immunoassay
CDC Split Type:

Write-up: Fever, chills, muscle aches, runny nose, lost taste & smell, headache, fatigue, cough, shortness of breath, chest pain, nausea, vomiting.


VAERS ID: 1578643 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 AR / IM

Administered by: Pharmacy       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: Pfizer was given all the data we have on how the vaccine had been stored and for how long. We are awaiting stability data from them
CDC Split Type:

Write-up: The expired vaccine from the day before was mixed with non expired vaccine mixed that day. We are unsure if patient received expired vaccine


VAERS ID: 1578654 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Hyperhidrosis, Menstruation delayed, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Fertility disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline 50 mgs/day
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: At 5:30 AM the morning after my second vaccine, while I was doing my normal online teaching, I felt like I was going to vomit. I got very sweaty and knew I was about to faint. I did. I was passed out for a minute or so. This happened after a miserable headache that had started about 3:30 AM. I have had headaches every night since the vaccine. As well, I am over two weeks late with my period. I track my cycle and am never, ever late. There is zero chance of pregnancy.


VAERS ID: 1578665 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-17
Onset:2021-08-13
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

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

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

Write-up: syncope.


VAERS ID: 1578669 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-08-11
Onset:2021-08-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abnormal dreams, Headache, Tinnitus
SMQs:, Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bijuva, Synthroid, Ativan, Vitamin C, D, E, Iron, Folic Acid, Potassium, Zinc, Lutein, CoQ10, Krill Oil, B12
Current Illness: None
Preexisting Conditions: Hypothyroidism
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Intense ringing in the ears, headache, and vivid dreams. Will make a doctor appointment to address adverse events in the coming days.


VAERS ID: 1578671 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Ear pain, Fatigue, Feeling hot, Headache
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: vomiting, chills , malaise.
Other Medications: None
Current Illness:
Preexisting Conditions: Autoimmune, sjrogens
Allergies: Penicillin, keflex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, ear pain, overall feeling hot, fatigue


VAERS ID: 1578732 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

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

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

Write-up: Fever, bad throat, severe toothache, body pain


VAERS ID: 1578935 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysmenorrhoea, Polymenorrhoea
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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The following morning after receiving my first dose of the Pfizer COVID-19 vaccine I began my cycle early. It came about a week earlier than my normal cycle. I have a regular cycle towards the end of the month and have never been irregular. I also had painful cramping which is not normal during my cycle.


VAERS ID: 1578979 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Hypertension, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypertension (narrow), Hypersensitivity (broad)

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

Write-up: pt complains of throat tightening sensation about 20-30 minutes post-covid vaccination Pfizer #1 today. Has history of sulfamethoxazole/trimethoprim allergy, similar symptoms in the past w/ this, treated w/ benadryl only. Never has had anaphylaxis. Vitals stable /slightly hypertensive today and 25 mgs IM diphenhydramine today. Stable at discharge, symptoms have resolved,


VAERS ID: 1579190 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Face injury, Fall, Loss of consciousness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Patient received vaccine and upon leaving the immunization room, walked about 15 feet into an aisle and experienced syncope. This resulted in the patient briefly losing consciousness and falling to the floor where he hit his cheek. Pharmacist went to patient''s aid, sat him down, gave him water and monitored for any further issues. 911 was called and patient assessed in store, ambulance ride/hospital visit was declined by patient''s mother. Patient waited the remaining 15 minutes and left with mother.


VAERS ID: 1579200 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Pain
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

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

Write-up: Aches Pain Diarrhea


VAERS ID: 1579208 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 2 LA / IM

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

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

Write-up: PATIENT''S MOTHER STATED AND SIGNED WAIVER THAT THE PATIENT WAS 12 YEARS OLD. HOWEVER, IMMUNIZATION REGISTRY SITE HAS PATIENT LISTED AS ONLY BEING 11 YEARS OLD. THIS WAS FOUND AFTER THE VACCINATION WAS GIVEN AND THE RECORD WAS BEING ENTERED. THE FIRST DOSE WAS GIVEN BY ANOTHER PHARMACY


VAERS ID: 1579395 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Nausea, Vertigo
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dizziness. Vertigo. Going from laying down to standing or sitting up. Or just lifting or turning my head. Nauseous the day after but only the day after.


VAERS ID: 1579599 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dysgeusia
SMQs:, Taste and smell disorders (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: TOXOIDE
Diagnostic Lab Data:
CDC Split Type: VOCES

Write-up: Patient refers feeling a metal flavor in the roof of the mouth. Vitals are taken B/P 125/80, pulse 67, Oxygen 99%, temp 97.3. Dr. is consulted, keeping patient until she is back to normal and discharge after being aware of location, time and place.


VAERS ID: 1579611 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Texas  
Vaccinated:2020-08-09
Onset:2021-08-13
   Days after vaccination:369
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site warmth, Pain in extremity, Rash papular, Rash pruritic, Skin warm, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Large, raised welt approximately 2 inches x 5 inches. Very itchy and warm. Did not appear until 5 days after shot and continues to worsen. Began with ?normal? reaction (sore arm, warmth at injection site, etc)


VAERS ID: 1579743 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A214 / 1 LA / IM

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

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

Write-up: Patient developed a small "pimple-like" rash at injection site. Was about the size of a dime shortly after administration, and when reported 4 days later, the "rash" is about 2-3mm diameter. Patient states that it hurts slightly.


VAERS ID: 1580103 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Tennessee  
Vaccinated:0000-00-00
Onset:2021-08-13
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Heart rate, Nausea, Palpitations
SMQs:, Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LORAZEPAM
Current Illness: Abstains from alcohol; Anxiety; Drug allergy; Hypothyroidism; Non-smoker; Ragweed allergy
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 20210813; Test Name: Heart rate; Result Unstructured Data: 80 to 90 {beats}/min; Comments: Normal value 50 to 60 and while working 70 {beats}/min.
CDC Split Type: USJNJFOC20210829070

Write-up: HEART IS BEATING FASTER THAN NORMAL; NAUSEA; TIREDNESS; This spontaneous report received from a patient concerned a 65 year old female. The patient''s weight was 152.5 pounds, and height was 66 inches. The patient''s concurrent conditions included: hypothyroidism, anxiety, ragweed allergy, morphine allergy, non alcoholic, and non smoker. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 205A21A, expiry: UNKNOWN) dose was not reported, administered on 12-AUG-2021 15:05 for prophylactic vaccination. Concomitant medications included lorazepam for anxiety. On 13-AUG-2021, the patient experienced heart is beating faster than normal. On 13-AUG-2021, the patient experienced nausea. On 13-AUG-2021, the patient experienced tiredness. Laboratory data included: Heart rate (NR: not provided) 80 to 90 {beats}/min. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from heart is beating faster than normal, nausea, and tiredness. This report was non-serious.


VAERS ID: 1580111 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-08-13
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Nasopharyngitis, Pain, Sinus congestion
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Dry cough (Patient took ibuprofen to relive symptoms.); Headache (Patient took ibuprofen to relive symptoms.); Non-smoker; Social alcohol drinker (Patient consumes alcohol once in a month.)
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19 antigen test (negative results); COVID-19 PCR test (abnormal result); Comments: Patient had no known drug allergies and no drug abuse or illicit drug usage.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210830400

Write-up: COLD; BODY ACHES; CONGESTION; This spontaneous report received from a patient concerned a 46 year old female. The patient''s height, and weight were not reported. The patient''s past medical history included: covid-19 rapid antigen test, and ''regular'' nasal swab test, and concurrent conditions included: alcohol user, non smoker, dry cough, and light headache, and other pre-existing medical conditions included: Patient had no known drug allergies and no drug abuse or illicit drug usage. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 205A21A, expiry: 21-SEP-2021) dose was not reported, administered on 13-AUG-2021 16:30 for prophylactic vaccination. No concomitant medications were reported. On 13-AUG-2021, the patient experienced cold. On 13-AUG-2021, the patient experienced body aches. On 13-AUG-2021, the patient experienced congestion. Treatment medications (dates unspecified) included: ibuprofen. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from cold, body aches, and congestion. This report was non-serious.


VAERS ID: 1580114 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:2021-08-13
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Feeling cold, Feeling hot, Headache, Hyperhidrosis, Muscle spasms, Muscle swelling, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Leg cramps
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210814; Test Name: Body temperature; Result Unstructured Data: 102.1 F
CDC Split Type: USJNJFOC20210830488

Write-up: SWEATING; LEG WARM TO TOUCH; MUSCLE BULGING DUE TO THE CONTRACTIONS; FREEZING; ON AND OFF HEADACHE; FEVER; SEVERE LEFT LEG CRAMP; This spontaneous report received from a consumer concerned a 43 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: leg cramps. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, and batch number: 205A21A expiry: UNKNOWN) dose was not reported, administered on 13-AUG-2021 for prophylactic vaccination. No concomitant medications were reported. On 13-AUG-2021, the patient experienced severe left leg cramp. On 14-AUG-2021, the patient experienced sweating. On 14-AUG-2021, the patient experienced freezing. On 14-AUG-2021, the patient experienced leg warm to touch. On 14-AUG-2021, the patient experienced muscle bulging due to the contractions. On 14-AUG-2021, the patient experienced on and off headache. On 14-AUG-2021, the patient experienced fever. Laboratory data included: Body temperature (NR: not provided) 102.1 F. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from fever, severe left leg cramp, sweating, freezing, leg warm to touch, on and off headache, and muscle bulging due to the contractions. This report was non-serious.


VAERS ID: 1580117 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-08-13
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Hypoaesthesia, Neurological examination
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 202108; Test Name: Neurological examination; Result Unstructured Data: Decreased sensation on right foot compared to the other one
CDC Split Type: USJNJFOC20210832358

Write-up: PERSISTENT NUMBNESS IN RIGHT FOOT; This spontaneous report received from a physician concerned a 51 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 042A21A, expiry: 21-SEP-2021) dose was not reported, administered on 13-AUG-2021 for prophylactic vaccination. No concomitant medications were reported. On AUG-2021, Laboratory data included: Neurological examination (NR: not provided) Decreased sensation on right foot compared to the other one. On 13-AUG-2021, the patient experienced persistent numbness in right foot. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from persistent numbness in right foot. This report was non-serious.


VAERS ID: 1582102 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-12
Onset:2021-08-13
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003A21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Exposure to SARS-CoV-2, No adverse event, SARS-CoV-2 test
SMQs:, 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 (NORVASC) 10 mg tablet(Expired) fenofibrate (TRICOR) 54 mg tablet metoprolol succinate XL (TOPROL-XL) 25 mg 24 hr tablet(Expired) sildenafiL (VIAGRA) 50 mg tablet thiamine mononitrate, vit B1, 100 mg tablet
Current Illness:
Preexisting Conditions: Nervous Alcoholism (CMS/HCC) Confusion Acute otitis externa of left ear, unspecified type Acute encephalopathy Pruritus Respiratory Dyspnea on exertion Circulatory Essential hypertension Heart murmur MVP (mitral valve prolapse) Musculoskeletal Eczema Dermatitis Atopic dermatitis, unspecified type Endocrine/Metabolic Mixed hyperlipidemia Hyperglycemia Dyslipidemia Hyponatremia Hypochloremia Hypercalcemia Other Anxiety disorder Erectile dysfunction, unspecified erectile dysfunction type Abnormal CT of the chest
Allergies: SimvastatinMyalgia / Muscle Pain Hydrochlorothiazide
Diagnostic Lab Data: POCT COVID-19 Antigen (Collected 08/13/21)
CDC Split Type:

Write-up: Exposed to Covid No adverse events listed - POCT COVID-19 Antigen test is "probable"


VAERS ID: 1582123 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction, Dyspnoea
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)

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

Write-up: Systemic: Allergic: Anaphylaxis-Medium, Systemic: Allergic: Difficulty Breathing-Mild


VAERS ID: 1582135 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Chest discomfort, Chills, Dizziness, Dyspnoea, Fatigue, Headache, Influenza like illness, Lymph node pain, Lymphadenopathy, Malaise, Nasal congestion, Pain, Pain in extremity, Rash, Somnolence
SMQs:, Anaphylactic reaction (narrow), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Headache started at 10 PM on the date of the injection and chills. Sore arm started following day in the AM. Tiredness, dizziness, headaches, stuffy nose, sleepiness and overall not feeling well started Saturday evening. Took Tylenol. Sunday I felt tired and sleepy all day in addition to rest of symptoms. My body ache was like I had the flu. Took more Tylenol and ate citrus to help boost vitamin c. Monday the headache still has not subsided the tiredness/sleepiness was there and so are the body aches. Monday I had two small bumps protruding from my neck?Lymph nodes. Rested most of Monday. More Tylenol. Had a harder time breathing just like I would during any normal asthma issues. If I went up and down the stairs I would have to take deeper breaths in my chest felt tight. Tuesday a little bit of energy returned. The headache subsided. Tiredness is still there. The deep breathing is still hard. The lymph nodes still swollen. Neck/collarbone. Today is Wednesday 08/18/21, some of my energy has returned the headaches bodyaches seem to have subsided completely however my lymph nodes are still swollen and painful


VAERS ID: 1582306 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products, No adverse event
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: Acute stroke s/p craniotomy/thrombectomy
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was screened and stated he did not receive the COVID vaccine and the MD ordered the Moderna vaccine (per hospital supply). Patient was consented and given the vaccine dose. Then it was discovered that the patient already had completed the COVID-19 vaccine series having received 2 doses of Pfizer on 4/12/2021 and 5/3/2021. Patient did not have any adverse effects noted.


VAERS ID: 1582319 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-06
Onset:2021-08-13
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site rash, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)

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

Write-up: The area around the injection is warm to the touch and feels swollen with mild rash. This started a week after the injection and as of today the symptoms are still present. Took 1 dose of Benadryl one time and will take as needed.


VAERS ID: 1582420 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-07-26
Onset:2021-08-13
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19
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:
Current Illness:
Preexisting Conditions: hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt has covid 19 8/13/2021


VAERS ID: 1582448 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-14
Onset:2021-08-13
   Days after vaccination:211
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / UNK - / -

Administered by: Work       Purchased by: ?
Symptoms: COVID-19
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt currently has covid 19


VAERS ID: 1582457 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-01
Onset:2021-08-13
   Days after vaccination:134
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: currently has covid 19


VAERS ID: 1582467 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-20
Onset:2021-08-13
   Days after vaccination:115
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dose 1 Moderna 03/23/2021 lot 044A21A currently has covid 19


VAERS ID: 1582470 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-04
Onset:2021-08-13
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19
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:
Current Illness:
Preexisting Conditions: COPD, cardiac disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dose 1 Moderna 2/5/2021 016M2oA currently has covid 19


VAERS ID: 1582474 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-09
Onset:2021-08-13
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19
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: Dose 1 moderna 03/12/2021 031A21aA lot Currently has Covid 19


VAERS ID: 1582483 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 3 - / IM

Administered by: School       Purchased by: ?
Symptoms: Extra dose administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: School Nurse obtained consent from the child''s mother to give 2nd dose of vaccine to the child at school on 8/13/2021. The mother came to Hospital on 8/11/2021 to get her 2nd dose for herself & also got the child''s 2nd dose that day. The school nurses were not notified that the child received the 2nd dose on 8/11/2021 & the child did not tell them that she had already had her 2nd shot. This resulted in a 3rd dose given to the child on 8/13/2021. The mother of the child did speak to the school nurse after the event and the child did not have any adverse reaction at that time.


VAERS ID: 1582548 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chills, Fatigue, Headache, Myalgia, Nausea, Pain in extremity, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Arm soreness, chills, fever, myalgia, fatigue for 1-2 days. headache started day 1 and continues, nausea started day 5 with worsening headache, chest heaviness on day 5 Took tylenol on day 4 Started taking Motrin and Aleve day 5


VAERS ID: 1582572 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2020-12-29
Onset:2021-08-13
   Days after vaccination:227
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Headache, Nausea, SARS-CoV-2 test positive, Vomiting
SMQs:, Acute pancreatitis (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: This patient was fully vaccinated (Moderna 12/29/20 & 1/28/21) and tested positive for COVID-19 on 8/15/21. She was hospitalized for 2-3 days while symptomatic. She has a history of CVA 6 years prior and developed significant headache w/ nausea vomiting on 8/13/21. This worsened and she was seen in the ER on 8/15/21 to rule out CVA. She was admitted for further testing and Neurological consult. While hospitalized she tested (+) for COVID-19. She did not develop any respiratory symptoms and denies any SOB, cough, or congestion. Her symptoms have since improved and she is currently home under isolation with no further complaints.


VAERS ID: 1582578 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / N/A RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: On 8/13/2021 patient was given Pfizer following a first dose Moderna on 7/19/2021. No adverse reactions.


VAERS ID: 1582601 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Arthralgia, Burning sensation, Chills, Headache, Hyperhidrosis, Hypoaesthesia, Mobility decreased, Muscular weakness, Tenderness
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: metformin, glimepride, jardiance, megesterol, lisinopril
Current Illness: recent diagnosis of endometrial cancer
Preexisting Conditions: type 2 diabetes
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 5 minutes after shot, left arm went numb from above elbow down to fingers, broke out in a sweat. 3 hours after shot, left leg went numb from below knee to toes. That evening I had severe tenderness, stomach pain, excruciating joint pain to the point I could not move my arm. It felt like fire. I had chills, headache. 5 days later I still had tenderness, arm weakness, tired muscles, headache, deep joint pain.


VAERS ID: 1582681 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-12
Onset:2021-08-13
   Days after vaccination:213
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EL0140 / 1 - / SYR

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

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

Write-up: COVID +


VAERS ID: 1582708 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-03-25
Onset:2021-08-13
   Days after vaccination:141
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 RA / IM

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

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

Write-up: Caught Covid despite vaccination


VAERS ID: 1582719 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-02-26
Onset:2021-08-13
   Days after vaccination:168
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19
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: Iron deficiency anemia 8/18/2021 - Present Hemoptysis 8/18/2021 - Present Duodenitis 8/18/2021 - Present COVID-19 8/13/2021 - Present Chronic venous insufficiency of lower extremity 5/21/2021 - Present Mixed hyperlipidemia (Chronic) 5/21/2021 - Present Hypertension (Chronic) Unknown - Present Incomplete bladder emptying 9/22/2020 - Present Frequency of urination 9/22/2020 - Present Obstructive sleep apnea on CPAP (Chronic) 7/22/2019 - Present Seborrheic dermatitis of scalp 3/27/2018 - Present Throat irritation 3/27/2018 - Present Hx of tobacco use, presenting hazards to health 3/27/2018 - Present Biceps rupture, distal 7/5/2017 - Present Hypothyroidism (Chronic) 9/13/2013 - Present BPH with urinary obstruction (Chronic) 9/13/2013 - Present CAD (coronary artery disease) (Chronic) 9/13/2013 - Present Gluten enteropathy 9/13/2013 - Present Depression (Chronic)
Allergies: adhesives niacin
Diagnostic Lab Data:
CDC Split Type:

Write-up: covid infection despite vaccination


VAERS ID: 1582751 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-10
Onset:2021-08-13
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Feeling cold, Headache, Hypoaesthesia, Pain, Paraesthesia, Pyrexia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: Patient was seen at ER on 8/14/21
CDC Split Type:

Write-up: See below notes for dos 8/17/21: Patient presents today stating that on 8/13 she began with numbness and tingling in both hands and feet. No paralysis. She had facial numbness and could feel it in the back of her throat. She was able to swallow and chew okay. No facial droop or blurry vision. She did have a headache, but not a migraine. The next day all her symptoms were still present so she went to ER. Labs were normal than. She states that she now having more muscle weakness, mostly in her legs, but some in her arms. She still has numbness in her feet and in her hands, but the tingling is gone. The facial numbness/tingling is improved. She still has some R sided facial numbness, but she has had this before. No headache now. She recently had the J&J COVID vaccine on 8/10 at Pharmacy. She denies any hx of reaction to vaccines in the past. She states that on 8/13 she had some SOB with vacuuming on 8/13, but she hasn''t noticed any SOB since 8/13, but she has been resting. She does note some feelings of being off balance, but denies falls. She had chills, fever, and body aches after the COVID for 48 hours.


VAERS ID: 1582795 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Fatigue, Headache, Pain, Palpitations
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

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

Write-up: 24yo male received the 2nd dose of Moderna COVID-19 vaccine on Friday 8-13-21. Symptoms started later that evening and progressed over the weekend with headache, body aches, fatigue, chest tightness, shortness of breath and intermittent palpitations. Denies taking any medication for symptoms. Denies prior medical problems. TELEDOC consult on 8-18-21 and referred patient to ER for in-person evaluation.


VAERS ID: 1582797 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bradycardia, Hypotension
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dehydration (broad), Hypokalaemia (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: Certirizine 10mg daily
Current Illness:
Preexisting Conditions: Chronic Pain, Hypertension, hypothyroidism
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: approximately one hour post Pfizer injection, the pt was beginning a routine exam and became hypotensive and bradycardic. She was given 500cc of normal saline via IV at 12:08. Her vitals were raised to normal and she was dismissed after fluid administration.


VAERS ID: 1582802 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Immediate post-injection reaction, Rash macular, Vein disorder
SMQs:, Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: patient noticed a "vein" appear on her right thigh immediately following the vaccine administration and then she developed a few other red spots clustered together near the "vein"


VAERS ID: 1582851 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / UNK - / IM

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

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

Write-up: Individual misrepresented vaccination status to staff in order to receive third dose of Pfizer prior to CDC recommendation for booster.


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