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

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



Case Details (Reverse Sorted by Onset Date)

This is page 148 out of 6,867

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VAERS ID: 1675035 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-08-09
Onset:2021-08-13
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816027 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Blepharospasm, Blood test, Cyanosis, Epistaxis, Erectile dysfunction, Erythema, Haemorrhage, Muscle spasms, Pain in extremity, Peripheral coldness, Skin discolouration, Testicular pain, Urine analysis
SMQs:, Anaphylactic reaction (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Dystonia (broad), Acute central respiratory depression (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Urine Analysis 08/28/2021 Blood drawn waiting for results 09/02/2021
CDC Split Type:

Write-up: Coldness in my left arm, balls were achy for two days, got little red marks on my arms, a little blood when I wiped one time, blood in nose, muscle spasms, pain in fingertips, a twitch in my right eye that comes and goes, can''t get hard, left thumb turned blue for a second, fingers were white when I got out of the shower, back pain.


VAERS ID: 1675076 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac stress test, Cough, Dyspnoea, Echocardiogram, Electrocardiogram, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: No allergies known
Diagnostic Lab Data: I have done: - EKG to rule out heart issue that are known as side effects - Echocardiogram - Stress test - breathing, which showed medium signs of wheezing/constricted airways while breathing out - Covid test - Virus tests - possibly more Results showed no heart issues. Showed difficulty breathing out and restricted airways. I have been put on prescription cough medicine, an inhaler, and allergy medicine. None have helped so far. Further testing with an allergist, sleep specialists, and ENT are recommended due to the medicine not helping
CDC Split Type:

Write-up: The morning after I received my vaccine I had the following symptoms which have not gone away till today: - Slight shortness of breath - Inability to complete a full deep breath in - Coughing - Coughing while sleeping


VAERS ID: 1675188 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

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

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

Write-up: On 8/13/2021 patient was vaccinated with 1st dose Pfizer vaccine . On 9/5/2021 patient came with her parents for the second dose and upon checking in at registration patient was identified to be under age and second dose was not administered


VAERS ID: 1675371 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amenorrhoea, Hormone level abnormal, Muscle spasms, Nausea
SMQs:, Acute pancreatitis (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Fertility disorders (broad)

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

Write-up: Prolonged and chronic nausea. Hormonal changes. Cramping, lack of period


VAERS ID: 1675579 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-11
Onset:2021-08-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Colitis ulcerative, Condition aggravated
SMQs:, Gastrointestinal ulceration (narrow), Ischaemic colitis (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LDN 4.5mg
Current Illness: None
Preexisting Conditions: Ulcerative colitis
Allergies: None
Diagnostic Lab Data: Bloody diarrhea
CDC Split Type:

Write-up: Severe flare up of ulcerative colitis


VAERS ID: 1675642 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FO8448 / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Injection site erythema, Injection site swelling, Intermenstrual bleeding
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prescribed medication: birth control Greenstone Brand - a generic for Taytulla. Over the counter medications: melatonin, Vitamin D, Zinc, and a multi-vitamin.
Current Illness: None
Preexisting Conditions: None
Allergies: Allergy to oral minocycline treatment for acne.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Moderate to severe headache, chills, and fatigue every day for 9 days for which I took acetaminophen at least once daily. Irregular non-period related bleeding the day after the vaccine. Redness and swelling at the injection site for about 3 days beginning August 14th.


VAERS ID: 1677137 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Blood pressure measurement, Chest pain, Lipids normal, Musculoskeletal pain, Neck pain
SMQs:, Rhabdomyolysis/myopathy (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Blood pressure; Cholesterol
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210818; Test Name: Blood pressure; Result Unstructured Data: good; Test Date: 20210818; Test Name: Cholestrol; Result Unstructured Data: good
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: musculoskeletal pain; Chest Pains; Neck Pain; This spontaneous case was reported by a consumer and describes the occurrence of CHEST PAIN (Chest Pains), NECK PAIN (Neck Pain) and MUSCULOSKELETAL PAIN (musculoskeletal pain) in a 39-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 005C21A) for COVID-19 vaccination. Concurrent medical conditions included Blood pressure and Cholesterol. On 12-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 13-Aug-2021, the patient experienced CHEST PAIN (Chest Pains) and NECK PAIN (Neck Pain). On an unknown date, the patient experienced MUSCULOSKELETAL PAIN (musculoskeletal pain). The patient was treated with IBUPROFEN ongoing since an unknown date for Adverse event, at an unspecified dose and frequency. At the time of the report, CHEST PAIN (Chest Pains) had not resolved, NECK PAIN (Neck Pain) had resolved and MUSCULOSKELETAL PAIN (musculoskeletal pain) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 18-Aug-2021, Blood pressure measurement: normal (normal) good. On 18-Aug-2021, Lipids normal: normal (normal) good. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medication was provided. On 13-Aug-2021, the patient started getting neck and chest pains. the patient went to the local ED (emergency department), where they diagnosed with musculoskeletal pain. The patient was advised everything was normal by ED team and was discharged the same day without prolong hospitalization. The patient had also been advised by HCP to take ibuprofen and monitor the symptoms. The patient states that neck pain went away couple of days ago, but chest pain was still ongoing. The patient took blood pressure and cholesterol medications (unspecified).


VAERS ID: 1677250 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039C21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Exposure during pregnancy
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Received the vaccine being pregnant; This spontaneous prospective pregnancy case was reported by a consumer and describes the occurrence of EXPOSURE DURING PREGNANCY in a 25-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 039C21A) for COVID-19 vaccination. No Medical History information was reported. On 13-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. The patient''s last menstrual period was on 17-Feb-2021 and the estimated date of delivery was 24-Nov-2021. On 13-Aug-2021, the patient experienced EXPOSURE DURING PREGNANCY. The patient received mRNA-1273 (Moderna COVID-19 Vaccine) beginning around the twenty-fifth week of the pregnancy. On 13-Aug-2021, EXPOSURE DURING PREGNANCY (Received the vaccine being pregnant) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Concomitant product use was not provided by the reporter. Treatment information was not provided by the reporter. This is a case of product exposure during pregnancy with no associated AEs for this 25-year-old female. Further information has been requested.


VAERS ID: 1677424 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Headache, Malaise, Myalgia, Nausea, Pain, Pain in extremity, Vaccination site swelling, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101052082

Write-up: Headache; Nauseous; arm pain; he felt his whole body hurting; Muscle pain; Chills; Injection site swelling; not feeling well; he felt like he could vomit; This is a spontaneous report from a contactable consumer or other non-healthcare professional reported for male patient (reporter son). A male patient of an unspecified age received bnt162b2 (BNT162B2, PFIZER-BIONTECH COVID-19 VACCINE, Solution for Injection,), via an unspecified route of administration on 13Aug2021 (Batch/Lot Number: FC3181) as DOSE NUMBER UNKNOWN, SINGLE for covid-19 immunization. The patient medical history and concomitant medications were not reported. On 13Aug2021, the patient experienced headache, nauseous, arm pain, he felt his whole body hurting, chills, muscle pain, injection site swelling, not feeling well and he felt like he could vomit. The reporter was calling to report side effect for son. It was reported that he got his Pfizer Covid-19 Vaccine shot yesterday morning and by evening he felt he had a worse headache he ever had, he felt nauseous, he felt his whole body hurting, he had headache, muscle pain, chills, chills were really bad. The reporter did not know about his fever and did not check his fever and injection site swelling and then he also had nausea, not feeling well and he felt like he could vomit but he did not and arm pain. The reporter gave him two Tylenol last night and gave him two more today. Reporter was unwilling to provide further information. Limited information was available over the call. The clinical outcome of the events was unknown. No Follow-up attempts are possible. No further information is expected.


VAERS ID: 1678685 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-18
Onset:2021-08-13
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, COVID-19, Fall, Illness, SARS-CoV-2 test positive
SMQs:, Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient is fully vaccinated. Hospitalized due to COVID-19. Patient fell on 8/11/2021 due to weakness and was seen in the ER where he was tested positive by PCR. States he has since been hospitalized on 8/16/2021 and was discharged. He is still pretty weak and has not fully recovered from the illness.


VAERS ID: 1679041 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Abdominal pain upper, Axillary mass, Axillary pain, Diarrhoea, Headache, Injection site erythema, Injection site mass, Injection site pain, Injection site pruritus, Injection site swelling, Tenderness
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Demerol= violent vomiting HCTZ= lowers my white blood cells Bactrim= itchy rash Sulfa products= itchy rash
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Day 1: Headache and diarrhea. Day 2; Normal Day 3: Normal Day 4: Tenderness in underarm Day 5: Found lump in armpit- very sore under arm Day 6: Same Day 7: Same Day 8: Terrible pains in my stomach (like childbirth). More diarrhea. Also, injection site is hugely swollen, big red itchy, achy lump. Day 13: Swellings going away.


VAERS ID: 1679149 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059EZ1A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Cardiac discomfort, Chest pain, Dizziness, Feeling abnormal, Injection site pain, Joint stiffness, Mood altered, Musculoskeletal chest pain, Oral discomfort, Pain in extremity, Paraesthesia, Sleep disorder
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (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: none
Current Illness: none
Preexisting Conditions: none
Allergies: penicillin, peppers, latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Day 1 Joint pain in hands, wrists, knees my ribs hurt especially the right rib, heart rate pulsing sensation in the morning in the middle of my chest , left arm soreness at injection , light headed-floating Day 2 left calf throbbing, like electricity night ad morning continues both legs pins and needles, ligtning Day 7 both legs pins and needles, lightning also felt like the flesh was being torn from my upper thigh on the right chest pain, moody, joint stiffness and soreness Day 1-25 lack of sleep only slept one night longer than 6 hours due to weird health issues listed above tried tylenol aand/or advil a few times Day 15 lower lip burning ( i thought maybe poison ivy would happen but just a pain, then finger tips heated and tender pulses in lower legs continue, left eye tender Day 25 Injection site pain came back left arm new tingling at he top of my head-scalp


VAERS ID: 1679314 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-02
Onset:2021-08-13
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821281 / UNK LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Tinnitus
SMQs:, Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin B complex, Magnesium, Fish Oil, Wobenzym N
Current Illness: None
Preexisting Conditions: Back pain
Allergies: Mangos
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Constant strong ringing in right ear. Occasional ringing in left ear.


VAERS ID: 1681466 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Colorado  
Vaccinated:0000-00-00
Onset:2021-08-13
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Discomfort, Peripheral swelling, Thrombosis, Ultrasound scan
SMQs:, Cardiac failure (broad), Angioedema (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Alcohol use (patient drinks occasionally); Non-smoker
Preexisting Conditions: Comments: No known allergies
Allergies:
Diagnostic Lab Data: Test Date: 20210903; Test Name: Diagnostic ultrasound; Result Unstructured Data: Confirmed blood clot
CDC Split Type: USJNJFOC20210908108

Write-up: BLOOD CLOT; RIGHT LEG TO THE KNEE WAS SWOLLEN, ELEVATING IT AND ICING AND THE SWELLING HAD GONE DOWN BUT HASN''T GONE AWAY; DISCOMFORT; This spontaneous report received from a patient concerned an 81 year old male of unknown race and ethnicity. The patient''s height, and weight were not reported. The patient was non-smoker, and alcohol use (drinks occasionally), the patient had no known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 205A21A, and expiry: UNKNOWN) dose was not reported, 1 total, administered on 06-AUG-2021 on Left Arm for prophylactic vaccination. No concomitant medications were reported. On 13-AUG-2021, 7-10 days after vaccination patient''s right leg to the knee was swollen noticeably. He has been elevating it and icing and the swelling had gone down but hasn''t gone away. On same day, the patient experienced discomfort. On Wednesday, 01-SEP-2021, he attempted to go to urgent care but they could not help him so he went to the emergency room (ER) on 03-SEP-2021, and was diagnosed with blood clot. In the emergency room (ER), they did an ultrasound to confirm. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the blood clot, discomfort and right leg to the knee was swollen, elevating it and icing and the swelling had gone down but hasn''t gone away was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0: 20210908108-COVID-19 VACCINE AD26.COV2.S-blood clot. 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: 1681606 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: chest pain; chest pressure; very sore arm; This spontaneous case was reported by a consumer and describes the occurrence of CHEST PAIN (chest pain), CHEST DISCOMFORT (chest pressure) and PAIN IN EXTREMITY (very sore arm) in a 39-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 13-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 13-Aug-2021, the patient experienced CHEST PAIN (chest pain), CHEST DISCOMFORT (chest pressure) and PAIN IN EXTREMITY (very sore arm). On 15-Aug-2021, CHEST PAIN (chest pain), CHEST DISCOMFORT (chest pressure) and PAIN IN EXTREMITY (very sore arm) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant product use was not provided by the reporter. The patient experienced sore arm, chest pain, and chest pressure four hours after the first dose, chest pain and pressure never lasted more than a minute and continued to happen off and on that weekend. The symptoms resolved after Sunday,15-Aug-2021. She did not take any treatment to help with the symptoms.


VAERS ID: 1681785 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC318O / 1 - / -

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? 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: USPFIZER INC202101064287

Write-up: Little rash on my ankle; Have a rash on both ankles and on my legs and on my back; This is a spontaneous report from a contactable consumer (patient). A patient of an unspecified age and gender received first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE, formulation: solution for injection, Batch/Lot number: FC318O, expiration date not provided) via an unknown route of administration, administered on 12Aug2021 as DOSE 1, SINGLE for covid-19 immunisation. The patient''s medical history and concomitant medication was not provided. On 13Aug2021, the patient experienced a little rash on ankle and then had a rash on both ankles, legs and on back. The patient wanted to know what could take to reduce it. The patient did not receive any treatment for the events. The outcome of the event was unknown. No follow-up attempts are needed. No further information is expected.


VAERS ID: 1681992 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-01
Onset:2021-08-13
   Days after vaccination:193
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210815; Test Name: Covid-19; Test Result: Positive
CDC Split Type: USPFIZER INC202101111918

Write-up: My sister-in-law, who had been vacinated with both doses of the Pfizer vaccine in the Feb / Mar timeframe, contracted COVID-19, confirmed by a positive test, and required infusion therapy. She is rec; My sister-in-law, who had been vacinated with both doses of the Pfizer vaccine in the Feb / Mar timeframe, contracted COVID-19, confirmed by a positive test, and required infusion therapy. She is rec; This is a spontaneous report from a contactable consumer. This consumer reported for 64-year-old female patient (sister-in law). A 64-year-old female non-pregnant patient received second dose of dose bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, solution for injection, Batch/Lot number: Not provided) via intramuscular route of administration on Mar2021 as dose 2, single and received first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, solution for injection, Batch/Lot number: Not provided) via intramuscular route of administration on Feb2021 as dose 1, single for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The patient previously took steroids. It was unknown If patient receive any other vaccine in four weeks and other medications that patient receives in two weeks. Patient did not have COVID prior vaccination, and it was yes Covid tested after post vaccination. The patient concomitant medications were not reported. known allergies I do not believe so. On 13Aug2021, it was reported that my sister-in-law, who had been vaccinated with both doses of the Pfizer vaccine in the Feb / Mar timeframe, contracted COVID-19, confirmed by a positive test, and required infusion therapy. She was recovering. The patient underwent lab tests and procedures which included sars-cov-2 antibody test: positive on 15Aug2021. Therapeutic measures were taken for the events. Patient visits the physician office for the events. Outcome of events was recovering. Information on the lot/batch number has been requested.


VAERS ID: 1682450 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-03-02
Onset:2021-08-13
   Days after vaccination:164
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: melatonin, lorazapam, spironolactone, amlodipine, silodosin, c
Current Illness: none
Preexisting Conditions: hypertension, BPH, hypercholesterolemia
Allergies: IV iodine, quinolones, NSAIDS
Diagnostic Lab Data: MRI about 08/16/2021
CDC Split Type:

Write-up: Numbness in left arm and leg increasing over several hours Additional medications not fitting in #9: Crestor, famotidine latanaprost eye drops, dorzolamide HCl/timolol maleate eye drops


VAERS ID: 1682948 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anger, Frustration tolerance decreased, Product preparation issue
SMQs:, Hostility/aggression (narrow), 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: The Pfizer Covid-19 vaccine was diluted incorrectly. 2.0 mL was used instead of 1.8 mL. We were notified by the nurse who administered in 8/16/21. We called Pfizer before calling the patients to see what they recommended. They said they did not recommend giving the dose and that the CDC says that the dose should not be reported. Our Medical Director called the patient on 9/7/21 and reported the following: Advised her of the vaccine error around the CoVID shot. 2mL of saline used for diultion vs. 1.8mL. Explained what that meant in terms of "extra salt water" being given. Advised it was not a matter for an unknown substance being given. Patient expressed concern and being upset. "I don''t understand how this happened." "You''re injecting people with things, how could you do this." I apologized for the mistake and assured her that we were taking actions to correct our process in the future. She expressed frustration that she is only finding out about the error now. I again apologized. She stated that the error made her not want to get the second dose. I strongly advised that she get the second dose. I explained that I''ve known her for several years and her kids. I would want her and the kids to be as protected as possible. I advised that she does NOT have to receive the second dose here and I could understand if she makes that decision, but I advised strongly that she consider getting it elsewhere. I also advised that we spoke with Pfizer and based on their recommendations and the CDC, they would not recommend that she needs any extra dosing and to just complete the second dose as previously planned. Patient again expressed being upset at the error and at the delay in notification. I again apologized and offered to help her in any way I could or answer any further questions. She denied any and the conversation ended.


VAERS ID: 1682961 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, Underdose
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: The patient received a dose that was diluted with 2.0mL dilutant instead of 1.8mL. We were notified by the nurse who administered it on 8/16/2021. We first called Pfizer to see what their recommended actions were. They recommended not administering the dose and said the CDC recommends not repeating the dose. Our Medical Director spoke to the patient''s mother on 9/7/21 which is also when the child received their second dose of the Pfizer Covid-19 vaccine. She reported: Spoke with mother Provided more detail of the error She is frustrated because this is the second vaccine error that occured for this child in 2 months Was given an expired vaccine in June I apologized and advised that we are working hard to identify system errors and correct them. I advised that we will be retraining everyone on vaccines She stated that her husband wants to pull kids out of the office. She wants to keep them here as she likes the doctors but is frustrated on the mistakes. I advised that I share in her frustration and again apologize. We discussed that we checked with Pfizer and the CDC and no further action is needed at this time. She is requesting that from now on, I visually oversee all vaccine administration for her family


VAERS ID: 1683031 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-02-12
Onset:2021-08-13
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9263 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Condition aggravated, Migraine
SMQs:

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: Symbicort BID, Claritin SID, Tylenol as needed.
Current Illness: None
Preexisting Conditions: Asthma - diagnosed July 2020 after chronic bronchitis caused by unknown upper respiratory infection in January of 2020. Anemia - lifelong
Allergies: Allergic to doxycycline, sulfa based drugs, Pseudocholinesterase deficiency syndrome leads to anesthesia concerns.
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: I have been getting intermittent migraines (I have tracking data of dates, severity, and possible triggers) for over a year. During this specific incident, the pain was in a different location, and didn''t respond to any of my usual tricks to get it to clear. I tried to resolve on my own at home for about 4 days before seeking medical care. It took me an additional week to actually be able to get medical care. With help from a pharmacist I was able to get it manageable and saw my doctor for a new migraine prescription on August 26th. I have had intermittent headaches since then.


VAERS ID: 1683089 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain in extremity, Product administered to patient of inappropriate age
SMQs:, Tendinopathies and ligament disorders (broad), 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: was vaccine for his age group, pain down arm all the way to his hand


VAERS ID: 1683243 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025A21A / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram head, Headache
SMQs:

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

Write-up: Patient began having severe headaches the day after the immunization and has had persistent headaches since then.


VAERS ID: 1683348 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-09
Onset:2021-08-13
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angina pectoris, Chest pain, Pain
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Other ischaemic heart disease (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: Vitamin C, B, Glucosamine, Omega 3
Current Illness: None
Preexisting Conditions: Genetically confirmed mild case of Hereditary Hemorrhagic Telangiectasia
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Four days after the first dose, she started feeling a pinch or prick type of pain in her heart/chest area that radiated out and slowly dissipated. It would last a few minutes and happen without a specific interval several times a day for about four days. After that, it didn?t happen again. We wanted to go to urgent care, but at the end didn?t go.


VAERS ID: 1683718 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-14
Onset:2021-08-13
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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: None occasionally Tylenol PM
Current Illness: None
Preexisting Conditions: - back pain
Allergies: Have seasonal allergies
Diagnostic Lab Data: I visited dermatologist, she gave me cream to use but didn?t seem to help, I visited my doctor he stated it was allergic reaction to something I ate, I didn?t change my diet nor did I eat anything different or changed anything since vaccine, he gave me a shot and a 6 day medication which seemed to help, slowly the rash is going away but I have marks on my legs and dark spots hoping it will go away
CDC Split Type:

Write-up: After 1 st shot my arm was red and hot but then went away, after 2nd shot had something and it went away, 2 or so weeks ago I got this itchy weird rash, on my arms feet, legs and one on my shoulder, it was a rash I never experienced, it was patchy, itchy, had bubbles, looked almost like poison ivy but different


VAERS ID: 1683746 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-20
Onset:2021-08-13
   Days after vaccination:115
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Palpitations, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101152759

Write-up: Woke up with blurred vision; Felt heart racing; This is a spontaneous report from a contactable consumer, the patient. A 59-year-old non-pregnant female patient received second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the right arm on 20Apr2021 at 10:00 (at the age of 59-years-old) as a single dose for COVID-19 immunisation. The patient had no medical history. The patient had no known allergies. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the COVID vaccine. The patient did not receive any concomitant medications. The patient previously received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration on an unknown date as a single dose for COVID-19 immunisation. On an unknown date in 2021, the patient felt that her heart was racing for 3 weeks after the vaccine. Recently on 13Aug2021, the patient woke up with blurred vision and looked up if this could be a side effect, and it was. The patient also reported that it had been 3 weeks and her eyesight was still blurred which happened over night. The events did not result in doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care. Since the vaccination, the patient had not been tested for COVID-19. Therapeutic measures were not taken as a result of the events. The clinical outcome of the events felt heart racing and woke up with blurred vision was not recovered at the time of this report. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.


VAERS ID: 1684120 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Headache, Hypoaesthesia, Injection site erythema, Injection site nodule, Metabolic function test, Nausea, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

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

Write-up: The following day after receiving my first vaccination my right arm had numbness and tingling down to my fingertips, redness at injection site, and a nodule the size have a golf ball. On the second day after receiving vaccine I continued to have the numbness and tingling down my arm, the redness had spread to over half of my right arm, and I started to have headaches and nausea for the next two weeks.


VAERS ID: 1684491 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-08-08
Onset:2021-08-13
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Site: Itching at Injection Site-Mild, Site: Redness at Injection Site-Mild, Site: Swelling at Injection Site-Mild, Systemic: Allergic: Rash Generalized-Mild, Systemic: pityriasis rosea (per MD diagnosis)-Mild, Additional Details: Patient saw prescriber and was told to report adverse reaction as pityriasis rosea to the pharmacy who administered.


VAERS ID: 1684736 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-08-11
Onset:2021-08-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Muscle twitching, Muscular weakness, Musculoskeletal stiffness, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Singulair, baclofen, vitamin d, fish oil, cod liver oil, magnesium, iron, loratadine
Current Illness: None
Preexisting Conditions: MS
Allergies: Seasonal
Diagnostic Lab Data:
CDC Split Type:

Write-up: A couple of days after getting injection, I started to get weakness and stiffness in the arm of the injection site, my thumb is twitching and pain in my forearm


VAERS ID: 1684804 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reports left armpit area swelled up for a day after to the size of a golfball. He took some iburprofen and that helped. no difficulty breathing, pain, or redness. Reports mother had same reaction


VAERS ID: 1684869 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-08-09
Onset:2021-08-13
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Back pain, Chest pain, Headache
SMQs:, Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril 40mg/d, HCTZ 50mg/d, Amlodipine 10mg/d, Novolin 70/30 16u bid, Metformin 1000mg bid
Current Illness: N/A
Preexisting Conditions: DM2, hyperlipidemia, HTN, depression
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: 4 days following the first dose (8/13), pt started with mild headache and chest pain that radiated to her back. This pain lasted the entire month, and when she got her second dose on 8/30, she had worsening back pain that radiated down to her right hip and down to her right knee. Pt feels inflamed.


VAERS ID: 1684901 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-19
Onset:2021-08-13
   Days after vaccination:206
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Malaise, Metabolic acidosis, Pancytopenia, Pollakiuria, Pyrexia, SARS-CoV-2 test positive, Urinary hesitation, Viral sepsis
SMQs:, Agranulocytosis (narrow), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Chronic kidney disease (broad), Myelodysplastic syndrome (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen, albuterol, ibuprofen, lisinopril-HCTZ
Current Illness:
Preexisting Conditions: HTN, history of mitral valve prolapse, asthma, obese (BMI 37)
Allergies: Chocolate
Diagnostic Lab Data: Coronavirus 2019 PCR deteted 8/13/21
CDC Split Type:

Write-up: 8/13/21: Patient is a 46-year-old female presenting to emergency room today for further evaluation of urinary frequency, hesitancy, malaise and fever that started 3 days ago. She reports she is fully vaccinated for COVID-19 denies any sick contacts however she does work at skilled nursing facility as a CNA. Diagnosed with viral sepsis, COVID-19, metabolic acidosis, pancytopenia secondary to COVID-19 8/16/21: Patient discharged Home. Note: Received first dose of Pfizer vaccine on 12/30/2020 and second dose on 1/19/2021.


VAERS ID: 1684920 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-01-08
Onset:2021-08-13
   Days after vaccination:217
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 08/13/2021 PCR+ COVID-19 test
CDC Split Type:

Write-up: Breakthrough COVID-19 case


VAERS ID: 1684944 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-05-13
Onset:2021-08-13
   Days after vaccination:92
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 08/13/2021 PCR+ COVID-19 test at Hospital
CDC Split Type:

Write-up: Breakthrough COVID-19 case


VAERS ID: 1684956 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-02-09
Onset:2021-08-13
   Days after vaccination:185
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 08/13/2021 PCR+ COVID-19 test
CDC Split Type:

Write-up: Breakthrough COVID-19 case


VAERS ID: 1684970 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-09
Onset:2021-08-13
   Days after vaccination:185
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 08/13/2021 PCR+ COVID-19 Test.
CDC Split Type:

Write-up: Breakthrough COVID-19 Case


VAERS ID: 1684988 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-23
Onset:2021-08-13
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 08/13/2021 PCR+ COVID-19 test at Medical Center
CDC Split Type:

Write-up: Breakthrough COVID-19 Case


VAERS ID: 1685004 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-04-28
Onset:2021-08-13
   Days after vaccination:107
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 08/13/2021 PCR+ COVID-19 test.
CDC Split Type:

Write-up: Breakthrough COVID-19 Case


VAERS ID: 1685022 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-02-11
Onset:2021-08-13
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 08/13/2021 PCR+ COVID-19 case
CDC Split Type:

Write-up: Breakthrough COVID-19 case


VAERS ID: 1685616 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: centrium - multivitamins, effexorxr -150 milligram, gabapentin 300milligrams, amlodipine , metoprolol tartrate and protonix - 40 milligram
Current Illness: no
Preexisting Conditions: high bp, cholesterol, trigyientre, depression and back problems and disabled because of the backpain gurd. restless leg symdrome
Allergies: iodine and morphine
Diagnostic Lab Data: no
CDC Split Type: vsafe

Write-up: the next day in the am headache and nausea , diareahhe ,on the 14aug on migraine meds. every day after you had headaches. Headache did not go away. Everything ended 2 days later except the headache


VAERS ID: 1686011 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-11
Onset:2021-08-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Paraesthesia, Pruritus
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Rybelsus , glipizide , levothyroxine
Current Illness: Non
Preexisting Conditions: Diabetic
Allergies: None
Diagnostic Lab Data: Doctor office visit 9-9-21 . Reccomended I go to a neurologist . put me on prednisone for a 7 days to see if that helps
CDC Split Type:

Write-up: Tingling, numbness and itching sensation in left arm and hand and left leg and foot


VAERS ID: 1686444 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-08-01
Onset:2021-08-13
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (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: vibriyd, wellbutrin
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: chest pain that I never felt before. felt short of breath and it lingers almost daily for short periods when I am just sitting or driving the car. I just got the second dose and am feeling chest pain in the heart 7 hours after receiving the shot.


VAERS ID: 1686745 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-01
Onset:2021-08-13
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Chronic kidney disease (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Hospitalized for Pericarditis September 2019. Reoccurring mild symptoms.
Preexisting Conditions: Reoccurring pericarditis. Heart palpitations.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pericarditis symptoms. Relieved when patient took colchicine which is standard treatment patient was receiving for previous instance of pericarditis.


VAERS ID: 1554341 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

Write-up: Pain in left arm, general muscle pain, severe pain in right leg for 24h. Fever.


VAERS ID: 1555604 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-08-01
Onset:2021-08-13
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Diarrhoea, Headache, Injection site swelling, Lymphadenopathy, Myalgia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Vomit, diarrhea, shiver, headache, swelling of the injection site, lymph nodes, muscle pain.


VAERS ID: 1574244 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD7206 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Dizziness, Gaze palsy, Mobility decreased, Pain in extremity, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Sore arm on the first day. I couldn?t even raise it und use my arm properly during 2 days. On the second day I experienced headache, fever, dizziness, cough, breakdown.


VAERS ID: 1575614 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-16
Onset:2021-08-13
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA9099 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bell's palsy, Blood test, Computerised tomogram head, Facial paralysis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)

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

Write-up: Partial face paralysis, diagnosed as Bell?s Palsy. Treated by Prednisone and Valacyclovir.


VAERS ID: 1588736 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-08-12
Onset:2021-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052C21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Feeling abnormal, Feeling cold, Hyperhidrosis, Lethargy, Pain, Pyrexia, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none healthy
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe shaking at night and cold to touch. Full body aches for full week so far, cough, aches, shooting pains, lethargic, foggy, fever for 4 days, and sweats.


VAERS ID: 1632257 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-08-11
Onset:2021-08-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 057D21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Muscle twitching, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Dyskinesia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (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: Sodium ascorbate Probiotics
Current Illness: Hyperacidity
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Lower legs and lower arms weakness Dizziness Muscle twitches Shooting pain all over the body 2 weeks as of today.


VAERS ID: 1636821 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-08-06
Onset:2021-08-13
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre 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: Continuous tingling in both legs, thighs and hands. No treatment taken yet. Adverse event still persists.


VAERS ID: 1642411 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: GBPFIZER INC202101049289

Write-up: Muscle soreness; This is a solicited report from the regulatory authority program from a contactable consumer, downloaded from the regulatory authority, Regulatory authority report number GB-MHRA-YCVM-202108141334529910-NCTMW, Safety Report Unique Identifier GB-MHRA-ADR 25800416. A 17-year-old non-pregnant female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 via an unspecified route of administration on 13Aug2021 (Lot number was not reported) (at the age of 17-year-old) as single dose for COVID-19 vaccination. The patient''s medical history and concomitant medications were not reported. Patient has not had symptoms associated with COVID-19. Not had a COVID-19 test. Patient is not pregnant. Patient is not currently breastfeeding. Also reported a menstrual period date 15Jul2021. On 13Aug2021, the patient experienced muscle soreness. The report was considered as serious due to Other medically important condition by the regulatory authority. The outcome of the event was recovering. Patient is not enrolled in clinical trial. The reporter''s assessment of the causal relationship of the event with the suspect product was not provided at the time of this report. Since no determination has been received, the case is managed based on the company causality assessment. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Sender''s Comments: Based on temporal association, a causal relationship between the event muscle soreness and BNT162B2 cannot be excluded. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.


VAERS ID: 1654549 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, Pain in extremity, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad), 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: GBPFIZER INC202101049378

Write-up: Vomiting; Painful arm; bnt162b2 on 15Jun2021 as first dose/on 13Aug2021 as second dose; This is a spontaneous report from a contactable consumer received from the regulatory authority. The regulatory authority report number is GB-MHRA-WEBCOVID-202108140644026360-ZP06Y, Safety Report Unique Identifier GB-MHRA-ADR 25798509. An 18-year-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection), via an unspecified route of administration on 13Aug2021 (Lot number was not reported) at the age of 18 years old, as second dose, single for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. Patient has not had symptoms associated with COVID-19 and not had a COVID-19 test. Patient has not tested positive for COVID-19 since having the vaccine. Patient is not enrolled in clinical trial. The patient previously took bnt162b2 (Lot number: not reported), on 15Jun2021 as first dose, single for covid-19 immunisation. On 14Aug2021, the patient experienced vomiting and painful arm. Outcome of the events vomiting and painful arm was not recovered No follow-up attempts are possible, Information about Batch/Lot Number cannot be obtained. No further information is expected.


VAERS ID: 1674992 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-08-13
Onset:2021-08-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue
SMQs:

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

Write-up: Fatigue that last and still having from the day vaccinated up to now


VAERS ID: 1548783 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-11
Onset:2021-08-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Hypoaesthesia, Pain in extremity, Sleep disorder
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Benadryl, sertraline, vitamin C, vitamin B complex, Zinc, multivitamin, vitamin D3
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None yet
CDC Split Type:

Write-up: Severe arm pain- woke me from sleeping several times throughout the night. Numbness in left side of body, especially in face -noticed the morning following the vaccine


VAERS ID: 1548961 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-08-11
Onset:2021-08-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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: unknown
Current Illness: Unknown
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: patient woke up experiencing fever 100.6, chest pain, and shortness of breath. Told patient to seek doctor consultation through family md or emergency room.


VAERS ID: 1549026 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-08-11
Onset:2021-08-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / IM

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

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

Write-up: Patient was administered the 2nd dose of their vaccine series 14 days after the first dose, instead of 21 days


VAERS ID: 1549039 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-31
Onset:2021-08-12
   Days after vaccination:134
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / UNK - / -

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

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

Write-up: Hospitalized for COVID 19 post vaccination.


VAERS ID: 1549108 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was given J&J on 8-10-21 and when Shots was pulled up to enter information it was discovered that she had already recived (2) doses of Moderna in Jan & Feb of this year. I asked her if the profile I showed her on shots was correct and she admitted that yes she had received the Moderna already. I called her on 8-11-21 to ask how she was feeling and she stated she was not having any side effects. She again apologized for not being forthcoming the previous day and admitted she was wrong for doing this.


VAERS ID: 1549117 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-03
Onset:2021-08-12
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 04C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus, 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: None reported/in patient file
Current Illness: None reported
Preexisting Conditions: None reported
Allergies: none reported on the administration form she filled out, cyclobenzaprine in her patient file
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pt developed redness, swelling, and itchiness at the injection site 9 days post vaccination. Pt was advised to do ibuprofen/acetaminophen, cold compress, and Benadryl if needed. Also to go to urgent care/call doctor if symptoms spread. Today was day 1 of symptoms.


VAERS ID: 1549120 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Blood glucose normal, Dizziness, Hyperhidrosis, Loss of consciousness
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), Vestibular disorders (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient stated he had 6-7 drinks last night. Came in today on empty stomach. Sated has no long-term health care problems. Asked him if he ever had an adverse event following a vaccine and stated he did not. Pt has no allergies.
Current Illness: Pt stated in good health
Preexisting Conditions: None stated
Allergies: No known allergies
Diagnostic Lab Data: EMS took O2 level, blood sugar level,heart rate and blood pressure, all of which were normal. Police officer stated the combination of alcohol from previous night, empty stomach and anxiety over shot caused him to pass out.
CDC Split Type:

Write-up: Patient became sweaty and felt dizzy. Got patient water and they remained seated. While seated patient "passed out" for a few seconds. He never had swelling of face or tongue and did not have trouble breathing. Pharmacist and store manager remained with patient until EMS took over. EMS put patient on stretcher and took him to hospital. Local police officers also responded after 911 call was made.


VAERS ID: 1549126 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 1 RA / IM

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

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

Write-up: Patient underage for this vaccine according to EUA. No adverse outcomes/reactions noted. No extra monitoring required. Moderna (manufacturer) was contacted. We were given the advice that the patient may receive a 2nd dose of Moderna vaccine after 28 days if the provider chooses, although such use is still technically off-label and we need to acknowledge that fact.


VAERS ID: 1549147 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Electrocardiogram, Eye movement disorder, Head injury, Hyperhidrosis, Loss of consciousness, Moaning, Motor dysfunction, Mydriasis, Pallor, Seizure like phenomena, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Ocular motility disorders (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: None known
Current Illness: None known
Preexisting Conditions: None known
Allergies: None known
Diagnostic Lab Data: EMT tests (ecg, bp, etc.)
CDC Split Type:

Write-up: Pt presented to pharmacy for his shot appointment (as required by his employer). Less than one minute post injection, patient turned to leave store and collapsed. He basically leaned right as right side of head impacted wall. As he was falling, he rotated a bit and the back of his head hit lower wall - actually damaging the sheetrock. Patient had lost control of all motor functions, became unconscious as his eyes dilated and rolled back in his head, and he was moaning. Looked very much like an epileptic event. 911 was called while patient was unconscious. Approximately 1 minute later patient recovered enough to be oriented x3, unaware of what had happened. He was then able to sit up, but pale and sweaty even though building is cool. Fire and EMT arrived on scene in less than 5 minutes from call and proceeded to evaluate patient according to their protocols. Pt declined several offers to go to hospital or clinic. Post evaluation Pt was provided cold water at their suggestion.


VAERS ID: 1549150 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Maryland  
Vaccinated:2020-08-12
Onset:2021-08-12
   Days after vaccination:365
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysphagia, Dyspnoea, Headache, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

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

Write-up: Patient started to develop nausea and a headache about 10 minutes after vaccination. About 15-20 minutes after vaccination, she complained of shortness of breath and difficulty swallowing. 0.3mg epi administer and patient sent to the hospital.


VAERS ID: 1549163 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Flushing, Paraesthesia, Pruritus, Throat irritation
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 20-25 MIN AFTER VACCINE GIVEN, CLIENT BEGAN TO FEEL FLUSHED, BODY TINGLING, ITCHY, AND THROAT "TICKLING". VITALS WERE MONITORED FOR 30 MIN AND BENEDRYL GIVEN AT 11:22 AM. CLIENT BEGAN TO FEEL BETTER AND LEFT THE HEALTH DEPT AT 1145 WITH DAUGHTER. CLIENT WAS GOING HOME AND DAUGHTER WOULD BE WITH HER AT HOME TODAY.


VAERS ID: 1549186 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-08-11
Onset:2021-08-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Chest pain, Fatigue, Muscular weakness, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ivermectin, azithromycin, malarone, nystatin, vitamins C, D3, zinc, potassium, magnesium, multivitamin, monolaurin, liposomal glutathione, sacro B, probiotics
Current Illness: Lyme disease, babesiosis, coronary vasospasm
Preexisting Conditions: Lyme disease, babesiosis, coronary vasospasm
Allergies: Fluconazole, clarithromycin, sulfa
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Muscle aches, joint pain, chest pain, fatigue, weakness in legs. Calcium channel blocker needed for chest pain


VAERS ID: 1549199 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 LA / IM

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

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

Write-up: Client was given Moderna for 1st dose on July 14th 2021. Client was inadvertently given Pfizer for second dose after client reported verbally and written that client was given pfizer for first dose. Upon looking in OSSISS noted client was given moderna for first dose. No adverse affects noted at this time. Informed client of incident and notified to monitor any symptoms. notify PCP or Health dept if needed.


VAERS ID: 1549222 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Pt was given a dose drawn up greater than 12 hours, approximately 36 hrs.


VAERS ID: 1549229 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-08-02
Onset:2021-08-12
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Electric shock sensation, Erythema, Rash, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 8/2 Annular rash started on neck and has since moved to chest. 8/11 electric feeling in arm, swelling, heat and red


VAERS ID: 1549230 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Discomfort, Tongue discomfort
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

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

Write-up: Received Pfizer COVID vaccine at 12:38om. At 12:53pm reported feeling heaviness in tongue. Benadryl administered at 12:56pm. reports relief of symptoms at 1:04pm.


VAERS ID: 1549233 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-02-11
Onset:2021-08-12
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Imaging procedure abnormal, Infection, Pneumonia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: diabetes type 2, diabetic neuropathy, hypertension, multiple myeloma, COPD
Allergies: TMP/Sulfa (shortness of breath), penicillins (not specified), ramipril (not specified)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Breakthrough COVID infection. Direct admit to Hospital from Medical Center. SpO2 100% on 4LNC, presented to for shortness of breath, had positive COVID test, and pneumonia noted on imaging.


VAERS ID: 1549237 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Confusional state, Extremity contracture, Fatigue, Feeling abnormal, Heart rate decreased, Limb discomfort, Malaise, Muscle rigidity, Pallor, Syncope, Unresponsive to stimuli
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), Dementia (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Patient and dad stated she had a "cold" about a week ago.
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient stated she was not feeling well, volunteers/staff moved her into the shade, moments later she fainted. On assessment HR rate was 45, BP not obtained. Patient was pale, eyes wide open staring off into space, arms ridged contracted outward, not able to answer questions. Patients body was supported, cold compress applied to back of next. HR monitored. Continuously asking patient questions until able to respond. Thirty seconds to a minute patient started to ask what happened, her color began to come back. She was able to drink water and orange juice. Patient stated she felt tired and her legs felt heavy. Patient was monitored for thirty more minutes with no other effect. Parent was told to notify physician.


VAERS ID: 1549267 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-10
Onset:2021-08-12
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Induration
SMQs:, Extravasation events (injections, infusions and implants) (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: Wellbutrin XL, Pravachol, Dexilant, Zyrtec
Current Illness: None
Preexisting Conditions: None
Allergies: Mastisal, Betadine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Less than 48 hours of having the vaccine, I noticed a large lump in my left armpit. It is significantly swollen, approximately the size of a peach, and very sore. I went back to pharmacy and discussed it with the pharmacist. After looking at it, she told me she had not seen this reaction and suggested I take something for pain and swelling and for me to report my reaction to the CDC. She said if the condition persist, I needed to notify them again.


VAERS ID: 1549268 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Syncope, Urinary incontinence
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), 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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none reported
Current Illness: none reported
Preexisting Conditions: none reported
Allergies: kiwi
Diagnostic Lab Data:
CDC Split Type:

Write-up: 2 MINUTES AFTER VACCINE ADMINISTRATION - PATIENT SAID SHE FEELS LIKE SHE IS GOING TO PASS OUT - HAD HER SIT DOWN AND SHE FAINTED - WE CALLED 911 - LOST CONTROL OF HER BLADDER - REGAINED CONSCIENCE - PARAMEDICS ARRIVED AND TOOK HER TO THE HOSPITAL


VAERS ID: 1549273 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Injection site rash, Nausea, Nervousness, Paraesthesia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Hypoglycaemia (broad), Sexual dysfunction (broad)

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

Write-up: Patient was extremely nervous about the vaccine. He immediately started to feel tingling/numbness of the RA, following a localized rash at the injection site. After 15 minutes the rash subsided and patient states he is feeling nauseous and still having numbness.


VAERS ID: 1549291 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose normal, 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pt vomited last immunization as well (mother says when he was 12ish)
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt fainted after receiving the vaccine, then vomited. 911 was called, EMTs checked his O2 (98-99), BP (98/58), and Blood Sugar (104). Pt slowly started to feel better, no extra measures were needed. Pt was given water and walked out to his car with his mother.


VAERS ID: 1549303 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Paraesthesia, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Pharmacist reports that after administration of 1st dose of Moderna 08/12/2021, Pt. started to experience tingling and slight swelling in the right leg. Still continuing as Pt. left the facility.


VAERS ID: 1549313 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Hypotension, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Patient experienced dizziness, lightheadedness and brief (30-60 seconds) syncopal episode. Patient was visibly diaphoretic and hypotensive. Patient placed in recumbent position and blood pressure recovered within 5 minutes. Patient observed for 35 minutes total and left in stable condition.


VAERS ID: 1549342 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, Loss of consciousness
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), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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: syncope
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt passed out as soon as shot was given.


VAERS ID: 1549343 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-11
Onset:2021-08-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

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

Write-up: Pfizer-BioNTech COVID 19 vaccine EUA Fever of 100.9, chills, body aches, headache, tired


VAERS ID: 1549344 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Flushing, Hyperhidrosis, Lethargy, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (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), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Severe


VAERS ID: 1549349 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: New York  
Vaccinated:2021-01-23
Onset:2021-08-12
   Days after vaccination:201
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Abdominal discomfort, Asthenia, Autoimmune disorder, Chest X-ray, Chest discomfort, Flank pain, Joint noise, Joint range of motion decreased, Laboratory test abnormal, Liver function test increased, Movement disorder, Myalgia, Osteoarthritis, Pain, Pain in extremity, Pyrexia, Sensory disturbance, Sleep disorder due to a general medical condition, Spinal X-ray abnormal, Spinal pain, X-ray limb normal
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol, Valtrex, Cymbalta, Synthroid, cholestyramine, voltaren, entyvio, apap, leflunomide, metoprolol
Current Illness: Foot neuropathy, acutely developed around 12/25/20
Preexisting Conditions: ulcerative colitis, inflammatory arthropathy, both stable and controlled at the time
Allergies: avelox (anaphylaxis), NSIADs, vancomycin, wasp venom
Diagnostic Lab Data: Shoulder xray, CXR
CDC Split Type:

Write-up: RUE pain - After COVID vaccine in L arm on 1/23 developed fever (tmax 104, could only get it down to 102 with apap and ibuprofen) and severe upper body myalgias.This resolved by 2 days later, but has had persistent RUE pain since. Describes she had to sleep upright x1.5 weeks and was nearly in tears due to the pain. Using peppermint oil with improvement. Noticing pain with flexion $g90 and scapular popping sensation. Weakness, while washing hair (has to prop her elbow on shower wall) and inability to cross arm across her chest. Also having difficulty lifting grocery bags. Was having R lower chest wall/inframammary/RUQ discomfort too. Talked about these sx with rheum, had shoulder xray which was normal and cspine xray which showed DJD. labwork showed brief elevation in LFTs which subsequently normalized. Has persistent R flank pain since November, currently dull. Not limiting her, just constantly there . Some shooting pains up/down spine at times +scapular winging on exam, subsequently seen by ortho and neurology given onset and acute nature of the scapular weakness (long thoracic distribution), most likely that this was neuralgic amyotrophy/parsonage turner syndrome, which is in general an idiopathic auto-immune disorder that affects all or portions of the brachial plexus, but very commonly the long thoracic nerve alone


VAERS ID: 1549353 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Flushing, Hyperhidrosis, Hypoaesthesia, Injection site pain
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

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

Write-up: Site: Pain at Injection Site-Severe, Systemic: Dizziness / Lightheadness-Medium, Systemic: numbness in fingers-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Weakness-Mild, Additional Details: Patient just moved from out of country and does not have a PCP


VAERS ID: 1549359 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Dizziness, Dysphagia, Eye swelling, Flushing, Hyperhidrosis, Hyperventilation, Mouth swelling, Nausea, Paraesthesia, Pruritus, Rash, Swelling face, Swollen tongue, Throat tightness, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Allergic: Difficulty Swallowing, Throat Tightness-Severe, Systemic: Allergic: Itch (specify: facial area, extremeties)-Severe, Systemic: Allergic: Rash (specify: facial area, extremeties)-Severe, Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Severe, Systemic: Abdominal Pain-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Flushed / Sweating-Severe, Systemic: Hyperventilation-Medium, Systemic: Nausea-Medium, Systemic: Tingling (specify: facial area, extemities)-Severe, Systemic: Vomiting-Medium


VAERS ID: 1549362 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad)

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

Write-up: Complained of chest tightness, shortness of breath, closing of throat. Checked blood pressure 114/76, pulse of 64. Administered 2 diphenhydramine 25mg and observed for a further 30 minutes. Appeared normal when they left the pharmacy.


VAERS ID: 1549367 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose normal, Dizziness, Dysstasia, Fall, Loss of consciousness
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), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Vestibular disorders (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: none
Allergies: unknown
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient informed immunizer that he did not have food in the 6 hours leading up to vaccination. Patient felt light headed within 5 minutes after vaccination. Patient rapidly lost consciousness and fell down within 6 minutes after vaccination. Patient regained consciousness within 1 minute and was alert and talking. EMS was called and evaluated patient. Blood sugar was at 98. Patient was advised to go to hospital because they were feeling lightheaded and unable to stand on their own. Patient''s caregiver declined ambulance and chose to transport patient to hospital or clinic themselves.


VAERS ID: 1549374 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

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

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

Write-up: About 10 minutes after receiving the vaccine, patient fainted while he was walking in the store. Ambulance was immediately called and they arrived within 10 minutes. Patient regained consciousness prior to ambulance''s arrival.


VAERS ID: 1549379 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-12
Onset:2021-08-12
   Days after vaccination:153
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Feeling abnormal, Headache, Hypoaesthesia, Inappropriate schedule of product administration, Joint swelling, Malaise, Nausea, Pain in extremity, Skin discolouration, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Dementia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none known but pt had flu vaccine one day before 3-11-2021 before receiving her second dose of Pfizer covid-19 vaccine on 3-12-2021 pt states vaccines were given by the military not received in our office
Preexisting Conditions: pt had been undergoing workup for general fatigue, joint pain and hair loss in the last year
Allergies: nada
Diagnostic Lab Data: pt had been referred to a rheumatologist for joint pain prior to vaccination, and sought attention at local urgent cares after her symptoms started . She related receiving steroid injections and oral prednisone in urgent care
CDC Split Type:

Write-up: pt received flu vaccine one 3-11-2021day prior to covid-19 vaccine 3-12-2021 per her report given through the military pt presented to my office 8-2-2021 relating after her covid 19 vaccine ( this was her second dose) she had 2 week history of malaise, followed by numbness in her hands and pain in hands in wrists accompanied by swelling in wrists and discoloration of fingers, associated nausea and vomitting with the joint pain , she complains of brain fog and headaches since her immunizations


VAERS ID: 1549388 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Flushing, Gait disturbance, Hyperhidrosis, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ESCITALOPRAM, MULTIVITAMIN, IBUPROFEN, OMEGA-3 FATTY ACIDS, PROPRANOLOL
Current Illness: NONE
Preexisting Conditions: HYPERLIPIDEMIA, ANXIETY
Allergies: NONE
Diagnostic Lab Data: NONE. TAKEN TO ED FOR EVALUATION.
CDC Split Type:

Write-up: PATIENT RECEIVED 2ND DOSE OF PFIZER COVID VACCINE AT 1220. AT 1228 PATIENT WALKED TO THIS RN AND STATED HE WAS FEELING FLUSHED. PATIENT WAS OBSERVED TO BE PALE AND DIAPHORETIC. THIS RN ATTEMPTED TO GET PATIENT BACK IN CHAIR BUT PATIENT STUMBLED; ATTEMPTED TO LOWER PATIENT TO GROUND BUT PATIENT AND THIS RN COLLAPSED ONTO FLOOR. NO INJURY NOTED. PATIENT DOES NOT RECALL THIS HAPPENING. PATIENT ASSESSED AND TAKEN TO ED FOR FURTHER EVALUATION.


VAERS ID: 1549403 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness:
Preexisting Conditions: Hypoglycemia
Allergies: N/A
Diagnostic Lab Data: Vital signs were taken immediately. 110/60, T: 98 , P: 73, R: 23, DXT: 106
CDC Split Type:

Write-up: Patient reported dizziness and fainting after first dose of Pfizer vaccine.


VAERS ID: 1549413 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure decreased, Cold sweat, Eye movement disorder, Heart rate decreased, Hyperhidrosis, Loss of consciousness, Nasopharyngitis, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (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: Unknown
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient became unconscious cold, clammy and sweaty. and eyes rolled back. Was unresponsive for about 15 seconds, but had a pulse in the mid 50s. Blood pressure was in the 80s/50s. Nurses from nearby clinic intervened. Patient was placed in the supine position with legs raised up, She slowly became more and more conscious. Responded to verbal commands and became more and more alert.


VAERS ID: 1549417 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / UNK LA / IM

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

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

Write-up: Patient came into the pharmacy requesting the moderna covid vaccine. Patient wrote on the consent form that it is his first dose of covid vaccine; also confirmed so right before administration. Patient was given the moderna vaccine, had no adverse reactions at the pharmacy during observation. However, later on in the day, there was a patient profile found on system with the same name and phone number although different address and slightly different birth date (05/22/1962 versus 05/21/1962 on the consent form) who had a record of previously receiving both doses of moderna on 01/27/21 and 02/24/21.


VAERS ID: 1549422 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-08-10
Onset:2021-08-12
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood creatine phosphokinase MB increased, Blood creatine phosphokinase increased, C-reactive protein normal, Chest pain, Electrocardiogram ST segment elevation, Myocarditis, Pericarditis, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), 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), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: Guillain barre - flu vaccine age 12
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data: Ekg 8/12/21 with global ST elevation consistent with pericarditis. All labs on8/12/21 -troponin 6.5, ck 696, ck-mb 118, crp 2.37
CDC Split Type:

Write-up: Myopericarditis. Chest pain 2 days after second vaccine. Ekg consistent with pericarditis and troponin elevated.


VAERS ID: 1549434 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-03-24
Onset:2021-08-12
   Days after vaccination:141
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chest tube insertion, Coma scale abnormal, Computerised tomogram abnormal, Endotracheal intubation, Facial bones fracture, Road traffic accident, SARS-CoV-2 test positive, Subdural haematoma
SMQs:, Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CORONAVIRUS TEST 08/12/2021 POSITIVE.
CDC Split Type:

Write-up: Pt admited on 8/12/21 via ems from scene of poss atv accident. Pt had been struck by vehicle. GCS 3. Pt had obvious facial fractures, transferred to hospital as level 1 trauma. On arrival, King airway was exchanged for an ET tube. Chest tube was placed on the right for pneumothorax. CT showed right sided subdural hematoma. Tested for COVID on 8/12/2021. Pt in still an inpatient.


VAERS ID: 1549437 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-22
Onset:2021-08-12
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053C21A / 1 LA / IM

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

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

Write-up: Received first covid vaccine on 7/22/21. Required admission to hospital for covid pneumonia on 8/12/21


VAERS ID: 1549452 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-11
Onset:2021-08-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Erythema, Heart rate increased, Pain in extremity, Peripheral swelling, Pruritus, Pyrexia, Swelling face
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Cellulitis of left arm, 51, 12/19/2017, pneumonia vaccine
Other Medications: Trazadone 150mg- as needed for sleep, Flonase
Current Illness:
Preexisting Conditions:
Allergies: Levaquin, hydrocodone, cockroaches and grass
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever x''s 14+ hours, arm pain and redness, swelling of extremities, systemic itching, facial swelling, chest pain,increased heart rate, difficulty breathing


VAERS ID: 1549457 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Vaccine was given to 15 year old female patient in error (age not within approval). No symptoms or AEs per pt.


VAERS ID: 1549458 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Dysphagia, Dyspnoea, Erythema, Flushing, Swelling face
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: CAN''T SWALLOW. FLUSHING. REDNESS AND SWELLING ON FACE. COUGHING. CAN''T BREATHE.


VAERS ID: 1549471 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: bupropion XL 150 Testosterone 200 mg/ml 0.5 ml every 2 weeks
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: LEFT-SIDED FACIAL NUMBNESS 5 MINUTES FOLLOWING INJECTION, NO PARALYSIS NOTED, HAD NOT RESOLVED BY THE TIME HE LEFT CLINIC 30 MINUTES LATER


VAERS ID: 1549497 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site pain, Product preparation error
SMQs:, Extravasation events (injections, infusions and implants) (broad), 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: 975 mg Tylenol given due to pain at the injection site.
Current Illness: none
Preexisting Conditions: none
Allergies: Amoxicillin and Penicillin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient was given 0.3 ml of the Pfizer vaccine that was not diluted. Patient complained of tenderness at the injection following administration. Administered 975 mg of Tylenol.


VAERS ID: 1549502 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-08-12
Onset:2021-08-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Hyperhidrosis, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypoglycaemia (broad)

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

Write-up: Pt received dose and went and set down, within a minute he reported severe nausea. He began to sweat profusely . Pulse was erratic. He started to complain of chest pain and trouble breathing. We laid him down and administered epinephrine 0.3 and he responded immediately. He was doing well by the time the ambulance arrived.


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