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From the 6/11/2021 release of VAERS data:

Found 352,386 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 145 out of 3,524

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VAERS ID: 1330625 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK AR / IM

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

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

Write-up: Pfizer vaccine mixed incorrectly (used sterile water)


VAERS ID: 1330649 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

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

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

Write-up: Pfizer vaccine mixed incorrectly (used sterile water)


VAERS ID: 1330696 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

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

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

Write-up: Patient scheduled second dose. The store is listed only for Pfizer vaccine. Patient presented with appointment for second dose. Upon verifying the date of 1st dose, we gave Pfizer second dose. Patient needs Moderna second dose, but was given Pfizer second dose. No reaction/adverse reaction happened at the time of the incident. Patient was given CDC guidance regarding getting two different covid-19 vaccine. Patient was told that per CDC recommendation, patient is considered fully vaccinated and no further Covid-19 vaccine is required.


VAERS ID: 1330786 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Hypoaesthesia, Nausea, Paraesthesia, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: None
Preexisting Conditions: None
Allergies: No known allergies
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Fingers tingling in vaccinated arm, vomiting , diarrhea, nausea, numbness in both arms


VAERS ID: 1330791 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 1 LA / IM

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

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

Write-up: Patient states 8-10 hours after receiving vaccination she began developing rash on arms which progressed to most of body. Pt currently monitoring for worsening of rash or anaphylactic event.


VAERS ID: 1330900 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-15
Onset:2021-05-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Blood creatinine normal, Blood urea normal, C-reactive protein increased, Chest pain, Coagulation test, Echocardiogram abnormal, Ejection fraction, Electrocardiogram ST segment elevation, Electrocardiogram T wave inversion, Electrocardiogram abnormal, Fibrin D dimer normal, Full blood count abnormal, Immunoglobulin therapy, Intensive care, Laboratory test, Magnetic resonance imaging heart, Neck pain, Pain, Pain in extremity, Pericarditis, Procalcitonin normal, Pyrexia, Red blood cell sedimentation rate normal, SARS-CoV-2 antibody test positive, SARS-CoV-2 test negative, Serum ferritin normal, Sleep disorder, Troponin T increased
SMQs:, Haematopoietic leukopenia (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Other ischaemic heart disease (broad), Chronic kidney disease (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Hypokalaemia (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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: urinary urgency
Allergies: none
Diagnostic Lab Data: troponin 0.62
CDC Split Type:

Write-up: Patient is a 19 y.o. male with a variety of minor past medical problems but without any significant PMH who presents with 24h of acute onset chest pains. He reports yesterday morning he was woken from sleep at 3-4 am with severe substernal chest pains that radiated to his arm and neck. This was worsened by laying flat and better if he waked around/pacing. He took ibuprofen and it got better so he went back to sleep. The pain returned about 6 hours later and was getting more severe so he went to see his doctor. There an EKG was abnormal so he was referred to the ED where a work up showed ST elevations c/w pericarditis and an elevated trop I of 24. The night prior, he reported a low grade temperature. He has not had any more fevers for the past 12-18 hours. He denies any other symptoms such as palpitations, shortness of breath, cough syncope. He denies sick contacts but did have a sore throat 4-5 days ago without any other associated symptoms. He has had recent negative COVID tests while at college. Of note he did receive the 2nd dose of Pfizer on 5/15 about 24-36 hours before onset of symptoms. Of note, he does boxing at school and has been participating in work outs until about a week ago. ED course: EKG w/ diffuse ST segment elevation in V3-V6, I, II, II, AVF. Troponin I 24. Creatnine 1.2 with baseline of 0.5 but BUN WNL (11). CBC WNL, CRP mildly elevated to 3.1, Transferred to another ED. Second ED Course: BP 120/64 | Pulse 83 | Temp 36.7 ?C (98.1 ?F) (Temporal) | Resp 18 | Wt 76.3 kg | SpO2 97% exam non-focal, COVID ab notable for +spike neg nuclear capsid consistent with vax but no infection, D-Dimer, procal, ESR, ferritin, Coags all WNL, Trop T elevated to 1.46,, ECG with consistent diffuse ST seg elevations, seen by ped cards who did echo in ED and notable for EF ~50%, admitted to PCICU for further management and treatment Admitted to the PCICU in stable condition. Placed on telemetry monitoring for the duration of the admission. Started on IV steroids and given IVIG on hospital day 1. Continued on toradol which was switched to motrin on hospital day 2. Cardiac MRI did not show signs of fibrosis. Troponin downtrended throughout his stay. At the time of DC echo showed normal function, ekg showed T wave inverions, and troponin was down trending to 0.57. Pt to be restricted from physical activity until cleared by cardiology. Infectious workup also sent, most of which was pending at time of discharge.


VAERS ID: 1330933 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-26
Onset:2021-05-17
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 LA / IM

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

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

Write-up: Individual was vaccinated prior to the approval of Pfizer for 12-15 year old''s. On April 26, 2021, individual arrived at vaccination site for first dose of COVID-19 Pfizer vaccine and provided birth year of 2004, parent consented. This date of birth would make the individual age 16 and eligible to receive the vaccine. Individual arrived for the second dose of Pfizer COVID-19 vaccine on May 17, 2021 and registrar recognized the minor and questioned the date of birth provided. The minor provided their correct birth year of 2006, with parent consent. On May 17th, Pfizer was approved for 12yrs and older and received his second dose of Pfizer vax. Individual did not have any adverse events during the observation period.


VAERS ID: 1330987 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-05-15
Onset:2021-05-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, Chest pain, Ejection fraction normal, Electrocardiogram PR shortened, Electrocardiogram abnormal, Leukocytosis, Myocarditis, Nausea, Pain, Painful respiration, Pericarditis, Pleuritic pain, Troponin I increased, Ultrasound scan normal, Ventricular tachycardia, Vomiting, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Patient is a 21 y.o. male with no past medical history who got his second dose of COVID (Pfizer) vaccine on Saturday presented with chest pain since Sunday. Patient says that he was in his USOH until yesterday when he started having substernal chest pain which was getting worse with inspiration but also with specific movements. He does have pain even at rest sometimes but he thinks that it''s exacerbating by breathing. Had some nausea/vomiting as well. Denies other symptoms. Not really sob or leg swelling. In the ER, his Trop I was 10.7 and his WBC was 12.2. His EKG was NSR with short PR and STE I, II, III, AVF, V4-V6 Patient is a 21 y.o. male with no past medical history who got his second dose of COVID (Pfizer) vaccine on Saturday presented with chest pain since Sunday with some pleuritic characteristics. He was found to have a very elevated trop I to 10.7, leukocytosis to 12.2 and STE in I, II, III, AVF, V4-V6. His POCUS in the ER was without significant pericardial effusion and probably normal EF. Differential at this point includes pericarditis vs myopericarditis (there are some myocarditis cases reported in Israel post Pfizer vaccination, predominantly in young male patients) vs less likely ACS. Will need admission and further work up and treatment -Admission to Cardiology -NPO in case team tomorrow decides to proceed to LHC -Full echo and cardiac MRI tomorrow -Telemetry monitoring -Repeat EKG q4h overnight -send CRP, ESR -trend Trop to peak -would not start heparin gtt at this point -Please start tonight ASA 650 TID + Colchicine 0.6 mg BID 21-year-old man admitted with signs and symptoms of acute myo-pericarditis or in the setting of recent COVID-19 vaccination. He apparently had the findings are vaccine 2 days ago and developed pleuritic chest pain. His ECG shows pathognomonic changes for pericarditis in the is a small troponin elevation. He has no past medical history or exertional symptoms to suggest CAD. Bedside echocardiogram showed preserved left ventricular systolic function. He was admitted and placed on aspirin and colchicine. A cardiac MRI today showed evidence of myopericarditis. He had 3 beats of nonsustained VT on tele.


VAERS ID: 1330997 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / IM

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

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

Write-up: Patient vomited approx a few minutes after vaccine was given. Patient slowly fell onto the ground from the standing position. No injuries occured.


VAERS ID: 1331095 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-12
Onset:2021-05-17
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient is having hive that come and go. They appear all over the body, especially with heat or sweating. They go away and come back. Patient has been taking benadryl to help reduce.
Current Illness:
Preexisting Conditions:
Allergies: na
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient stated he was having hives that come and go that started about 5 days after vaccination. They come on with heat or sweat. he has been taking benadryl to keep them away.


VAERS ID: 1331124 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Back pain, Chest pain, Chills, Headache, Muscle spasms, Night sweats, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Horrendous chills, terrible back and joint pain, uncontrollable shivering and muscle spasms, intense nightsweats, fever, extreme headache, Soreness in chest/heart area. All 1000x worse than Covid which I had in December. Would have gone to the hospital if I didn?t know I had the vaccine.


VAERS ID: 1331131 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 RA / -

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

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

Write-up: Vaccine was given greater than 3 hours past the 6 hour window for being left out of the fridge.


VAERS ID: 1331239 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-14
Onset:2021-05-17
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / N/A RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec Rosuvastatin
Current Illness: None
Preexisting Conditions: High cholesterol managed by medication
Allergies: Penicillin Pine nuts Latex Metals
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Day 3 sudden severe onset of nausea, followed by vomiting and chills. Day 4 nausea and weakness Day5 back to normal- just sore from vomiting


VAERS ID: 1331455 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-04-21
Onset:2021-05-17
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose, Blood magnesium, Blood potassium, Blood prolactin, Blood thyroid stimulating hormone, Brain natriuretic peptide, Chest X-ray, Computerised tomogram head, Creatinine renal clearance, Culture urine, Electrocardiogram, Electroencephalogram, Full blood count, Glomerular filtration rate, Metabolic function test, Prothrombin time, SARS-CoV-2 test, Thyroxine free, Troponin I, Urine analysis, Venipuncture
SMQs:, COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamins C & D
Current Illness: None
Preexisting Conditions: None
Allergies: Allergic to mangoes
Diagnostic Lab Data: Basic metabolic panel, COVID 19 test, comp metabolic panel, brain natriuretic peptides, CBC with Diff, estimatedCrCl, estimatedGFR, Free T-4,glucose point of care, Magnesium, Potassium, Prolactin, Stroke, PT, Troponin-I, TSH, UA w culture reflex South/East, Venipuncture Collection Charge, CT brain w/o contrast, DX Chest portable, EKG, EEG All tests were done 05/17 and 05/18/2021.
CDC Split Type:

Write-up: On Monday, 05/17/2021 at approximately 3:30am, I had a seizure at home. According to my husband and daughter, it lasted a few minutes. When I came to, I remember being disoriented, dizzy, nauseous, sweating and headache in the back of my head. I was taken to the Hospital.


VAERS ID: 1331802 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Patients wife called to voice concern over excessive pain in patients arm and concern over shot placement


VAERS ID: 1332025 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Chills, Decreased appetite, Fatigue, Headache, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: synthroid, celexa, singulair, zyrtec, estrogen, vit D, zinc, vitc, multivitamin, coQ10, fish oil,
Current Illness: none
Preexisting Conditions: chronic obstructive pulmonary disease, hypothyroid, hay fever, depression
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: 48 hours of severe chills, rigors, fevers, severe headache, severe joint pains in all joints, full body muscle aches, nausea, loss of appetite, severe fatigue. Tylenol and Advil prn. (Note: I had monoclonal antibody IV 2/5/21, was told to wait 90 days which I did. These symptoms are exactly why I got those antibodies. I am a retired Nurse Practitioner in Internal Medicine. Why is the CDC and government official NO recognizing and giving credit for natural antibodies. I''ve had covid 19, monoclonal antibodies, there is herd immunity, and yet you want EVERYONE to get vaccinated. Very poor judgement for the cdc and government official. You wonder why people don''t trust both of them? What if I had died or had resulting health conditions because of what I just went thru? I will never trust either again and will recommend others NOT get the vaccine. We don''t even know what permanent disability or damage may come from this.


VAERS ID: 1332434 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-05-16
Onset:2021-05-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Decreased appetite, Fatigue, Headache, Injection site erythema, Injection site pain, Injection site swelling, Pain, Sleep disorder, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypoglycaemia (broad)

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

Write-up: -extreme body ache (lasting 3 days) -bad headache -lost of appetite for two days. -extreme fatigue and sleepiness -round redness around shot area which is very sensitive. Looks like a rash but it is not. -swelling in shot injection area with the redness. -extreme sensitivity to left arm in shot injected area. -I cannot lift my arm all the way up without pain and cannot lean on it or sleep on it without pain.


VAERS ID: 1332464 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Ohio  
Vaccinated:0000-00-00
Onset:2021-05-17
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chills, Headache, Injection site pain, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210532861

Write-up: CHILLS; MUSCLE ACHES; NAUSEA; SORENESS AT INJECTION SITE; HEADACHES; This spontaneous report received from a patient concerned a 47 year old male. The patient''s weight, height, and medical history were not reported.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 204A21A, expiry: UNKNOWN) dose was not reported, administered on 16-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 17-MAY-2021, the subject experienced chills. On 17-MAY-2021, the subject experienced muscle aches. On 17-MAY-2021, the subject experienced nausea. On 17-MAY-2021, the subject experienced soreness at injection site. On 17-MAY-2021, the subject experienced headaches. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from chills, and nausea on 17-MAY-2021, was recovering from muscle aches, and soreness at injection site, and had not recovered from headaches. This report was non-serious.


VAERS ID: 1332468 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Florida  
Vaccinated:0000-00-00
Onset:2021-05-17
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816027 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Back pain, Blood pressure measurement, Headache, Heart rate, Heart rate increased, Hypertension, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Hypertension (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 20210517; Test Name: Pulse rate; Result Unstructured Data: High; Test Date: 20210517; Test Name: Blood pressure; Result Unstructured Data: 102/68; Test Date: 20210517; Test Name: Blood pressure; Result Unstructured Data: 103/69
CDC Split Type: USJNJFOC20210533280

Write-up: HIGH BLOOD PRESSURE; HIGH PULSE RATE; BODY ACHE; BACK ACHE; HEADACHE; FEVER; This spontaneous report received from a patient concerned a 60 year old female. The patient''s weight, height, and medical history were not reported.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1816027, and batch number: 1816027 expiry: UNKNOWN) dose was not reported, administered on 17-MAY-2021 11:00 for prophylactic vaccination. No concomitant medications were reported. On 17-MAY-2021, the subject experienced headache. On 17-MAY-2021, the subject experienced fever. Laboratory data included: Blood pressure (NR: not provided) 103/69, 102/68, and Pulse rate (NR: not provided) High. On 17-MAY-2021 14:00, the subject experienced high blood pressure. On 17-MAY-2021 14:00, the subject experienced high pulse rate. On 17-MAY-2021 14:00, the subject experienced body ache. On 17-MAY-2021 14:00, the subject experienced back ache. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from headache, high blood pressure, high pulse rate, fever, body ache, and back ache. This report was non-serious.


VAERS ID: 1332470 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-05-17
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: The patient had no known drug allergies.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210533599

Write-up: PAIN ON RIGHT CALF; This spontaneous report received from a patient concerned a 54 year old female. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included the patient had no known drug allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1821286 expiry: UNKNOWN) dose was not reported, administered on 17-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 17-MAY-2021, the subject experienced pain on right calf. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from pain on right calf. This report was non-serious.


VAERS ID: 1332480 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Virginia  
Vaccinated:0000-00-00
Onset:2021-05-17
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / 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: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210534590

Write-up: ARM WAS SORE; This spontaneous report received from a patient concerned a male of unspecified age. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 16-MAY-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 17-MAY-2021, the subject experienced arm was sore. The action taken with covid-19 vaccine was not applicable. The patient had not recovered from arm was sore. This report was non-serious.


VAERS ID: 1332486 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: North Carolina  
Vaccinated:0000-00-00
Onset:2021-05-17
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Headache, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Patient was not on birth control
Allergies:
Diagnostic Lab Data: Test Date: 20210517; Test Name: Body temperature; Result Unstructured Data: 102 F
CDC Split Type: USJNJFOC20210534719

Write-up: SEVERE SHAKING; 102 F FEVER; SEVERE HEADACHE; This spontaneous report received from a consumer concerned a female of unspecified age. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included patient was not on birth control.The patient received covid-19 vaccine (suspension for injection, route of admin not reported, and batch number: 206A21A expiry: UNKNOWN) dose was not reported, administered on 17-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 17-MAY-2021, the subject experienced severe shaking. On 17-MAY-2021, the subject experienced 102 f fever. On 17-MAY-2021, the subject experienced severe headache. Laboratory data included: Body temperature (NR: not provided) 102 F. The action taken with covid-19 vaccine was not applicable. The patient recovered from severe shaking on 18-MAY-2021, and had not recovered from 102 f fever, and severe headache. This report was non-serious.


VAERS ID: 1332871 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-16
Onset:2021-05-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 2 LA / IM

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

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

Write-up: Sharp pain in left armpit. Occurred about a day or so after the vaccination. Has not worsened or gotten better. Stiff swelling near vaccination site. Much more stiff than first dose but is going down a couple days after vaccination.


VAERS ID: 1332978 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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), 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: No known drug allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had a syncope event minutes after receiving first moderna covid vaccine. She was in and out of consciousness more that once for a period of 10 -15 minutes. She fully regained consciousness at the end of that period and stayed that way until she was comfortable enough to leave the premise.


VAERS ID: 1332986 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site erythema, Injection site reaction
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad)

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

Write-up: Site: Bruising at Injection Site-Mild, Site: Redness at Injection Site-Mild, Additional Details: pt came to pharmacy on 5/19/2021 to show/discuss brusing and slight redness near injection site area. Patient has also experienced bruising/itching/injection site reaction (lump) to flu shot approximately 2 years ago.


VAERS ID: 1333193 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Adverse reaction, Blood pressure decreased, Blood pressure measurement, Cardiac failure, Hyperhidrosis, Nausea, Taste disorder, Vision blurred
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol (PROAIR/PROVENTIL/VENTOLIN) 90 mcg/actuation Inhl HFAA Cetirizine (ZYRTEC) 10 mg Oral Tab Cholecalciferol, Vitamin D3, (D3-50 CHOLECALCIFEROL) 1,250 mcg (50,000 unit) Oral Cap Cholecalciferol, Vitamin D3, (DIALYVITE) 5,000 unit Or
Current Illness: NA
Preexisting Conditions: Patient with CF
Allergies: Peanuts Cefepime Piperacillin
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Patient received Pfizer vaccine at 1054am Reaction started at 1105am. Patient stated blurred vision, diaphoretic, salty mouth, and nauseous. RN requested help and patient was laid back down on the ground. Cold washclothe applied to neck and forehead. 12.5/5ml Diphenhydramine given oral solution After about 20 minutes, patient verbalized she felt better - she was brought inand iupright postion and seated in an chair w/o issue. Blood pressures taken at time of incident and through out monitoring - Vital unremarkable. Rn called patient mother , who was able to come to the clinic to pick up patient. At time of pick up patient started to feel additional reaction, CF team at medical facility called for additional intervention. FNP from CF team advised to get orthostatic BP and record. Ortho Static taken with a drop in BP from laying to standing. BP was as low as 50/30 P:66 O2: 98 on RA 911 activated as patient conitnued to have sudden decrease in BP. Patient went to the hospital via EMS. Patient parents and twin sister with patient. Admin notified - chart documented.


VAERS ID: 1333233 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-04-01
Onset:2021-05-17
   Days after vaccination:46
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032B21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Thrombosis, Ultrasound scan
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (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: cholecalcif, albuterol/ipratropine prn, flonase, hydroxyzine, glargine insulin, magnesium oxide, metformin, sildenafil citrate, zinc
Current Illness: none
Preexisting Conditions: DMII, chronic neck and back pain, PTSD, htn
Allergies: penicillin
Diagnostic Lab Data: Ultra Sound, blood work, chest xray
CDC Split Type:

Write-up: large blood clot to lower extremity


VAERS ID: 1333258 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-05-14
Onset:2021-05-17
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 2 - / SYR

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

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

Write-up: Rash on thigh and spots over body


VAERS ID: 1333322 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-16
Onset:2021-05-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary mass, Lymphadenopathy
SMQs:, 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: Junel Fe birth control, Vitamin D supplement, Immunity Support Supplement, Probiotic Supplement, Apple Cider Vinegar Supplement, Ashwagandha Supplement, DHA Omega 3 fish oil supplement.
Current Illness: NKA
Preexisting Conditions: Fibromyalgia, migraines, Reynauld''s Syndrome, Early onset menopause
Allergies: NKA
Diagnostic Lab Data: None - home remedies
CDC Split Type:

Write-up: after 1st and 2nd doses of shot - my L armpit lymph nodes swelled and became tender and painful. After 1st dose the pain subsided after 3 or so days; wasn''t too bad just uncomfortable. After the 2nd dose the lymph nodes swelled even more than the first time and there was a constant pain/discomfort that lasted for several days with no relief from tylenol and mild temp relief from hot compresses.


VAERS ID: 1333506 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Nausea, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: Chills-Mild, Systemic: Nausea-Mild, Systemic: Shakiness-Mild


VAERS ID: 1333609 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-25
Onset:2021-05-17
   Days after vaccination:53
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Acetaminophen prn, aspirin 81, atorvastatin, cisplatin IV, insulin glargine, metformin, metoprolol tartrate, nitroglycerin prn, omeprazole, ondansetron prn, pembrolizumab IV, prochlorperazine
Current Illness:
Preexisting Conditions: Cervical cancer, T2DM, HLD, HTN, CAD, depression, GERD, chronic nausea, neuropathy
Allergies: Penicillins (rash), Taxol, Cefepime
Diagnostic Lab Data: Novel Coronavirus PCR - SARS-COV-2 detected (5/17/2021)
CDC Split Type:

Write-up: 62 YO female with recurrent cervical cancer on cisplatin/pembro and concurrent radiation. PMH significant for T2DM, HLD, HTN, CAD, depression, GERD, chronic nausea, and neuropathy. She is s/p full Pfizer COVID-19 vaccination: first dose on 3/4 and second dose on 3/25. On 5/17 pt calls this institution to explain that she had been exposed to someone COVID-19 positive. Only symptom reported was fatigue. Nasopharyngeal swab obtained from pt on 5/17 and resulted positive. Pt opted to discontinue upcoming radiation appt and continue on systemic therapy alone for her cancer.


VAERS ID: 1333637 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Indiana  
Vaccinated:2012-05-17
Onset:2021-05-17
   Days after vaccination:3287
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Bed rest, Chills, Decreased appetite, Disorientation, Fatigue, Haematemesis, Headache, Insomnia, Nausea, Paraesthesia, Pyrexia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal haemorrhage (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Toperol, baby aspirin, multivitamin, miloxican, tylenol #3 with codeine
Current Illness: none
Preexisting Conditions: had benign tumor removed from spinal cord in 2017, atrial fibrillation
Allergies: none
Diagnostic Lab Data: saw physician 2 days alter and received phenergan for nausea on 5/17/21
CDC Split Type:

Write-up: 13 hours after the shot patient was eating an orange and started vomiting blood, blood came out through the nose, became disorientated, fever, fingers tingling, chills headache, great fatigue, in bed for 3 days after. Most symptoms abated but headache and great fatigue persisted, left arm very sore, cannot sleep on it, nausea and loss of appetite


VAERS ID: 1333654 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Headache, Pyrexia, Somnolence, Tension headache
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Arthritis (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: 2010: Multiple vaccinations before going out of country to work. Sick for a day.
Other Medications: Clopidogrel 75mg Potassium 595mg Losartan/Hydrochlorothiazide 12.5mg Aspirin 81mg Atenolol 50mg Avorvastatin 80mg Amlodipine Besylate 5mg
Current Illness: None
Preexisting Conditions: High blood pressure. Lower back problems.
Allergies: None to my knowledge.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Day of injection: Slight fatigue, fever and headache began about 6-7 hours after injection. Next day; extreme fatigue, slept three hours in the middle of the day, no fever immediately (slight in the evening) but increased headache, tightness feeling in head all day, joint pain. Next day; fatigue worse, no headache nor fever, joint pain increased. At this point, I considered seeing a doctor but did not. Today; slight headache, no fever, fatigue seems to be getting better.


VAERS ID: 1333661 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-25
Onset:2021-05-17
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 1 LA / IM

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

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

Write-up: Patient called on 5/19/21 and spoke with pharmacist, he indicated that on 5/17/21 he noticed the skin around the injection site was abnormal. Patient described the site as being black in color, painful and swollen measuring about an inch in diameter. Patient states he lightly palpated the area and when he removed his finger the skin around the injection site fell off, he says he could "see the meat" underneath the skin; denies presence of pus, blood or other systemic symptoms. Advised the patient to seek medical care right away by going to urgent care. Patient indicated he would, Asked patient to report back to us or we would follow up with him via phone call in a few days to assess outcome and any complications for his second dose of the vaccine series.


VAERS ID: 1333670 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-07
Onset:2021-05-17
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, C-reactive protein increased, Chest pain, Pleural effusion, Pulmonary embolism, Pulmonary infarction
SMQs:, Systemic lupus erythematosus (broad), Embolic and thrombotic events, venous (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Sertraline 100mg orally every day
Current Illness:
Preexisting Conditions: History of pectus excavatum
Allergies: Cats
Diagnostic Lab Data: 5/19/21 CTA Chest with IV contrast PE showing evidence of 2 right lower lobe pulmonary emboli with suspected end occlusion in the posterior basilar segment of the right lower lobe with small wedge-shaped pulmonary infarct and trace pleural effusion. , 5/19/21D- dimer test - result (H) 2171 ng/mL DDU , 5/19/21C-RP test - result (H) 6.1 mg/dL
CDC Split Type:

Write-up: Pt has been admitted with chest pain


VAERS ID: 1333755 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-16
Onset:2021-05-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

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

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

Write-up: Ovoid rash about 7cm diameter at injection site, as well as itchy, erythematous rash on back and bilateral arms. Rash appeared 1 day after vaccination, and has continued for several days; however patient reports rash was initially raised but is now flat. No medications given yet.


VAERS ID: 1333766 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-02-09
Onset:2021-05-17
   Days after vaccination:97
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Valtrex, Rivastigmine, Dronedarone, Metoprolol Succinate, Crestor, Acetaminophen, Aspirin, Stalevo, Diazepam, Lexapro, Lunesta, Gabapentin, Norco, Memantine, Selegiline, Calcium Carbonate/Vitamin D3, Advair Diskus, Cyanocobalamin, Pyridoxi
Current Illness: None
Preexisting Conditions: Back pain, Paroxysmal A-Fib, Parkinson disease, Lumbar radiculopathy, Hypertension, Hyperlipidemia, Rheumatoid Arthritis, Coronary Artery Disease
Allergies: Beans, Cat Dander, Dog Dander, Meperidine, Pollen, Adhesive, Atorvastatin, Ciprofloxacin, Lovenox, Garlic, Infliximab, Wool Alcohols, Latex, Penicillin, Ramipril, Epinephrine, Sulfamethoxazole
Diagnostic Lab Data: 5/17 COVID positive 5/20 repeat COVID test to be sent to state to be tested for variants
CDC Split Type:

Write-up: Patient tested positive for COVID on 5/17


VAERS ID: 1333775 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Lymphadenopathy, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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: high fever (103), diarrhea, swollen lymph nodes in arm.


VAERS ID: 1333777 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 2 RA / IM

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

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

Write-up: PATIENT FAINTED IMMEDIATELY FOLLOWING THE VACCINE ADMINISTRATION. LAID PATIENT FLAT ON THE FLOOR, PUT HIS FEET UP AND PATIENT WAS OK WITHIN 30 SECONDS.


VAERS ID: 1333794 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-14
Onset:2021-05-17
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Nausea, SARS-CoV-2 test negative, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Gluten
Diagnostic Lab Data: COVID-19 test 5/17/21--negative.
CDC Split Type:

Write-up: Nausea and vomiting, onset 3 days after dose and lasting 48 hours.


VAERS ID: 1333881 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Fall, Head injury, Hyperhidrosis, Nausea, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Event occurred during COVID vaccination clinic of students at School, under direction of Hospital COVID Vaccination team. Syncopal event 5 minutes after injection. Fell backwards striking her head on the floor. Regained consciousness immediately. Pale, diaphoretic, reported lightheadedness and nausea. BP 86/50 HR 116 SpO2 99%. Consumed several ounces water and ice pack to head and neck while in observation. Released to parent after 30 minutes. BP 110/60 HR 90 SpO2 98% skin dry, color pink, denied nausea. Able to ambulate without assist. Presented to urgent care 5/18/21 for concussion evaluation reporting sensitivity to bright lights. Advised by provider to rest, avoid electronics and strenuous physical activity.


VAERS ID: 1333952 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-15
Onset:2021-05-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Ear discomfort, Oropharyngeal pain, Respiratory tract congestion, Rhinorrhoea, Sneezing
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chest congestion runny nose sneezing sore throat coughing ear pressure


VAERS ID: 1333977 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-05-14
Onset:2021-05-17
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal distension, Arthralgia, Lymphadenopathy
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (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: flovent 220 mcg
Current Illness:
Preexisting Conditions: Eosinophilic Esophagitis food allergies
Allergies: peanuts, tree nuts, sesame, zithromax
Diagnostic Lab Data:
CDC Split Type:

Write-up: very swollen lymph node in neck, above clavicle toward the neck, left side (side of vaccination). Getting bigger every day for 4 days now. Overall soreness of shoulder (despite not having much injection site soreness the days after the shot)


VAERS ID: 1334095 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Per parent: child and parent were informed at check in for clinic that both Janssen and Pfizer vaccines were available. Child was excited to hear that she could have a one dose vaccine and mother was unaware that Janssen was not licensed for people under 18. Nurse providing vaccine did not recognize child''s age after child and parent said they would take Janssen. Second nurse at clinic overheard part of conversation and asked providing nurse (after child had received a vaccine) if that child was 18. Providing nurse was then reminded that Janssen is not approved for people under 18. Pediatrician was consulted 2 days after event by parent. Parent was also contacted by myself and informed that there is no information currently available about any different types of expected side effects just because of age. Parent also informed that child did not need to have any other vaccine in addition to this one. Parent expressed understanding.


VAERS ID: 1334189 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Dyspnoea, Fatigue, Pyrexia, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: The evening patient received the vaccine started feeling feverish, tired, anxious, and experienced shortness of breath with the feeling of "throat closing" This resolved on its own, patient did not seek any medical care and patient was fine at the time of reporting to the pharmacy (5/20/21)


VAERS ID: 1334195 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-29
Onset:2021-05-17
   Days after vaccination:49
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Adenovirus test, Adrenomegaly, Angiogram pulmonary abnormal, Anticoagulant therapy, Atelectasis, Blood lactate dehydrogenase increased, Blood lactic acid normal, Bordetella test negative, C-reactive protein normal, COVID-19, COVID-19 pneumonia, Cardiac aneurysm, Chest X-ray abnormal, Chest pain, Chlamydia test negative, Condition aggravated, Cough, Dyspnoea, Echocardiogram, Ejection fraction normal, Enterovirus test negative, Fibrin D dimer increased, Glycosylated haemoglobin, Human metapneumovirus test, Human rhinovirus test, Hypercholesterolaemia, Hypertension, Hypoxia, Influenza A virus test negative, Influenza virus test negative, Interstitial lung disease, Lung consolidation, Lung infiltration, Major depression, Mitral valve incompetence, Mycoplasma test negative, Orthostatic hypotension, Oxygen saturation decreased, Pleuritic pain, Procalcitonin normal, Pulmonary embolism, Pulmonary thrombosis, Renal cyst, Respiratory syncytial virus test negative, Respiratory viral panel, Right ventricular enlargement, SARS-CoV-2 test positive, Scan with contrast abnormal, Sepsis, Tachycardia, Tricuspid valve incompetence, Type 2 diabetes mellitus, Ultrasound Doppler abnormal, Vertebral osteophyte, Viral test negative
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Dyslipidaemia (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), 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), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (narrow), Psychosis and psychotic disorders (broad), Pulmonary hypertension (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (narrow), Lipodystrophy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), 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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Medications amLODIPine (NORVASC) 5 mg tablet apixaban (ELIQUIS) 5 mg tablet ascorbic acid, vitamin C, (VITAMIN C) 500 mg tablet atorvastatin (LIPITOR) 20 mg tablet guaiFENesin (MUCINEX) 600 mg 12 hr tablet insulin glargine (LANTUS) 100 unit
Current Illness:
Preexisting Conditions: Circulatory Essential hypertension Hypertensive urgency Other pulmonary embolism without acute cor pulmonale Genitourinary BPH without obstruction/lower urinary tract symptoms Musculoskeletal Arthritis Endocrine/Metabolic Mixed hyperlipidemia Type 2 diabetes mellitus Other Depression with anxiety Major depressive disorder Physical deconditioning
Allergies: AtorvastatinCoughing
Diagnostic Lab Data: 04/16/21 1229 Respiratory virus detection panel Collected: 04/16/21 1116 | Final result | Specimen: Swab from Nasopharynx Adenovirus Not Detected Mycoplasma pneumoniae Not Detected Chlamydophila pneumoniae Not Detected Parainfluenza Not Detected COVID-19 SARS-CoV-2 Overall Result DetectedCritical Enterovirus/Rhinovirus Not Detected Coronavirus Not Detected Respiratory Synctial Virus Not Detected Influenza A Not Detected Bordetella pertussis Not Detected Influenza B Not Detected Bordetella parapertussis Not Detected Metapneumovirus Not Detected Procedure Component Value Ref Range Date/Time CT angiogram chest pulmonary embolism with and without contrast Resulted: 04/16/21 1313 Order Status: Completed Updated: 04/16/21 1314 Narrative: CT angiogram of the chest HISTORY: Elevated D dimer. Cough for 2 days. Covid 19 infection. Comments: CT angiogram of the chest was performed utilizing a pulmonary embolism protocol after the intravenous administration of 150 mL of Omnipaque 350. Multiplanar MIP MIP and 3-D reconstruction images were performed under concurrent radiologist supervision on an independent 3-D workstation and reviewed. Automated exposure control was utilized. The patient had one CT scan within the last year. The heart is normal in size and configuration with no pericardial effusions or thickening. There are no enlarged hilar mediastinal or axillary lymph nodes. Evaluation of the pulmonary arteries demonstrates no intraluminal filling defects to suggest pulmonary embolism. There is no aortic dissection or aneurysmal dilatation of the aorta. Lung windows show no focal lung consolidations. There are no pleural effusions or pneumothoraces. The visualized liver, spleen and pancreas are normal in contour. The left adrenal is slightly enlarged which could be hyperplasia. There are bilateral renal hypodense lesions. The left renal hypodense lesions are likely cysts. The right renal hypodensity is incompletely imaged. Osseous structures show no bony destructive lesions. Endplate osteophytes are noted of the spine. IMPRESSION: 1. No pulmonary embolism. 2. No lung consolidation. 3. Hypodense renal lesions as described above. X-ray chest 1 view Resulted: 04/16/21 0948 Order Status: Completed Updated: 04/16/21 0949 Narrative: XR CHEST 1 VW PORT IMPRESSION: Mild basilar atelectasis. END OF IMPRESSION: INDICATION: Shortness of Breath. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 6/10/2020. FINDINGS: There is mild atelectasis at the lung bases. There is no effusion or pneumothorax. The cardiac silhouette is normal size. The trachea is midline. The osseous mineralization is normal. x-ray chest 1 view Result Date: 4/29/2021 XR CHEST 1 VW PORT INDICATION: worsening hypoxemia, covid. Encounter: Subsequent. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 4/26/2021. FINDINGS: The moderate bilateral pulmonary infiltrates are minimally denser than before. No other change. END OF IMPRESSION: X-ray chest 1 view Result Date: 4/26/2021 XR CHEST 1 VW PORT IMPRESSION: There is patchy bibasilar consolidation consistent with atelectasis or pneumonia. END OF IMPRESSION: INDICATION: Shortness of Breath. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 4/16/2021. FINDINGS: There is patchy consolidation seen at the lung bases, right greater than left. There is no effusion or pneumothorax. The cardiac silhouette is normal size. The trachea is midline. The osseous structures are normally mineralized. X-ray chest 1 view Result Date: 4/16/2021 XR CHEST 1 VW PORT IMPRESSION: Mild basilar atelectasis. END OF IMPRESSION: INDICATION: Shortness of Breath. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: X-ray 6/10/2020. FINDINGS: There is mild atelectasis at the lung bases. There is no effusion or pneumothorax. The cardiac silhouette is normal size. The trachea is midline. The osseous mineralization is normal. Transthoracic echo (TTE) complete Result Date: 5/4/2021 Gender: Male Age:78 Procedure Date: 5/4/2021 02:06 PM Study Quality: Fair Ht / Wt / BSA: 70.00 in / 225.00 lb / 2.19 m2 Heart Rate: 86 bpm BP: 143 / 83 mmHg Indications: HTN Transthoracic 2D, Color Flow, and Doppler Echocardiogram Conclusions: Normal left ventricular size and systolic function. The visually estimated ejection fraction is 50-55% (normal range 50-70%). All wall segments showed normal motion. No prior study for comparison. There is no aortic valve stenosis by color flow and doppler analysis. There is no aortic valve regurgitation by color flow and doppler analysis. Mildly increased right ventricular cavity size with preserved RV function. There is a focal outpouching/aneurysm of the lateral RV wall seen in some views of unclear significance Presentation and History: Indication: The patient presents for evaluation of htn. The patient has a history of obesity and hypertension. Findings: Procedure Information: Contrast agent, definity, is being given per protocol without apparent complications. Due to technical limitations in the assessment of the left ventricle, imaging was performed after the administration of intravenous Definity echocontrast, as per protocol. Left Ventricle: Normal left ventricular size and systolic function. The visually estimated ejection fraction is 50-55% (normal range 50-70%). Doppler findings are consistent with normal diastolic function. Wall Motion: All wall segments showed normal motion. Right Ventricle: Mildly increased right ventricular cavity size. Atria: Both atria are normal in size. Aortic Valve: Normal aortic valve structure and function. There is no evidence of aortic valve stenosis or insufficiency by color flow and doppler analysis. There is no aortic valve stenosis by color flow and doppler analysis. There is no aortic valve regurgitation by color flow and doppler analysis. Mitral Valve: Normal mitral valve structure and function. There is no evidence of mitral valve stenosis or insufficiency by color flow and doppler analysis. There is trace mitral valve regurgitation by color flow and doppler analysis. There is no mitral valve stenosis by color flow and doppler analysis. Pulmonic Valve: The pulmonic valve was not well visualized. Tricuspid Valve: Normal tricuspid valve structure. There is trace tricuspid valve regurgitation by color flow and doppler analysis. There is no evidence of pulmonary hypertension. Great Vessels: All visible segments of the aorta are normal in size. Venous: The inferior vena cava was not well visualized. Pericardium/Pleural: There is no evidence of pericardial effusion. Prior Study Comparison: No prior study for comparison. Measurements: Left Ventricle: IVSd: 1.19 cm (0.6-0.9/0.6-1.0) LVIDd: 3.24 cm (3.9-5.3/4.2-5.9) LVIDd Index: 1.48 cm/m2 (2.4-3.2/2.2-3.1) LVIDs: 2.18 cm (2.0-3.6) LVPWd: 1.11 cm (0.7-1.1) Ao Root: 3.50 cm (2.1-3.5) LV Mass: 141.46 g (67-162/88-224) LV Mass Index: 64.59 g/m2 (43-95/49-115) LVOT Diam: 2.00 cm (3.0+(-)1.3) LVOT Pk Vel: 0.80 LVOT Mn Vel: 0.53 LVOT VTI: 0.13 LVOT Pk Grad: 3.00 LVOT Mn Grad: 1.00 LVOT Diam: 2.00 LVOT Area: 3.14 MV Pk E: 0.38 MV Pk A: 0.84 E/A: 0.50 E''Medial: 8.16 E/E'' Med: 4.70 E'' Laterial: 11.50 E/E'' Lat: 3.30 Mitral Valve: MV Pk E: 0.38 MV PK A: 0.84 MV Decel Time: 261.00 E/A: 0.50 E''Lateral: 11.50 E''Medial: 8.16 E/E'' Med: 4.70 E/E'' Lat: 3.30 PHT: 77.00 MVA PHT: 2.86 Decel Slope: 1.46 Aortic Valve: AoV Pk Vel: 0.94 AoV Pk Grad: 4.00 Great Vessels: Ao Root-2D: 3.50 cm (2.0-3.7) Ao Asc: 3.80 cm (2.1-3.4) Updated on 5/4/2021 3:17:55 PM with Status of Final electronically signed on 5/4/2021 3:17:55 PM with status of Final CTA CHEST PULMONARY EMBOLISM W WO CONTRAST Result Date: 4/26/2021 CTA CHEST PULMONARY EMBOLISM W WO CONTRAST IMPRESSION: Moderate, diffuse Covid 19 pneumonia. Bilateral second and third order pulmonary emboli. Overall thrombus burden is mild. No evidence of right or left heart failure. Above critical findings personally communicated to the referring emergency department physician immediately at the close of this dictation. END OF IMPRESSION: INDICATION: Elevated D dimer, pleuritic chest pain, shortness of breath, pulmonary embolism, initial encounter CT chest obtained with 100 cc of Omnipaque 350 IV contrast material enhancement. Automated exposure control utilized. CTA technique with thin section arterial phase capture during peak pulmonary arterial enhancement. Multiplanar MIPS and 3-D reconstructions performed under concurrent radiologist supervision on an independent 3-D workstation and reviewed. Comparison 4/16/2021. 2 preceding 12 month CT studies. Examination is motion limited. Best possible study was obtained. Lungs now demonstrate diffuse interstitial infiltrates consistent with moderate Covid 19 pneumonia. No effusion, pneumothorax, or congestive failure. Filling defects are identified within the right and left lower lobe third order pulmonary arteries, not seen previously. Small filling defects are also noted within the second order left upper lobe and third order right upper lobe pulmonary arteries. Overall thrombus burden is mild. No right or left heart failure. Contrast-enhanced neck base and axillary regions are within normal limits. Mediastinum reveals normal size heart. No pericardial effusion. Minimal calcific arterial disease without aneurysm or dissection. No measurable central mass lesion or CT criteria adenopathy. No endobronchial or endotracheal lesion. Unremarkable esophagus. No acute upper abdominal or osseous finding. CT angiogram chest pulmonary embolism with and without contrast Result Date: 4/16/2021 CT angiogram of the chest HISTORY: Elevated D dimer. Cough for 2 days. Covid 19 infection. Comments: CT angiogram of the chest was performed utilizing a pulmonary embolism protocol after the intravenous administration of 150 mL of Omnipaque 350. Multiplanar MIP MIP and 3-D reconstruction images were performed under concurrent radiologist supervision on an independent 3-D workstation and reviewed. Automated exposure control was utilized. The patient had one CT scan within the last year. The heart is normal in size and configuration with no pericardial effusions or thickening. There are no enlarged hilar mediastinal or axillary lymph nodes. Evaluation of the pulmonary arteries demonstrates no intraluminal filling defects to suggest pulmonary embolism. There is no aortic dissection or aneurysmal dilatation of the aorta. Lung windows show no focal lung consolidations. There are no pleural effusions or pneumothoraces. The visualized liver, spleen and pancreas are normal in contour. The left adrenal is slightly enlarged which could be hyperplasia. There are bilateral renal hypodense lesions. The left renal hypodense lesions are likely cysts. The right renal hypodensity is incompletely imaged. Osseous structures show no bony destructive lesions. Endplate osteophytes are noted of the spine. IMPRESSION: 1. No pulmonary embolism. 2. No lung consolidation. 3. Hypodense renal lesions as described above.
CDC Split Type:

Write-up: ED to Hosp-Admission Discharged 4/16/2021 - 4/19/2021 (3 days) Hospital Doctor Last attending - Treatment team COVID-19 Principal problem Medical Problems Hospital Problems POA * (Principal) COVID-19 Yes Hypercholesterolemia Yes Hypertension Yes Type 2 diabetes mellitus Yes Major depressive disorder Unknown Acute respiratory failure with hypoxia Unknown Hypertensive urgency Unknown Presenting Problem/History of Present Illness/Reason for Admission COVID-19 Hospital Course (Patient) is a 78 y.o. male with medical history of hypertension, type 2 diabetes on insulin, and hyperlipidemia presents with SOB and she was admitted for acute hypoxic respiratory failure with sepsis .Patient was diagnosed with Covid on 4/15 and repeat COVID-19 was positive on admission. Acute hypoxic respiratory failure likely from COVID-19-improving o On admission satting low 90% ,required supplemental oxygen, normal lactic acid & CRP, elevated LDH 263 o CXR (4/16/21): mild basilar atelectasis. o Continue remdesivir (4/16-4/21, Day 4) and dexamethasone (4/16-) since O2 sat <94% on room air, requiring supplemental oxygen o Patient currently satting 95-97% on 2 L nasal cannula. Bedside study does not qualify patient for home oxygen while resting and/or ambulating. PT recommends safe discharge home. Patient clinically stable to be discharged home today. Patient to follow-up with PCP. Sepsis likely from COVID-19 -resolved o On admission HR $g90, RR $g20 + source of infection COVID= sepsis, procalcitonin neg- antibiotics not indicated Elevated D-dimer likely from SARs-COV-2 o On admission D-dimer elevated 0.59, patient was tachycardic o CTA significant for No pulmonary embolism. No lung consolidation. Hypodense renal lesions. Hypertensive urgency - resolved Essential hypertension o On admission BP $g180/120 o Continue home losartan and amlodipine. Diabetes mellitus type 2 o A1c (11/18/20):7.9, repeat A1c 6.7 (4/17) o Home meds metformin 500 BID, Novolin 70-30 : 40 unit AM, 75 unit PM. Home novolin 70-30 = lispro 34 units, glargine 80 unit approximately o Started SSI, lispro TID 5 units, Glargine 10 units BID, confirmed dose with pharmacy based on his home Novolin 70-30 conversion. Patient to continue home medications and follow-up with PCP. MDD-Continue home paroxetine, venlafaxine Hyperlipidemia - Continue home statin Treatments: steroids: Dexamethasone 6 mg and remdesivir 100 mg, benzonatate capsule 100 mg Procedures: None Consults: pulmonary/intensive care Pertinent Test Results: CXR: There is mild atelectasis at the lung bases. There is no effusion or pneumothorax. The cardiac silhouette is normal size. The trachea is midline. The osseous mineralization is normal. CTA: IMPRESSION: 1. No pulmonary embolism. 2. No lung consolidation. 3. Hypodense renal lesions as described above. ED to Hosp-Admission Discharged 4/26/2021 - 5/6/2021 (10 days) Hospital Doctor Last attending ? Treatment team Acute pulmonary embolism, unspecified pulmonary embolism type, unspecified whether acute cor pulmonale present Principal problem HPI: (Patient) is a 78 y.o. male with past medical history of T2DM, HTN, HLD, and depression/anxiety who presented to the ED on 4/26 with COVID pneumonia and acute bilateral PE. Orthostatic Hypotension. Improved with IV fluids. No orthostasis this morning. TTE done yesterday showing preserved EF. Acute hypoxemic respiratory failure secondary to Covid 19 Pneumonia with some contribution from PE. Patien.t now on room air. Patient completed Remdesivir. Completed 10 days of Dexamethasone. He will be transitioned to prednisone 20 mg daily for 7 days, 10 mg daily for 7 days then 5 mg daily for 7 days. He was givenTocilizumab: 8 mg/kg, 4/29. He is not a candidate for convalescent plasma. Acute bilateral PE: Mild clot burden without evidence of RV strain. Was initially started on therapeutic Lovenox, transitioned to Eliquis 4/29. Eliquis priced and affordable to the patient. T2DM: On lantus 23 units nightly and Humalog to 10 units with meals HTN: Continue losartan and amlodipine with holding parameters HLD: Continue statin Depression with anxiety: Continue paroxetine and Effexor BPH: Continue Flomax Suspected OSA: Per his daughter concern for OSA. Will need outpatient sleep study.


VAERS ID: 1334306 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood glucose increased, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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? No
Hospitalized? No
Previous Vaccinations: Details unknown
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Type 1 diabetic; multiple allergies; history of reactions
Allergies: Yes, no details were indicated on consent form
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient''s sister came over to get RN and said patients throat was closing up. RN Grabbed doctor on site to assess. MD and RN auscultated with stethoscope; good air movement and color. Alert, oriented, speaking full sentences. The patient had a potential reaction to COVID-19 vaccine. Many co-morbidities and previous reaction noted. Rn and MD evaluated. Despite good air flow, patient reports throat closing up. Patient self-dosed Benadryl (50mg) with no improvement. 911 called. Mom Called. RN gave report to EMS, EMS took over care and consulted mom who denied transport and with patient. Patient''s blood glucose also read "high" on meter x2 times.


VAERS ID: 1334396 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0011A / 1 RA / IM

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

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

Write-up: No adverse event. The patient received the Moderna vaccine at the age of 15 years.


VAERS ID: 1334570 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Immediate post-injection reaction, Malaise, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (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: n/a
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: NKDA
Diagnostic Lab Data: patient given saline and zofran as a prescription. temp, hr, bp, rr, and oxygen sat were taken and normal
CDC Split Type:

Write-up: The patient received his first dose of the COVID vaccine. The father states as they were walking out, the pt complained or "not feeling well". He describes this as feeling of dizziness and nauseaous. The father asked is he could come back to an urgent care room to lay down which is where he had a n episode of emesis.


VAERS ID: 1334703 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Nausea, Pallor, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Melatonin Albuterol 90 MCG Ciclesonide 80mcg
Current Illness: none
Preexisting Conditions: none
Allergies: Flu Vaccine
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Vaccine Administered: Pfizer COVID-19 Patient reaction: Flushing Pale Skin Nausea/Vomiting Fainting Dizziness Action taken: Antihistamine given. Outcome: Patient recovered. Late charting for 5/17/2021 - 5ml Diphenhydramine given PO 10 minute after c19 vaccine - patient dizzy, diaphoretic, and nauseous. Emergency medication entered and signed.


VAERS ID: 1334771 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Michigan  
Vaccinated:0000-00-00
Onset:2021-05-17
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Hyperhidrosis, Thrombosis
SMQs:, Neuroleptic malignant syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210534558

Write-up: BLOOD CLOT IN LEG; SWEATING; This spontaneous report received from a consumer concerned a 70 year old male of unspecified ethnicity. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on APR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date in 2021, the patient experienced sweating which lasted about one day. It was stated that patient received vaccine around 18-APR-2021. It was also reported that actual date of vaccination may have been prior to 18-APR-2021 but definitely in April. On 17-MAY-2021, patient visited hospital and got diagnosed with blood clot in leg. The patient was on unspecified medications to dissolve clots. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from sweating on 2021, and had not recovered from blood clot in leg. This report was serious (Hospitalization Caused / Prolonged).; Sender''s Comments: V0- 20210534558-Covid 19 Vaccine- This case concerns a 70 yr old male. Blood clot in leg, Sweating. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).


VAERS ID: 1334801 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Illinois  
Vaccinated:0000-00-00
Onset:2021-05-17
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 208A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Headache, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Allergic reaction to bee sting; Anaphylactic reaction; Anxiety; Environmental allergy
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210537446

Write-up: INSIDES SHAKY LITTLE IN THE BEGINNING; HEADACHE; SUBJECTIVE FEVER; This spontaneous report received from a patient concerned a 64 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included anxiety issues, environmental allergy, allergy to bee stings, and anaphylactic reactions. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 208a21a, expiry: 21-JUN-2021) dose was not reported, administered on 17-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 17-MAY-2021, the subject experienced insides shaky little in the beginning. On 17-MAY-2021, the subject experienced headache. On 17-MAY-2021, the subject experienced subjective fever. The action taken with covid-19 vaccine was not applicable. The patient recovered from insides shaky little in the beginning on MAY-2021, headache on 18-MAY-2021, and subjective fever on 17-MAY-2021. This report was non-serious.


VAERS ID: 1335999 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-05-16
Onset:2021-05-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: C-reactive protein increased, Chest pain, Echocardiogram abnormal, Fibrin D dimer normal, Intensive care, Pericarditis, Respiratory viral panel, SARS-CoV-2 RNA undetectable, SARS-CoV-2 antibody test positive, Troponin increased
SMQs:, Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None reported
Current Illness: None
Preexisting Conditions: None
Allergies: None reported
Diagnostic Lab Data: 5/18: troponin 1163 ng/L 5/19: troponin 1225 ng/L 5/20: troponin 1136 ng/L D dimer normal, CRP 4.26 mg/dl Respiratory PCR panel negative Covid RNA negative COVID IgG +
CDC Split Type:

Write-up: Patient developed chest pain starting 3 PM on 5/17. Presented to a local ED for this on 5/18 and was found to have elevated troponin level. Transferred to a hospital with pediatric floor and was seen by a pediatric cardiologist. Echocardiogram notable for evidence of pericarditis but normal cardiac function. Given concern for development of arrhytmia, transferred to a hospital PICU. Chest pain was mild to moderate, stabbing, and was somewhat relieved by antinflammatory therapy. He never had fever, chills, vomiting, diarrhea or rash. He had no ill contacts. He had no history of prior COVID nor did his family


VAERS ID: 1336264 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 1 LA / IM

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

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

Write-up: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)


VAERS ID: 1336288 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-05-17
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Fatigue, Feeling hot, Heart rate increased, Hypertension, Paraesthesia, Pyrexia, Swollen tongue, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypertension (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Hypertension; Hypocholesteremia; Migraine
Preexisting Conditions: Medical History/Concurrent Conditions: Anaphylactic reaction
Allergies:
Diagnostic Lab Data: Test Date: 20210517; Test Name: Body temperature; Result Unstructured Data: 99.2 F
CDC Split Type: USJNJFOC20210535640

Write-up: TIREDNESS; TINGLING FACE FOR 5 MINUTES; CLOSING OF THROAT ABOUT 5 MINS BUT AIRWAY CLEAR; TONGUE SWELLING FEW MINUTES; HOT FACE; HIGH BLOOD PRESSURE; HIGH HEART RATE; FEVER; This spontaneous report received from a pharmacist concerned a 56-year-old female. The patient''s height, and weight were not reported. The patient''s past medical history included anaphylaxis reaction to flu shot, and concurrent conditions included hypertension, hypocholesteremia, and migraines. The patient was previously treated with Lisinopril, Atorvastatin, Zonisamide for migraine, Tizanidine for muscle pain related to migraine, Promethazine, Ketorolac, Trazodone for sleep, Influenza vaccine (Flu shot); and experienced drug allergy when treated with Epinephrine for unknown indication. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 201A21A, expiry: 23-JUN-2021) dose was not reported, administered 01 total, on 17-MAY-2021 in left arm for prophylactic vaccination. No concomitant medications were reported. On 17-MAY-2021, about 15 minutes after vaccination, the patient experienced tingling face for 5 minutes, closing of throat about 5 mins but were airway clear, tongue swelling for few minutes, hot face, high blood pressure, high heart rate, and fever, was given Benadryl (diphenhydramine hydrochloride) 50mg IM (intramuscular) to right arm after 30 mins of vaccination. On 18-May-2021, the patient experienced tiredness. Laboratory data included: Body temperature (NR: not provided) 99.2 F. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from tingling face for 5 minutes, closing of throat about 5 mins but airway clear, tongue swelling few minutes, hot face, high blood pressure, and high heart rate on 17-MAY-2021, and had not recovered from fever, and tiredness. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0 20210535640-COVID-19 VACCINE AD26.COV2.S-Tingling face for 5 minutes, closing of throat about 5 mins but airway clear, tongue swelling few minutes, hot face, and high heart rate . This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s). V0 20210535640-COVID-19 VACCINE AD26.COV2.S-High blood pressure. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: MEDICAL HISTORY. V0 20210535640-COVID-19 VACCINE AD26.COV2.S-Fever. This event(s) is labeled per RSI and is therefore considered potentially related.


VAERS ID: 1336293 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Ohio  
Vaccinated:0000-00-00
Onset:2021-05-17
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Feeling abnormal, Insomnia, SARS-CoV-2 test
SMQs:, Dementia (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:
Current Illness: Abstains from alcohol; Diabetes (controlled with medications.); Hypertension (controlled with medications.); Non-smoker
Preexisting Conditions: Comments: The patient had allergy to chloroquine (difficulty sleeping, itching, fast heartbeat).
Allergies:
Diagnostic Lab Data: Test Date: 20210429; Test Name: COVID-19 PCR test; Result Unstructured Data: Negative; Test Date: 20210504; Test Name: COVID-19 PCR test; Result Unstructured Data: Negative
CDC Split Type: USJNJFOC20210537352

Write-up: FEEL STRONG IN THE MORNING; DIFFICULTY SLEEPING; This spontaneous report received from a patient concerned a 55 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included diabetes, hypertension, non alcohol user, and non smoker, and other pre-existing medical conditions included the patient had allergy to chloroquine (difficulty sleeping, itching, fast heartbeat). The patient experienced drug allergy when treated with chloroquine for drug used for unknown indication. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1821286, expiry: UNKNOWN) dose was not reported, administered on 17-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 29-APR-2021, Laboratory data included: COVID-19 PCR test (NR: not provided) Negative. On 04-MAY-2021, Laboratory data included: COVID-19 PCR test (NR: not provided) Negative. On 17-MAY-2021, the subject experienced difficulty sleeping. On 18-MAY-2021, the subject experienced feel strong in the morning. Treatment medications (dates unspecified) included: diphenhydramine hydrochloride/naproxen sodium. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from difficulty sleeping, and the outcome of feel strong in the morning was not reported. This report was non-serious.


VAERS ID: 1336477 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Facial pain, Headache, Hypoaesthesia, Hypoaesthesia oral, Injection site movement impairment, Injection site pain, Pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Glaucoma (broad), Vestibular disorders (broad)

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

Write-up: -Face tingly and/or numb starting with lips before spreading to entire face about 40 minutes after injection. Felt like face was going in and out of conscienceness entire time. Sometimes felt like the sensation when a scab on a scrape is healing and the new skin is forming under the scab. Based on internet research with others having this rare side effect wanted to note that there was no swelling or change in heart rate (also I have not had any cosmetic surgery). But most reactions tended to be after the second dose and not the first as in my case. This mainly lasted about 48 hours at a pain level of medium with occasional minor occurrences after that. -Left bicep soreness (entire bicep not localized to injection). Pain intensified when touched or arm lifted above head. Pain level medium but consistent. Started about 16 hours after injection and last about 60 hours. - Overall body soreness. Felt like being hit by a freight train. Pain level fairly high starting about 18 hours after injection and lasting about 24 hours gradually decreasing in pain level over duration of that period. - About 40 hours after injection, face felt like it was hit by a frying pan, most pain localized to where nose meets face (not tip of nose) and radiated out from the bones around the nose to the rest of the face. These symptoms were high pain level for 36 hours and probably a low pain level about 24 hours after that. - About 70 hours after injection, dizziness and headache lasting for about 8 hours. Medium pain level. - Almost all high and medium level side effects are finally gone after 4 days although still minor face pain and left arm bicep pain exist. (Sorry I didn''t know I could report side effects so have been trying to keep track on paper as best as I could this week).


VAERS ID: 1336619 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-14
Onset:2021-05-17
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8713 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood creatine phosphokinase MB increased, C-reactive protein increased, Cardiac imaging procedure abnormal, Laboratory test normal, Left ventricular dysfunction, Magnetic resonance imaging heart, Myocardial oedema, Myocarditis, Pericardial effusion, Pericardial fibrosis, Red blood cell sedimentation rate increased, Troponin increased
SMQs:, Cardiac failure (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Clinically presented with findings concerning for myopericarditis. Trop 1900 -$g 1600 -$g 1300. CK MB 42 -$g 5.1 CRP 90 -$g 83 -$g 17. ESR 40 -$g 34 -$g 44. Infectious work up negative. Autoimmune work up negative. Cardiac MRI: Cardiac MRI findings of moderately reduced left ventricular systolic function. There is significant subepicardial enhancement on early gadolinium and late gadolinium imaging of the lateral, inferior and anterior wall of the left ventricle and free wall of the right ventricle. The native T2 is elevated at 63 ms consistent with myocardial edema. There is mild pericardial thickening with small pericardial effusion and patchy areas of enhancement. Findings are consistent with acute myopericarditis
CDC Split Type:

Write-up: Myopericarditis


VAERS ID: 1336625 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too High


VAERS ID: 1336630 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too High


VAERS ID: 1336632 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too High


VAERS ID: 1336883 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 LA / IM

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

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

Write-up: pt has a "lump" at the site of injection and as of 5/19/2021 has "heat" at the injection site. Has not used any ice/heat to area as of yet. advised to seek md advise if continues or worsens.


VAERS ID: 1337013 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too High


VAERS ID: 1337149 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too High


VAERS ID: 1337269 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too High


VAERS ID: 1337426 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-25
Onset:2021-05-17
   Days after vaccination:53
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram pulmonary normal, COVID-19, Chronic obstructive pulmonary disease, Condition aggravated, Cough, Dyspnoea, Fibrin D dimer increased, Procalcitonin normal, Rhonchi, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Haemorrhage laboratory terms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol klonopin
Current Illness: None known
Preexisting Conditions: COPD
Allergies: Contrast Dye Methadone Morphine Oxcodone Zoloft
Diagnostic Lab Data:
CDC Split Type:

Write-up: shortness of breath which is been ongoing for the last several days. His symptoms have progressively worsened over that time. He was seen here in the ED 5 days ago and had a neb treatment for COPD, he had a positive D-dimer and negative CT angiogram of the chest for PE. He was discharged home on Azithromycin and prednisone for AECOPD. His symptoms unfortunately continued to worsen with increased cough and shortness of breath no fever, chills, sore throat, nausea, vomiting or diarrhea. He came back to the ED today for evaluation since he was feeling worse. Patient has a history of lung cancer on the right status post pneumonectomy in 2013. On initial eval in the ED he was noted to have bilateral rhonchi on the left greater than right and received neb treatments and Solu-Medrol 125 IV push. His symptoms did improve somewhat. ED staff checked a COVID 19, despite confirming his second Pfizer vaccine was received on 3/21/2021, and it came back positive. Procalcitonin was negative. He clearly has an exacerbation of his COPD but with the COVID 19 positivity, the ED staff was concerned with his comorbidities that his prognosis is poor in the face of progression of symptoms. I was contacted and agreed to admit him for Remdesivir therapy, supplemental O2, dexamethasone and supportive care.


VAERS ID: 1337608 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: rashes after the shot


VAERS ID: 1337615 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-05-13
Onset:2021-05-17
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Activated partial thromboplastin time, Asthenia, Blood creatine phosphokinase, Blood creatine phosphokinase MB increased, Blood culture, Catheterisation cardiac normal, Chest pain, Culture urine, Electrocardiogram, Fatigue, Full blood count, Intensive care, Myocarditis, Prothrombin time, SARS-CoV-2 test, Troponin increased
SMQs:, Myocardial infarction (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen 500mg 2 tablets
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: Troponins (May, 17 2533.4 / 4397. May 18, 12,245, May 20, 1847. May 21, 1051) Daily EKG Catherization (-) COVID-19 CK-MB (May 17, 37.7ng/ml ) CBC CPK PT-PTT U/C B/C
CDC Split Type:

Write-up: On May 14, patient developed fatigue and weakness. He took 2 tablets of acetaminophen 500mg and after a couple of hours he felt better. Three days later on May 17, at 5 am patient developed chest pain. He visited a local health clinic patient presented high troponin levels 2533.4. At 6:58 pm he was transferred to the Emergency Department. Patient was admitted to the Pediatric Intensive Care Unit (PICU) at 8:00pm. The date of the event patient received Motrin 400mg, Toradol 30mg, Aspirin 81mg, Brilinta 180mg and Tridil 250mg/50ml (at 3 ml/hr). An acute myocardial event was rule out with a negative result of the catheterization procedure. Patient was diagnosed with myopericarditis. He still hospitalized, his troponins levels are decreasing and chest pain has been resolved.


VAERS ID: 1337663 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-14
Onset:2021-05-17
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: sertraline 150mg daily
Current Illness:
Preexisting Conditions: autism spectrum disorder
Allergies:
Diagnostic Lab Data: MRI Confirmed myocarditis (5/17/2021)
CDC Split Type:

Write-up: patient diagnosed with MRI confirmed myocarditis following 2nd dose of Pfizer COVID vaccination


VAERS ID: 1337702 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-07
Onset:2021-05-17
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Peripheral swelling, Rash, Tenderness
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Clopidogrel Sennosides Nitroglycerin Albuterol Aspirin Cetirizine Clotrimazole-betamethasone cream Dicyclomine Docusate Empagliflozin Famotidine Fluticasone Furosemide Insulin glargine Insulin lispro Isosorbide mononitrate Levothyroxine Lin
Current Illness:
Preexisting Conditions: Diabetes Hypertension Asthma Hypothyroidism Gastroesophageal Reflux Disease Without Esophagitis Asthma Chronic Heart Failure With Preserved Ejection Fraction
Allergies: Morphine, Penicillins, Percocet
Diagnostic Lab Data:
CDC Split Type:

Write-up: (Purpura) Rash to her bilateral lower extremities. States that she first noticed it 4 days ago, and it has improved since she first noticed it but is causing her pain. Feels as if her legs are swollen, the rash is not itchy. It is slightly painful to the touch.


VAERS ID: 1338128 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-16
Onset:2021-05-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA VG5-20992-69001 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Pain in extremity, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Fever and weakness firts 24 hours, pain in the arm and shaking all time 5 days ago


VAERS ID: 1338151 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-01
Onset:2021-05-17
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Aortic thrombosis, Blood fibrinogen normal, Fibrin D dimer increased, Flank pain, Haemoptysis, Headache, Heparin-induced thrombocytopenia test positive, Immunoglobulin therapy, Pain in extremity, Platelet count decreased, Pulmonary embolism, Thrombocytopenia
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, venous (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Diverticulitis ? Hypertension ? Pain, chronic ? Smoker
Allergies: None
Diagnostic Lab Data: Fibrinogen 299 D-dimer $g20 Platelets 44 Heparin Induced Platelet Ab PF4 IgG elevated at 2.665 (baseline <0.4)
CDC Split Type:

Write-up: Hemoptysis, flank pain, bilateral leg pain, headache. Found to have thrombocytopenia of 44, extensive bilateral PEs, and nonocclusive aortic thrombus. Treated with IVIG x 2 days and argatroban. Course is ongoing at ~48 hours since presentation.


VAERS ID: 1338365 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-16
Onset:2021-05-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWV172 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Computerised tomogram, Concussion, Facial bones fracture, Loss of consciousness, X-ray
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), 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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Pro-Air
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Peanut
Diagnostic Lab Data: ER visit with blood work, IV fluids, X-Ray, & CT scan
CDC Split Type:

Write-up: Patient had a syncopal episode passed out hit her head and suffered bilateral nose fractures and concussion


VAERS ID: 1338829 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-16
Onset:2021-05-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood alkaline phosphatase increased, Blood fibrinogen increased, Blood sodium decreased, Brain natriuretic peptide increased, C-reactive protein increased, Diarrhoea, Lymphocyte count decreased, Multisystem inflammatory syndrome in children, Musculoskeletal stiffness, Neck pain, Pyrexia, SARS-CoV-2 antibody test positive, Vomiting, White blood cell count increased
SMQs:, Cardiac failure (broad), Liver related investigations, signs and symptoms (broad), Acute pancreatitis (broad), Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Toxic-septic shock conditions (broad), Pseudomembranous colitis (broad), Dystonia (broad), Parkinson-like events (broad), Biliary system related investigations, signs and symptoms (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Chronic kidney disease (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (broad), Sepsis (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow), 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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: 5/20 Fibrinogen 785, Ferritin 377, CRP, 321, WBC 16.6, Hgb 14.9, plts 203 BNP 225, troponin 1525 pg/ml Na 132, K 3.9, Bicarb 24, BUN 12, Cr 0.8 AST 32, ALT 31, AlkPhos 285 COVID IgG: detected COVID: not detected
CDC Split Type:

Write-up: 5 days prior to admission on 5/16/21, he received a first Pfizer COVID vaccination. The day after the vaccine, he had neck pain and stiffness. He subsequently developed fever, diarrhea, and vomiting. The day prior to admission, he developed a diffuse popular rash. He was seen in clinic on 5/20 and lab work was obtained, which was consistent with MIS-C findings (elevated troponin, elevated fibrinogen, elevated CRP, hyponatremia, relatively low absolute lymphocyte count).


VAERS ID: 1340213 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Florida  
Vaccinated:0000-00-00
Onset:2021-05-17
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / 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: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210533178

Write-up: MILD FEVER; This spontaneous report received from a consumer concerned a male of unspecified age. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 17-MAY-2021 11:00 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 17-MAY-2021, the subject experienced mild fever. The action taken with covid-19 vaccine was not applicable. The outcome of mild fever was not reported. This report was non-serious.


VAERS ID: 1340223 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Unknown  
Location: Louisiana  
Vaccinated:0000-00-00
Onset:2021-05-17
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 023A21A / 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: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210535447

Write-up: ADMINISTERED VACCINE AFTER IT WAS AT ROOM TEMPERATURE FOR MORE THAN 2 HOURS BUT LESS THAN 6 HOURS; This spontaneous report received from a pharmacist concerned a 25 year old of unspecified sex. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported and batch number: 023A21A expiry: 23-JUN-2021) dose was not reported, administered on 17-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 17-MAY-2021, the subject experienced administered vaccine after it was at room temperature for more than 2 hours but less than 6 hours. The action taken with covid-19 vaccine was not applicable. The outcome of administered vaccine after it was at room temperature for more than 2 hours but less than 6 hours was not reported. This report was non-serious.


VAERS ID: 1340517 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-31
Onset:2021-05-17
   Days after vaccination:47
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8272 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Thrombotic stroke, Weight, Weight decreased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: Weight; Result Unstructured Data: Test Result:Lost
CDC Split Type: USPFIZER INC2021568176

Write-up: Had a stroke from blood clot; she lost weight; This is a spontaneous report from a contactable consumer (mother) that: A 77-year-old female patient received second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, lot number: ER8272) via an unspecified route of administration on 31Mar2021, as a single for COVID-19 immunization. Previously patient received first dose of BNT162B2 (covid-19 vaccine, Batch/Lot Number: not clear) via an unspecified route of administration on 10Mar2021 as single dose for COVID-19 immunization. Medical history and concomitant medications were not reported. Reporter stated, "I don''t know so I just was try to find out or who I report or ask about. I convinced my mother to get her Covid vaccine, so she got her second shot on 31Mar we got it together. Yesterday (17May2021 ) my mom had a stroke from blood clot, and I was just asking myself if it could have had anything to do with from Pfizer shot as she never had any problem like that and now, she was in the hospital from the stroke, and I was just wondering if me talking her and getting her vaccine could possibly had to do with this. Reporter further stated, Absolutely, I have question as far as if that was the cause, was there any special treatment that she should be getting maybe I can at least inform the doctor about that anything. I am out of my mind right now because I felt that I talk to her getting the vaccine because I want to her to be safe, she was 77 yrs. old (Not clarified) she never had any medical problem I feel guilty. Height and weight: Reporter stated, She was approximately 5''6. I don''t know the weight as she lost weight, she was not obese or anything like that, but I honestly don''t know her weight. The outcome for the events was unknown.


VAERS ID: 1340597 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-15
Onset:2021-05-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anticoagulant therapy, Aphonia, Blindness, Blood test, Cerebrovascular accident, Computerised tomogram, Magnetic resonance imaging, Paralysis, Thrombosis, Transient ischaemic attack
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Metformin, prilosec, asprin, tramadol, flexril,lipitor
Current Illness: Asthma
Preexisting Conditions: Osetea arthritis, asthma
Allergies: Bees, adhesive,latex,sulfa,codiene,haldol,doxycyclune
Diagnostic Lab Data: Tpa 5-18-21 Ct scans from 5/18/21-5/20/21 Mri 5/19/21 Bloodwork Blood tginners stomach injection
CDC Split Type:

Write-up: I had a brain tia-stroke. Blood clots. Paralyzation.loss of vision. Loss of voice


VAERS ID: 1340859 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-05-10
Onset:2021-05-17
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Computerised tomogram, Computerised tomogram abnormal, 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: The was perform a CT scan and with a result of Non-specifi and possible reactive lymphadenopathy particularly at the left upper jugular chain as discussed above. Palpable adenopathy one week port covid 19 vaccination
CDC Split Type:

Write-up: The patient presented with fever 38.4 since may 20 2021 in the morning. the patient is taking for the fever motrin 200 every 6 hrs for the fever.


VAERS ID: 1340912 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-05-14
Onset:2021-05-17
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back injury, Blood test normal, Computerised tomogram normal, Dizziness, Electrocardiogram normal, Eye movement disorder, Fatigue, Head injury, Loss of consciousness, Mental impairment, Musculoskeletal stiffness, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Complete blood work was done and all parameters were within range. A CT scan was done the same day and it was normal as well. An EKG was also done and no abnormalities were seen as well. He has been referred to Dr. thereafter and we had the first visit with her yesterday 5/21. A holster device has been put on Pt''s chest to record data for 3 days.
CDC Split Type:

Write-up: Pt received first shot of Pfizer vaccine on 5/14 - 12:30 PM EST. On 05/17 around 7:45 AM, Pt passed out/fainted. He woke up few minutes prior to the event and this event started after he passed urine. As soon as he finished Urination, he felt nauseated, dizzy and then lost consciousness thereafter. He fell backwards as a result and hurt his back as well as back side of the head. During his unconsciousness his body was completely stiff and his eyes were rolled back. For few seconds then he became completely still (it felt he was not breathing). I gave him physical stimulus (slight slaps on the face) post which he started reviving. During this time we called 911. I gave him few sips of water forcibly and he started reviving thereafter. on 5/15 and 5/16 (post vaccination on 5/14) he was feeling tired and seemed bit dull. This was unusual as Pt is a competitive soccer player and highly active.


VAERS ID: 1341001 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-04-21
Onset:2021-05-17
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram, Atrioventricular block first degree, C-reactive protein increased, Catheterisation cardiac, Chest pain, Computerised tomogram thorax, Dyspnoea, Echocardiogram abnormal, Ejection fraction, Electrocardiogram QRS complex shortened, Myocarditis, N-terminal prohormone brain natriuretic peptide increased, Nodal arrhythmia, Sinus arrest, Sinus tachycardia, Supraventricular tachycardia, Syncope, Tachycardia, Troponin I increased, Troponin increased
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Disorders of sinus node function (narrow), Conduction defects (narrow), Supraventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: No Medications
Current Illness: None known
Preexisting Conditions: None known
Allergies: NKDA
Diagnostic Lab Data: Troponin I 5/18/21: 4.00ng/mL (peaked at 8.31 5/19/21) NT-proBNP 5/22/21: 5,715pg/mL CRP 5/19/21: 5.16mg/dL ECG 5/18/21: narrow complex tachycardia, probable sinus tachycardia with 1st degree AV block Echo 5/18/21: LVEF 65-70% global hyperdynamic function Cardiac cath 5/18/21: normal
CDC Split Type:

Write-up: Patient without significant past medical history presented 5/18/21 to the ED with sudden shortness of breath, chest pain and syncope. Found to have narrow complex tachycardia with 1st degree heart block with elevated troponin. Patient was admitted 5/18/21 with diagnosis of myopericarditis. Also found to have junctional tachycardia. Workup included CTA of chest negative for PE, echo showed preserved ejection fraction and cardiac cath was negative for CAD. Patient was treated with colchicine with improvement in chest pain and was discharged on 5/21/22. She was readmitted 5/22/21 with near syncopal event with sinus arrest and junctional bradycardia.


VAERS ID: 1341106 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816022 / 1 LA / IM

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

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

Write-up: He fainted 5 minutes after vaccine administration. After he came to on his own, he starting vomiting. Paramedics were called and took him to the emergency room for further evaluation.


VAERS ID: 1341227 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-14
Onset:2021-05-17
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

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

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

Write-up: Itchy uncomfortable rash on chin for 1-2 days about 2-3 days after 1st Pfizer COVID vaccine. 2 pictures available for review Resolved on own without intervention.


VAERS ID: 1341386 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-16
Onset:2021-05-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

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

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

Write-up: Tingling and numbness in arm and shoulder lasting 5 days after injection date


VAERS ID: 1341509 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-05-16
Onset:2021-05-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Skin odour abnormal
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: Fluoxetine Allegra Singular Drospirenone and Ethinyl Estradiol Melatonin Calcium
Current Illness:
Preexisting Conditions: Asthma, seasonal allergies, depression, anxiety
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Change in body odor ever since vaccine. It smells spicy? I don?t know how to describe it


VAERS ID: 1341674 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 0Y2A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose fluctuation, Deep vein thrombosis, Dyspnoea, Laboratory test, Loss of consciousness, Malaise, Seizure, Skin discolouration, Thrombosis, X-ray
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allopurinol - Probenecid-Colchicine - Celecoxib - Tamsulosin HCL
Current Illness: Surgery on knee tendons
Preexisting Conditions: Gout
Allergies: NONE
Diagnostic Lab Data: Tests were done at hospital on May 17, I do not know what kind, blood was drawn, and they found signs of blood clot, alos X-ray were done and completed several tests also I do not know what they were.
CDC Split Type:

Write-up: Could not get air into lungs, made sugar get out of control, had a seizure and turned purple, passing out , ambulance had to come get me from vehicle and take me to emergency room in the hospital, kept me there for about 6 hours then released me to go home, went to my Doctor next day and he immediately sent me to hospital. I was checked for Blood Cloth due to the signs being there along with other tests I am home however I still do not feel well.


VAERS ID: 1341805 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-05-11
Onset:2021-05-17
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / N/A LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Diarrhoea, Mobility decreased, Muscle spasms, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: Severe vomiting, severe diarrhea, weakness, spasms in legs. Could barely get out of bed for 36 hours.


VAERS ID: 1342245 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-15
Onset:2021-05-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Myocarditis
SMQs:, Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: myopericarditis


VAERS ID: 1342270 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-16
Onset:2021-05-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Activated partial thromboplastin time shortened, Alanine aminotransferase increased, Albumin globulin ratio, Aspartate aminotransferase normal, Blood albumin normal, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood calcium normal, Blood glucose normal, C-reactive protein increased, Cough, Fibrin D dimer increased, Full blood count, Immunoglobulin therapy, International normalised ratio increased, Metabolic function test, Multisystem inflammatory syndrome in children, N-terminal prohormone brain natriuretic peptide, Nausea, Ocular hyperaemia, Pain, Procalcitonin, Protein total normal, Prothrombin time prolonged, Pyrexia, Respiratory viral panel, SARS-CoV-2 antibody test positive, SARS-CoV-2 test negative, Serum ferritin increased, Troponin T normal, Vomiting
SMQs:, Liver related investigations, signs and symptoms (narrow), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Toxic-septic shock conditions (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Sepsis (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow), 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: none
Current Illness: none - However had COVID infection a little over a month prior to vaccination (4/8/21)
Preexisting Conditions: none
Allergies: peanut, apricot flavor
Diagnostic Lab Data: COVID PCR 5/22: Negative COVID antibody 5/22: positive CBC: 5/22: 10.49$g13.3/39.2<311, N 79.9, L 15.2 5/23: 10.56$g12.4/36.3<307 N 79.2 L 15.5 CRP: 5/22: 130.6 5/23: 151.5 D-dimer: 5/22: 608 5/23: 466 Procalcitonin: 5/22: 0.14 Ferritin: 5/22: 150 5/23: 169 RVP: 5/22: negative Troponin T 5/22: <0.010 5/23: <0.010 Pro-BNP 5/22: 25 5/23: 44 CMP: 5/22: 138/4.1/101/26/7-0.67/Gluc 108/Ca 9.5/ AG 11/ Alb 4.3/ TP 7.3/ Total Bili 0.7/ ALP 100/ ALT 37/ AST 26 5/23: 139/4.3/101/25/6-0.68/gluc 124/Cac 9.0/AG 13/Alb 3.7/TP 6.9/Total Bili 0.5/ALP 107/ALT 44/AST 32 PT/INR: 5/22: 14/1.2 5/23: 13.6/1.2 PTT: 5/22: 31.7 5/23: 30.7
CDC Split Type:

Write-up: Fever, eye redness, body pain starting 1 day after vaccine cough, nausea, abdominal pain 3 days after vaccine 1 episode of emesis 5 days after vaccine - Admitted to hospital with suspicion of MIS-C - As per ID and Hem/Onc, Started on IVIG and aspirin (5/23/21) - currently still admitted for management of MIS-C


VAERS ID: 1342384 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-13
Onset:2021-05-17
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Injection site pain, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydroxyzine, multi vitamin, albuterol
Current Illness: Covid19
Preexisting Conditions: Exercise induced asthma, seasonal allergies
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Excruciating pain shooting down same arm as injection site. The pain lasted between 8 to 10 hours. Ibuprofen would not help the pain.


VAERS ID: 1342445 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-07
Onset:2021-05-17
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Rash, Rash pruritic
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: Paroxetine, 40 mg, Levothyroxine, 200 mcg, Vitamin D3, 3000 IU/day
Current Illness: none
Preexisting Conditions: none known
Allergies: None known
Diagnostic Lab Data: None yet
CDC Split Type:

Write-up: I began developing an itchy rash on day 10 similar to hives. I still have it and it has increased from a small location to all over my body.


VAERS ID: 1342994 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-05-14
Onset:2021-05-17
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blister, Chills, Erythema, Pain, Pruritus, Pyrexia, Rash, Rash erythematous, Rash pruritic, Urticaria
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations: 1st vaccine, spots on her hands and wrist, has some scars still from them, again 3-4 days after but did not correspond them to t
Other Medications: Lamotrigine, multivitamin, Vitamin D.
Current Illness: None.
Preexisting Conditions: None.
Allergies: Cipro, adhesive and latex.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: She got her vaccine, she did not have any immediate reaction, had fever and chills by the end of the day which lasted a couple of days. On Monday she noticed that her chest was very red, looked like it was sunburned. She felt that was strange and where did it come from. on her hands and wrist she had some very red, itchy and skin colored rash that was starting. Every 4-5 hours it seemed to be getting worse, the chest rash started to separate and had white spots. On Tuesday noticed that it was getting worse and let it go and by Wednesday is was pretty bad, but she felt fine. She then noticed it was spreading down her stomach and going up to her neck. On Thursday she went to the UC and they told her that she should have gone to the ER but was stubborn as she felt fine. She was treated with Benadryl and Pepcid. She chest area is still a little red, but has spread all over her body and has blisters popping up, some on her face and one on her big toe. The rash is better, but still has a stinging itching feeling, but has red welts all over. Some have areas that cluster together and other areas are just blistered.


VAERS ID: 1343117 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Gait disturbance, Hyperhidrosis, Musculoskeletal stiffness, Myalgia, Palpitations, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin, multivitamin
Current Illness: None
Preexisting Conditions: Had covid in November. No taste or smell for 3 months. Now most everything smells or tastes like garbage or chemicals.
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Had fever and muscle pain and stiffness, could barely walk the night of the 17th. Profound fatigue on the 18th. Felt better on the 19th, but that night my heart was racing( pulse was 120) sweating, dizzy, lightheaded. From the 17th until today, having these same issues. Havent seen a doctor yet because I don''t have health insurance.


VAERS ID: 1343125 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-14
Onset:2021-05-17
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood urine present, Urine analysis normal
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Seasonal allergies
Allergies: None
Diagnostic Lab Data: Wednesday 5/19/2021. , urinalysis, Negative for UTI
CDC Split Type:

Write-up: Urinating blood. Took to the doctor on Wednesday 5/19/21, they confirmed that he has blood in his urine, and so far, they don''t know what is causing it. All tests for infection, etc., with his urinalysis came back negative. has never urinated blood in his entire life. We took him in on Friday May 14th to get his 1st COVID shot (Pfizer), less than 3 days later he started peeing blood, and he still is, every single day since.


VAERS ID: 1343128 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-14
Onset:2021-05-17
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Feeling abnormal, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Brain fog for a week long. Heart palpitations and sever Chest pain a week after vaccination. Seem to be getting better now but not totally gone yet


VAERS ID: 1343190 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-12
Onset:2021-05-17
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / -

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

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

Write-up: shingles, still in treatment for it


VAERS ID: 1343253 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-17
Onset:2021-05-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Fatigue, Feeling hot, Hot flush, Loss of consciousness, Nausea
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: Neurologist appointment on June 9th.
CDC Split Type:

Write-up: 5 min after shot. Warming sensation spread from arm across my entire body. Felt nauseous and blacked out. Passed out face first on the floor. No fear of needles. I have records of getting previous flu vaccines without passing out. I have been experiencing hot flashes, nausea and fatigue for 6 days now.


VAERS ID: 1343282 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-04-09
Onset:2021-05-17
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: Visible symptoms diagnosed by virtual doctor on 2021-May-23
CDC Split Type:

Write-up: Developed shingles on right side of chest


VAERS ID: 1343289 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-05-10
Onset:2021-05-17
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Patient presented to ED with rash that started 1 week prior, shortly after receiving 2nd COVID vaccine. Given steroid, pepcid, benadryl and some fluids in ED then discharged on 5 days benadryl + prednisone


VAERS ID: 1343302 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-04-29
Onset:2021-05-17
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Arthralgia, Erythema, Herpes zoster, Hypoaesthesia, Pain, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: tetracycline
Diagnostic Lab Data: None. For the 1st time in my life I have no medical coverage.
CDC Split Type:

Write-up: Within 48 hrs of injection, pain in all major joints on the left side of my body. Appro 2 weeks after injection developed soreness on left side of abdomen, just below my waist. Has now developed into shhingles with painful, itchy welts that are spreading from left of my belly button around toward my back and spine. The region, and especially the welts, are painful to the touch, the skin has shifting areas of numbness, and the welts vary in size - some seem to cluster, others are currently separate. No oozing, primarily redness and acute sensitivity to touch or clothing, with significant itching. No pain, itching, or welts on the right side of my body. No fever.


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