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From the 10/15/2021 release of VAERS data:

Found 800,916 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 15 out of 8,010

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VAERS ID: 1777316 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-10-01
Onset:2021-10-09
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Insulin
Current Illness: N/A
Preexisting Conditions: Type 1 DM
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: hives on face, started on day 8- persisted x3 days, intermittent, noted mostly on cheeks/forehead, resolve after 30 minutes


VAERS ID: 1777321 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939901 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site pain, Oropharyngeal pain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin, calcium, bilberry, dandelion, vitamin B, D & E, lutein.
Current Illness: None.
Preexisting Conditions: None.
Allergies: Minor allergy to pork.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Minor: in the hours following the injection, I experienced headache, slight fever (+1 degree), slightly sore throat. All resolved that day. Moderate: the next day, I experienced high levels of arm pain around the injection site. Pain was concentrated in the muscle and was painful when moving the arm or applying pressure to the affected area. I had full range of motion in the arm. The second day after injection, arm pain was slightly reduced and seems to be gradually improving. I also began to experience extreme tiredness and fatigue. Current events are ongoing.


VAERS ID: 1777343 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-10-01
Onset:2021-10-09
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Fatigue, Heart rate increased, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

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

Write-up: Tightness in chest, hard to breath, raising heartbeat, off and on fevers. Extremely fatigued


VAERS ID: 1777344 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Decreased appetite, Headache, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvatatin 20mg, Tamsulosinn.4mg, sildenafil 50mg
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headaches for the pass three days, loss of appetite, slight fever, chills, slight muscle pain


VAERS ID: 1777346 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-05
Onset:2021-10-09
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Constant cough and headache. Fever and chills.


VAERS ID: 1777565 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-11
Onset:2021-10-09
   Days after vaccination:240
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Cough, Headache, Pain, Respiratory tract congestion, Sinus congestion
SMQs:, Anaphylactic reaction (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: Fluticasone; ProAir; Fluorouracil cream; diazepam; lisinopril; amitriptyline; vitamin d3
Current Illness: none
Preexisting Conditions: Arnold chiari malformation; imbalance; basal cell carcinoma; GERD; chronic headaches; multiple allergies; vitamin D deficiency; mild depressioin; COPD; HTN
Allergies: penicillin drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: chest congestion, sinus congestion, headaches, body aches, cough. starting on 10/9/21


VAERS ID: 1777573 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-05
Onset:2021-10-09
   Days after vaccination:218
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Cough, Diarrhoea, Ear pain, Fatigue, Headache, Nasal congestion, Sinus congestion, Sinus pain
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), 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: Zinc, Vitamin D; Levothyroxine 50 mcg; and 75 mcg; Sumatriptan; Sertraline; Alprazolam
Current Illness: none
Preexisting Conditions: hypothyroidism; dyslipemia; anxiety/depression
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: dry cough, headache, fatigue, ear pain, sinus pain, sinus congestion, nasal congestion, diarrhea-2 times/no blood in stool, chest pain.starting 10/9/21


VAERS ID: 1777608 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PFIZER FE3590 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Sore arm, fatigue, headache to COVID Pfizer 2nd dose.
Other Medications: Viibryd 15 mg, Gabapentin 300 mg, Farxiga 10 mg, Metformin ER 1000mg, Novolog Insulin Solution, Prazosin 2 mg, Lamotrigine ER 200mg, Trazodone 50 mg, Tizanidine 10 mg (?)
Current Illness: Diagnosed with mononucleosis on 9/4/2021
Preexisting Conditions: Diabetes II
Allergies: NKA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: On the date of injection (10/9/2021), I found a quarter size spot of red, hot skin on right arm near the elbow (opposite injection arm), took Benadryl, problem persists 2 days later. On 10/10/2021, I found a quarter size spot of red, hot skin near the injection site, but not ON the injection site. Took Benadryl, problem persists 1 day later. On 10/11/2021, the red, hot skin on the right arm has spread and covers the entire upper arm, from the elbow to the shoulder.


VAERS ID: 1777819 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Adverse reaction, Arthralgia, Chills, Extra dose administered, Fatigue, Hyperhidrosis, Infection, Injection site erythema, Injection site swelling, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 3/06/21 Moderna 2nd shot
Other Medications: Dexilant 60mg,Simvastatin 40mg, Telmastartin, estrogen, progesterone,100, Welbutrin 100
Current Illness: none
Preexisting Conditions: none
Allergies: Bactrum/sulpher
Diagnostic Lab Data: none
CDC Split Type:

Write-up: injection given at 9:30am 10/09/21. Adverse reaction started at 4pm same day. Chills alternating with sweats, low grade fever, extreme pain in joints and muscles all over body, extreme fatigue. Symptoms subsided next day Sunday 9pm. Symptoms returned Monday approx 10am as well as extreme swelling and redness at injection site and down my arm approx 6inches. Saw my general physician. He decided to treat as an infection. Medication prescribed:Cephalexin 500mg. At this time, only 2 doses of medication have been taken. No change yet.


VAERS ID: 1777937 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC 3184 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Fatigue, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (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: Benazepril 5 mb
Current Illness: None
Preexisting Conditions: Low level high blood pressure
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Low grade fever of 100.4 F the morning following vaccination. Was tired enough to lay down. Took one 200 mg ibupofen tablet. Within an hour, temperature was down to 99.3. The following hour was back to normal at 98.6. Regained energy and felt fine the rest of the afternoon and evening. Time of tiredness lasted about 3 hours, and energy was regained once temp was back to normal.


VAERS ID: 1777948 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Discomfort, Dyspnoea, Headache, Pain
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Arthritis (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: N/A no illness perfectly healthy
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Woke up the following day with a massive headache. Whole body and joints were sore. Unable to get comfortable doing anything. Some troubles/labored breathing for 1 day.


VAERS ID: 1777965 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 1 RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Mouth was numb durin the 30 minute waiting period.
Other Medications: Venlafaxine Floudrocortisol Metoprolol Succ ER Digoxin JARDIANCE JANUVIA Ozempic Albuterol inhaler Zyrtec D
Current Illness: Just allergies.
Preexisting Conditions: Diabetes Type 2 Asthma and Allergic Rhinitis Poly Orthostatic Tension Syndrome Tachycardia Low Blood Pressure Depression
Allergies: Quinolones like Levoquin and Avelox. Cephalosporins Keflex Sulfas Augmentin Cipro Bananas, pineapple, macadamias, hazelnuts, pistachios, Most trees and grass. Mold and dust. Horses, cows, dogs, and cats.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Dose one, mouth felt numb. Dose three (booster) slow and gradual allergic reactions on left side of upper body and head.


VAERS ID: 1777975 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Dizziness, Injection site pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular 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: Shingrex
Other Medications: Glumetza Trajenta Aciphex Rosuvastatin Vitamin D Multi Vitamin
Current Illness: None
Preexisting Conditions: Diabetes High Blood Pressure
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Very sore injection site- Left Arm Chills Dizziness Fever- 100.6 Vomiting Tylenol in morning Fever went away after a Tylenol , no more vomiting or chills Felt better towards evening 10/9/2021


VAERS ID: 1778752 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 UN / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Mobility decreased
SMQs:, Anaphylactic reaction (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Celexa and birth control
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt stated that she had extreme difficulty breathing and chest pain the next day after her shot. She stated that she stayed in bed all day. Today is 10-12-21 and is complaining of continuous chest pain. Suggesting that she sees her PCP$g


VAERS ID: 1778783 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Fluid retention, Lymph node pain, Pruritus, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Tetanus Shot: Localized swelling in the arm Penicillin Shot: Hospitalized
Other Medications: Losartan 100mg (once daily)
Current Illness: None
Preexisting Conditions: High Blood Pressure
Allergies: Penicillin Codeine Sulfa
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Small rough bumps on right arm, raised whelps that itched and spread through the body, joint aches in legs and arms, sensitivity in lymph nodes in neck, fluid retention underneath both eyes


VAERS ID: 1778788 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 3 - / IM

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

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

Write-up: Client received a Moderna vaccine as a booster. Moderna was not approved for booster at the time of the vaccine administration. No adverse reaction was observed.


VAERS ID: 1778824 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-06
Onset:2021-10-09
   Days after vaccination:186
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / UNK RA / IM

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

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

Write-up: COVID 19


VAERS ID: 1778855 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Diarrhoea, Influenza like illness, Lymphadenopathy, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Trazadone, Wellbutrin, Diazepam. Tylenol and Ibuprofen
Current Illness: none
Preexisting Conditions: obesity and chronic seasonal allergies
Allergies: Mango and Cat Hair
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe flu like symptoms. Nausea, diarrhea, fever, chills, body aches and extremely enlarged lymph nodes under left arm (injection arm).


VAERS ID: 1778857 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Pain, Pyrexia, Vaccine positive rechallenge
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Suffered similar symptoms after first and second COVID vaccination doses.
Other Medications: Atorvastatin, hyosciamine, tamsulosin
Current Illness: None
Preexisting Conditions: coronary issues requiring pacemaker
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Several hours after vaccination I woke up with fever aches and pains. The fever, aches and pains lasted nearly all day Saturday. Still very tired on Sunday.


VAERS ID: 1778879 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 LA / IM

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

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

Write-up: Client presented to receive "booster" dose of Pfizer vaccine on 10/09/21 at our vaccine booth. He did not have his vaccine card with him, but reported he could get it when his father could be located. He left the event table to find his father. He returned a short time later and stated his father was "not around right now". He went on to explain that he had received his first doses. We agreed to look the doses up in system. System showed the previous doses given on 2/27/21 and 03/27/21. I proceeded to administer booster dose. Client did return with his COVID vaccination card a little later and that was when I realized he had received Moderna for his previous doses. Client was informed of the error and he was not concerned. Stating " I honestly thought I had Pfizer. But either way, I got a booster shot." I requested client contact clinic if he had any adverse side effects or concerns. I contacted the client on 10/12/21 to check on his status and he replied "I have had no issues".


VAERS ID: 1778915 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Electrocardiogram normal, Stress echocardiogram, 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin, flonase, losartan
Current Illness: None
Preexisting Conditions: Hypertension, hyperlipidemia, depression, environmental allergies, osteoarthritis Stated history of mitral valve prolapse, not confirmed on recent echo
Allergies: Bactrim (nausea) Lisinopril (cough) Norvasc (leg swelling) All these are likely medication intolerances and not true allergies
Diagnostic Lab Data: EKG 10/11/2021 - normal sinus rhythm, otherwise unremarkable Unremarkable stress echo 1/2021
CDC Split Type:

Write-up: After dose 1, patient had mild episodes of lightheadedness/dizziness that resolved spontaneously. Occurred while she was sitting at home. After dose 2, patient had episode of lightheadedness/dizziness that occurred while she was walking in grocery store. Did not have palpitations. She syncopized. Subsequently, has been asymptomatic. Not having dyspnea or chest pain.


VAERS ID: 1778936 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-10-07
Onset:2021-10-09
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: ALERGIC REACTION


VAERS ID: 1778969 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-03-12
Onset:2021-10-09
   Days after vaccination:211
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003A21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Chills, Dyspnoea exertional, Dysstasia, Hypoxia, Nasopharyngitis, Pain, Productive cough, Pyrexia, SARS-CoV-2 test positive
SMQs:, Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Chief Complaint via EMS patient reports increased weakness today after outpatient MAB infusion at LMH, unable to stand on own. COVID+ on Saturday. 38.8 in triage, hx of HTN. + generalized aching, chills. History of Present Illness 88yo woman with h/o HTN, paroxysmal afib, 2015 TIA, OSA, prior DVT, obesity, who had COVID vaccination with Moderna earlier this year. Was in usual state of health until trip to another state, last week. Then 3 days ago tested positive for COVID after feeling like she had a head cold. Received antibody infusion yesterday, and weakness became so profound that she went to her knees. Some DOE and cough that is minimally productive as well with no bloody component. Did not really feel the fever she had on arrival. No GI symptoms. No syncope, rashes, other pain. Was surprised that she was hypoxic on ED arrival.


VAERS ID: 1778989 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-09
Onset:2021-10-09
   Days after vaccination:122
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: Covid + on 10/09/2021. Hospitalized. Per ED Note: History of Present Illness 64-year-old male with a past medical history of COPD on 4 L nasal cannula, hypertension, diabetes and obesity presents to the emergency department for feeling tired. Patient states symptoms began this morning. Patient did get a vaccine for COVID-19. Patient states he is just feeling very weak. He denies fever, chills, cough, nausea, vomiting, shortness breath, chest pain, abdominal pain and urinary symptoms.


VAERS ID: 1779003 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cold sweat, Condition aggravated, Dizziness, Dry skin, Loss of consciousness, Skin warm, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. Client reports that he frequently looses consciousness following blood draws and/or injections.
Allergies: None
Diagnostic Lab Data: none.
CDC Split Type:

Write-up: Client reported feeling lightheaded following vaccination, then fainted. Client had LOC approx. 15-20 seconds and regained consciousness spontaneously with verbal prompts. Feet elevated. Client semi-reclined. VSS. HR 72, BP 120/64. Skin initially warm, moist. Skin dry, warm to touch within 2 minutes. Client offered and accepted sips of H2O. Cool cloth applied to back of neck. No change in VS on re-check. Client observed for 15 minutes without further incidence. Client stated, "I always faint with blood draws and other shots."


VAERS ID: 1779008 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-10-07
Onset:2021-10-09
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Neck mass
SMQs:

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: APAP, Cyancobalamiin, Finasteride, Flomax, Folic Acid, Metformin, MVI with minerals, Spironalactone, Thiamine, Vitamin D3, Apixaben, Gabapentin
Current Illness: Admitted to hospital on9/15/21 for sepsis with UTI and acute kidney injury, returned to facility on 9/19/21
Preexisting Conditions: Hyperlipidemia, DM, chronic kidney disease, BPH, high cholesterol, anemia, sleep apnea, obstructive and reflux uropathy,
Allergies: NKA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: noted lump on left side of neck


VAERS ID: 1779020 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Dyspnoea, Heart rate increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: High fever, chills, muscle aches, tightness of neck, tightness of chest, difficulty breathing, chest pain, chronic sweating
Current Illness: N/A
Preexisting Conditions: Sweating, Muscle Aches
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tightness and pain in the chest, increased heart rate, difficulty breathing. Patient called 911.


VAERS ID: 1779066 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-02
Onset:2021-10-09
   Days after vaccination:190
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / UNK - / -

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

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

Write-up: Covid positive household exposure


VAERS ID: 1779111 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Injection site induration, Injection site mass
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: Unknown
Current Illness: Unknown 3rd dose
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Hard Red lump at injection site. Not resolved by heat or ice.


VAERS ID: 1779126 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-07
Onset:2021-10-09
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 RA / SYR

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

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

Write-up: Patient reports site redness and itching 2 days after injection given; patient denies any fever, no pain, just itching at site.


VAERS ID: 1779173 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-09
Onset:2021-10-09
   Days after vaccination:214
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Diarrhoea, Dyspnoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Pt has a history of CAD, severe COPD with asthma (on 3L home oxygen), ischemic cardiomyopathy, and stage III CKD, presents with one week of diarrhea and worsening shortness of breath. Found to be COVID positive.


VAERS ID: 1779200 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-02
Onset:2021-10-09
   Days after vaccination:249
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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: pateint admitted with covid pneumonia


VAERS ID: 1779213 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 20254561 / 3 - / -

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

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

Write-up: Pain at injection site, spreads to shoulder and upward toward the neck.


VAERS ID: 1779239 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, Condition aggravated, Fatigue, Migraine, Myalgia, Nausea, Pain, SARS-CoV-2 test negative
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Taste and smell disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Immune-mediated/autoimmune disorders (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: Emgality, fluoxetine, vitamin b-2, vitamin d-3, multivitamin
Current Illness:
Preexisting Conditions: chronic migraine, autoimmune issues
Allergies: topical lidocaine, morphine, zofran
Diagnostic Lab Data: COVID-19 test (10/12/2021) - Negative
CDC Split Type:

Write-up: Muscle aches, body aches, severe migraine, nausea, lost of sense of taste, extreme fatigue


VAERS ID: 1779296 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Illness, Oropharyngeal pain, Peripheral swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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: None
CDC Split Type:

Write-up: I had just finished a one hour walk and was feeling great when I arrived at the pharmacy for my booster vaccine at 11 a.m. By 6 p.m. I had a sore throat, cough, and swelling in my left arm. I was sick all weekend. I know the vaccine is not supposed to give you a sore throat, but this one did. How do I know? When I have a "regular" sore throat there''s a gradual build up to it. I just don''t suddenly have a sore throat. I also have the exact same sore throat I had in March 2020 when I thought I had covid - fever, shortness of breath, sore throat, cough -- but I did not qualify back then for a test because of the shortage of tests available. Don''t tell me this is just a coincidence. I got covid symptoms from this shot. Next step is to get tested to see if I actually have covid. I may get a false positive because of the symptoms.


VAERS ID: 1779335 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-01-05
Onset:2021-10-09
   Days after vaccination:277
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Biopsy, Computerised tomogram neck, Fatigue, Lymphadenopathy, Malaise, Pain, Ultrasound scan
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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cimzia injection 200mg per 1ml one every two weeks, Marina Birth Control, Pro- Antibotic - Trader Jo brand Advance Strenght 3000billion fc per capsul
Current Illness: No
Preexisting Conditions: Inflammatory Arthritisis
Allergies: No
Diagnostic Lab Data: Ultra sound for the lymnode swelling,
CDC Split Type: vsafe

Write-up: 09/7/2021 Patient began feeling unwell 01/09/2021 discover the lymnodes swelling had 01/21/2021 , 01/22/2021 had a in person visit with ultra sound to 01/26/2021 neck specialist for the location of the lynode swelling in neck, then 01/27/2021 neck CT, 02/05/2021 byopsis of the lymnodes, 02/18/2021 follow-up with normal diagnoisis of no cancer and likely reactive from vaccination. swallen lymnodes with the second and had a bioysis, third vaccination 09/13-17, 2021 extrem fatigue, 10-14 hours ache/s and pains rumatologist is coming to prolong reaction to the vaccination self stimulation of caffine and base line heart rate 90-130 at a resting position not typical normal is 60-70 at rest. Our of break heart rate and short of breath .


VAERS ID: 1779368 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Fatigue, Feeling abnormal, Headache, Nausea, Peripheral swelling, Pyrexia
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Arm was swollen, fever, nausea, "cloudy mind", headache, weakness, fatigue; lasting at least 4 days


VAERS ID: 1779383 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: URI the week prior. Resolved per patient
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 10/11/2021 Covid +
CDC Split Type:

Write-up: Pt developed Cough, Congestion on Saturday, 10/9/2021 Developed SOB on Monday, 10/11/2021. COVID + and admitted to hospital for Oxygen.


VAERS ID: 1779429 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-01
Onset:2021-10-09
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

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

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

Write-up: breakthrough case


VAERS ID: 1779456 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-10-07
Onset:2021-10-09
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Injection site pruritus, Injection site rash, Injection site swelling, Injection site warmth, Rash erythematous
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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline 100mg, Atorvastatin 10mg, Losartan 50 mg, Metformin 500 mg, Fish Oil 2000 mg, CoQ10 200 mg. All medications taken 1 time per day.
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Developed moderately severe rash with itching at and below injection site. Area is slightly warm and moderately swollen, with red rash covering majority of upper arm.


VAERS ID: 1779494 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-10-07
Onset:2021-10-09
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE 3450 (OR 395 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Contusion, Lymph node pain, Lymphadenopathy
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Enlarged lymph nodes, armpit, Left arm (arm that received injection). Sore, like a bruise, in armpit and lower left collarbone. Swelling under armpit. Alternated ibuprofen and acetaminophen x3 days. Applied gel warm pack 2x/day x 3 days. Began two days after booster. 5 days after booster still tender but swelling reduced. This side effect not present during first two vaccinations.


VAERS ID: 1779496 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-07
Onset:2021-10-09
   Days after vaccination:185
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / UNK RA / IM

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

Write-up: COVID 19


VAERS ID: 1779506 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Headache, Hypertension, Nausea, Pain, SARS-CoV-2 test negative, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Gluten wheat shellfish latex
Diagnostic Lab Data: Went to doctor. Complete covid test . Negative result. Did an over all check ask vitals. High BP as well
CDC Split Type:

Write-up: Extreme headache nausea hives on face and neck eye flare up pain all over body


VAERS ID: 1779572 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Headache, Injection site pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Pain at injection site, abdominal pain and headache, fever of 99.4 to 100.2 continuing. Follow up with physician continues to worsen


VAERS ID: 1779585 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039021A / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft 100mg
Current Illness: N/A
Preexisting Conditions: Anxiety, Depression
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: I vomited a lot of the afternoon after I got the second dose of moderna. So very nauseated and lots of vomiting.


VAERS ID: 1779606 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Decreased appetite, Pain, Paraesthesia, Paraesthesia oral
SMQs:, Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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: xarelto, metoprolol, meloxicam, glimepiride
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt reports whole body aches since vaccine and as of 10/12/21 feeling of pins and needle, tingling on the tongue. Pt also reports loss of appetite.


VAERS ID: 1779615 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysstasia, Gait disturbance, Headache, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: Headache, arm pain 3 days Lost all control of legs -11pm to 4 pm next day Slept for 2 days.


VAERS ID: 1779620 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-06
Onset:2021-10-09
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac flutter, Dizziness, Extrasystoles, Fatigue, Feeling abnormal, Mobility decreased, Nausea, Palpitations, Visual impairment
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Parkinson-like events (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Tachyarrhythmia terms, nonspecific (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: metal allergy (earrings, dental work) - reaction to many metals including surgical steel, gold, silver, etc.
Diagnostic Lab Data: none yet
CDC Split Type:

Write-up: In bed all day Saturday and Sunday - tired, nauseas, headache with visual disturbances. Starting Monday (?) started feeliing a weird feeling in my heart. Fluttering, ponding, sometimes dizzy. Skips a beat and tired. Feels like my heart is too big for my chest.


VAERS ID: 1779637 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-09
Onset:2021-10-09
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F214 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Mobility decreased, Pain
SMQs:, Parkinson-like events (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: Lactose
Diagnostic Lab Data:
CDC Split Type:

Write-up: Body aches for 2 days following second shot, couldn''t get out of bed, headache.


VAERS ID: 1779661 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-10-07
Onset:2021-10-09
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Diarrhoea, Dyspnoea, Hypoaesthesia, Lymphadenopathy
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: no doctor consulted
CDC Split Type:

Write-up: patient got shot Thursday am 10/7, but Saturday morning 10/9 was experiencing underarm tenderness/pains in underarm on left side and swollen lymph nodes, temporarily lost feeling in left arm...also had some shortness of breath on sunday that has since resolved, and some diarrhea on Monday


VAERS ID: 1779695 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: New York  
Vaccinated:2021-10-05
Onset:2021-10-09
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Headache, Night sweats, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: DVT and PE, 2 nights in ER following second Pfizer on March 25, 2021, covid 19 dose
Other Medications: crestor, prozac, naltrexone, singulair, prolia, flonase, calcium/vitamin D
Current Illness: none
Preexisting Conditions: prostate cancer survivor
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: aches and pains, perspiration at night, headache, some coughing, probably fever but never measured all for about 3 days


VAERS ID: 1779911 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cellulitis, Condition aggravated, Diarrhoea, Dyspnoea, Fatigue, Headache, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Severe Cellulites left arm, fever, muscular pain, head pain, nausea, diarrhea, difficult respiration, cough. 47 year female pati
Other Medications: Cabergoline 5mg, Synthroid 137mg
Current Illness: prolactinoma
Preexisting Conditions: chronic Asthma, COPD
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe Cellulitis on left arm, 40 degree fever for 3 days. Body muscular pain, nausea, diarrhea, head pain, tiredness, difficult respiration. I started with Antibiotics, Levaquin 750mg ever 12 hours, Flovent HFA 110mcg twice per day, Albuterol 90mcg twice per day, Symbicort once per day. Severe Cellulites left arm, fever, muscular pain, head pain, nausea, diarrhea, difficult respiration, cough. 47 year female patient receives MODERNA 3rd dose October 10 2021.


VAERS ID: 1780324 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-01
Onset:2021-10-09
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia
SMQs:, Arthritis (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: Na
Current Illness: Na
Preexisting Conditions: Na
Allergies: Na
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe joint pain starting day after.


VAERS ID: 1780455 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-03-23
Onset:2021-10-09
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram thorax abnormal, Deep vein thrombosis, Pulmonary embolism, Respiratory failure, Ultrasound Doppler abnormal
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypokalaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin D3, Genicin, Flomax
Current Illness:
Preexisting Conditions: Chest pain, hyperlipidemia, syncope and collapse.
Allergies: NKMA
Diagnostic Lab Data: CT PE study and LLE Doppler.
CDC Split Type:

Write-up: Patient admitted to hospital with respiratory failure due to hypoxia, bilateral PE and LLE DVT.


VAERS ID: 1780456 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Wyoming  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: 16-year-old received a J & J by mistake.


VAERS ID: 1780465 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-10-06
Onset:2021-10-09
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysmenorrhoea, Headache, Heavy menstrual bleeding, Immediate post-injection reaction, Polymenorrhoea, Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: multivitamin armour thyroid
Current Illness:
Preexisting Conditions: hypothyroid
Allergies: Allergy to PEG, shellfish, mushrooms, mold,
Diagnostic Lab Data: nothing yet- will go and get a Ferritin, cbc, and d- dimer this week.
CDC Split Type:

Write-up: Immediate headache and tongue swollen, headache has continued off and on. Menorrhagia began early Saturday morning and I am going through 10 -12 tampons a day with large clots, heavy bleeding and cramping. My cycle is not supposed to start for another 2 weeks. I keep everything on an app and am still pretty regular.


VAERS ID: 1780812 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061E21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Bundle branch block left, Chest discomfort, Chest pain, Feeling hot, Headache, Hypoaesthesia, Injection site erythema, Injection site pain, Injection site swelling, Pain, Paraesthesia, Peripheral swelling, Pyrexia, Tachycardia, Tremor
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Sexual dysfunction (broad)

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

Write-up: Site: Pain at Injection Site-Severe, Site: Redness at Injection Site-Severe, Site: Swelling at Injection Site-Severe, Systemic: Body Aches Generalized-Severe, Systemic: Chest Tightness / Heaviness / Pain-Severe, Systemic: Fever-Medium, Systemic: Headache-Severe, Systemic: Joint Pain-Severe, Systemic: Numbness (specify: facial area, extremities)-Medium, Systemic: Shakiness-Medium, Systemic: Tachycardia-Medium, Systemic: Tingling (specify: facial area, extemities)-Medium, Additional Details: Partial Left Bundle Branch Blockage. Swelling of extremeties, chest pain, hot spots on legs


VAERS ID: 1782236 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-04
Onset:2021-10-09
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 2 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: I experience a small amount of painless vaginal bleeding on10/09/2021. Then today, 10/13/2021, a larger amount of painless vaginal bleeding was present. My gynecologist office opens at 9am I will be making an appointment.


VAERS ID: 1782255 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-22
Onset:2021-10-09
   Days after vaccination:229
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 2 UN / IM

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

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

Write-up: Tested Positive for Covid


VAERS ID: 1782292 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 301358A / 1 LA / IM

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

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

Write-up: Bruising around injection site accompanied by redness and soreness.


VAERS ID: 1782294 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 3 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lymphadenopathy, Pain in extremity
SMQs:, 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: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: UNKNOWN
Diagnostic Lab Data: UNAVAILABLE/NOT APPLICABLE
CDC Split Type:

Write-up: SORE ARM, AND LYMPH NODES UNDERNEATH ARM IN WHICH VACCINE ADMINISTERED SWOLLEN. BOOSTER DOSE OF VACCINE FOR PATIENT -- DOSES 1 AND 2 IN SERIES DID NOT CAUSE THIS SIDE EFFECT (PRIMARY SERIES DATES 1/19/2021, 2/9/2021)


VAERS ID: 1782317 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pruritus
SMQs:, Anaphylactic reaction (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Patient had Vitals done, and received PO diphenhydramine 25 mg x 1 dose
CDC Split Type:

Write-up: Patient experienced itching on arms, legs and below ear on their booster dose.


VAERS ID: 1782324 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-15
Onset:2021-10-09
   Days after vaccination:236
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: unknown
Preexisting Conditions: CAD, A-fibb, CHF, DM, HTN
Allergies: Morphine
Diagnostic Lab Data: COVID-19 positive
CDC Split Type:

Write-up: Patient admitted to hospital with breakthrough COVID-19 case. Increasing SOB. 87% on room air.


VAERS ID: 1782329 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-24
Onset:2021-10-09
   Days after vaccination:199
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 LA / IM

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

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

Write-up: Patient admitted to hospital with breakthrough covid case. Fever, cough, sore throat, SOB.


VAERS ID: 1782366 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-23
Onset:2021-10-09
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Head injury, Headache, Oropharyngeal pain, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hospital Spina Bifida With Hydrocephalus Central Sleep Apnea Syndrome Neurogenic Bladder Malformation Chiari Type I Paralysis Vocal Cord Unilateral Partial Ventriculoperitoneal Status Post COVID-19 Infection Non-Hospital Reflux Esophageal Rhinitis Allergic Wound Ear Open Initial Right Myelomeningocele Voice And Resonance Disorder Pressure Injury Of Left Buttock Stage 2 Stature Short Abnormal Gait Non Orthopedic Difficulty Walking Orthopedic Multiple Joint Debility Pain Neck Pain Back Lumbar Sepsis Tachycardia Dysphagia Pharyngeal Phase Abnormality Respiratory Hypoxemia Hypocalcemia Other Abnormalities Of Gait And Mobility Weakness General Pneumonia
Allergies:
Diagnostic Lab Data: Contains abnormal data SARS Coronavirus 2, PCR Rapid, V Symptomatic 10/11/2021
CDC Split Type:

Write-up: CHIEF COMPLAINT/REASON FOR VISIT Headache and Sore Throat HISTORY OF PRESENT ILLNESS 20-year-old female with a past medical history significant for spina bifida with hydrocephalus s/p VP shunt placement and partial vocal cord paralysis presents to the ED for evaluation of a sore throat and headache. Patient states that she has been in her normal state of health until two days ago (Saturday) when she developed an intermittent sore throat. Yesterday afternoon (Sunday), she was playing a ball game when she was struck in the back of the head with a volleyball. She did not lose consciousness or have immediate pain. Yesterday night, she had an onset of intermittent pain located in the posterior right side of her head, near the site of impact. She states that the pain comes and goes and does improve when she sits upright. Her pain was most severe this morning and was an 8/10 for severity. Given her history of a VP shunt, she now presents to the ED for evaluation, though states that her pain has since resolved. Patient notes that her father was recently ill but had a negative COVID test. She denies any known COVID exposures. She endorses an intermittent cough, but attributes this to her GERD. Patient also denies any recent fever, chills, diaphoresis, congestion, rhinorrhea, vision changes, chest pain, shortness of breath, abdominal pain, nausea, vomiting, bowel changes, urinary symptoms, or neurological changes. She is vaccinated against COVID-19. Patient is G-tube dependant and reports that she has been able to tolerate her feeds without difficulty. There are no other complaints at this time.


VAERS ID: 1782395 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-01-25
Onset:2021-10-09
   Days after vaccination:257
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Decreased appetite, Mental status changes, Myalgia, SARS-CoV-2 test
SMQs:, Rhabdomyolysis/myopathy (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: type 2 diabetes, hypertension, dementia, and depression
Allergies:
Diagnostic Lab Data: 2019 Novel Coronavirus RNA PCR specimen collection 9/30/2021
CDC Split Type:

Write-up: hospitalized for covid management; symptoms include muscle aches, change in mental status, loss of appetite


VAERS ID: 1782430 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-06
Onset:2021-10-09
   Days after vaccination:217
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 2 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, SARS-CoV-2 test positive
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: alendronate, aspirin, atorvastatin, calcium carbonate/vitamin, furosemide, metoprolol succinate, mirtazapine
Current Illness:
Preexisting Conditions:
Allergies: Cefazolin, Fish Derived, Ondansetron Hcl, Ibuprofen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient admitted as inpatient on 10/10/21 due to Pneumonia due to COVID-19 virus. Patient was tested for COVID-19 and was positive on 10/9/21.


VAERS ID: 1782524 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-06
Onset:2021-10-09
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood glucose increased, Blood test, Chest pain, Computerised tomogram, Electrocardiogram, Loss of consciousness, Muscle spasms, Tongue biting, Ultrasound scan, Vertigo
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Ravipril, Thorcimide, Atorvastatin
Current Illness: N/A
Preexisting Conditions: HBP
Allergies: Pennicillin, Strawberries
Diagnostic Lab Data: CT Scan 10/09/2021 Blood Work 10/09/2021 EKG 10/09/2021 Ultrasound 10/09/2021
CDC Split Type:

Write-up: Pt. states that after receiving the 1st dose of Phizer 10/06/2021, started experiencing symptoms 10/09/2021 of full body spasms, Blood Sugar +300, chest pain, and passing out spells. Biting of the tongue during spell (similar to Seizure) Emergency Room visit 10/09/2021 CT Scan, Blood Work, EKG, and Ultrasound. Diagnosed with Vertigo and follow-up with Neurologist. Appt. with Neurologist 01/2021, still experiencing symptoms with High Blood Sugar readings continuing.


VAERS ID: 1782540 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-25
Onset:2021-10-09
   Days after vaccination:198
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID positive test on 10/9/21
CDC Split Type:

Write-up: COVID vaccine breakthrough case


VAERS ID: 1782620 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0810 / 3 LA / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Axillary pain, Breast swelling, Discomfort, Dyspnoea, Injection site pain, Injection site swelling, Oedema peripheral, Peripheral swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)

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: Women''s multi vit, immune booster vit, flownase
Current Illness:
Preexisting Conditions: asthma (not problematic for years)
Allergies: yellow jackets, wasps, regland
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site pain and swelling, under arm swelling and soreness that began the day after the vaccine. Swelling increased over next four days to the point of fluid build up in L arm, L breast, L back, L shoulder causing shortness of breath and discomfort. I followed up with my PCP due to the shortness of breath and continued swelling.


VAERS ID: 1782626 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-28
Onset:2021-10-09
   Days after vaccination:164
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Epistaxis, Headache, Pain, Productive cough, Respiratory tract congestion, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Infective pneumonia (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: Mupirocin Calcium 2 % Ointment 1 application to abrasion on leg topically until healed Twice a day hydrOXYzine HCl 25 MG Tablet 1 tablet as needed Orally qhs, prn anxiety Triamcinolone Acetonide 0.1 % Cream 1 application to affected a
Current Illness: none
Preexisting Conditions: Obesity. Dysmenorrhea/menorrhagia/uterine fibroid; endometrial hyperplasia s/p ablation. h/o brain tumordiagnosed at age 12 s/p shunt placement and radiation (secondary seizure disorder) Neurology. Arthritis. DM. CVA x2-pons Right cerebellum (-carotid ultrasound, Echocardiogram mild dilated ascending aorta 3.7cm, Ef 55-60%) subsequent CVAs felt to be secondary to prior radiation trauma. Hyperlipidemia. G1P1001. Osteopenia DEXA 6/10 (T=-1.5), 2013-nl off fosamax 5/14. Hypothyroidism. ECHO 2/2012 nl LV with EF 60%. Neuropathy(2013). Colonoscopy 9/2015 tubular adenoma repeat 3 yrs. ECHO (6/2015 stable) compared to prev 2011, nl LVF with EF 55-60%.
Allergies: Sulfa: headaches
Diagnostic Lab Data:
CDC Split Type:

Write-up: headache, occasional productive cough, body aches, wheezing d/t congestion,nose bleeds. starting 10/9/21


VAERS ID: 1782652 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820096 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cold sweat, Fall, Feeling cold, Hyperhidrosis, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (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: Albuterol
Current Illness: none
Preexisting Conditions: asthma
Allergies: none according to patient
Diagnostic Lab Data: pulse rate taken GCS checked
CDC Split Type:

Write-up: After 5 minutes of receiving the dose patient fainted and fell from a chair he was cold and clammy, and sweating


VAERS ID: 1782682 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820096 / 1 - / IM

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

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

Write-up: patient received second dose of Janssen


VAERS ID: 1782695 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-29
Onset:2021-10-09
   Days after vaccination:194
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Blood sodium decreased, Blood urea increased, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Cough, Dyspnoea, Dyspnoea exertional, Exposure to SARS-CoV-2, Fatigue, Fibrin D dimer, Lung infiltration, Oxygen saturation, Pain, Pyrexia, SARS-CoV-2 test positive, Sick relative, Vaccine breakthrough infection, White blood cell count increased
SMQs:, Acute renal failure (broad), Anaphylactic reaction (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: ALZHEIMER''S, CAD, GERD,HYPERLIPIDEMIA
Allergies: APPLE, PEACH FLAVOR AND TOMATO
Diagnostic Lab Data: SAR-COV2 NAAT-POSITIVE, CXR-BILATERAL PULMONARY INFILTRATES, 02 SAT 85% ON ROOM AIR. D-DIMER-1.50, WBC-15.9, CO2-19, BUN-24, SODIUM-133,
CDC Split Type:

Write-up: BREAKTHROUGH HOSPITALIZATION CASE. VACCINATED FOR COVID-19 IN MARCH 2021. 10/9/21-STARTED HAVING SOB AND FATIGUE INCREASING IN SEVERITY, THEN HE PRESENTED IN THE ER ON 10/10/21. HE C/O HAVING BODY ACHES, FATIGUE, NON-PRODUCTIVE COUGH AND SOB WITH EXERTION. TEMP 102.7F. HIS WIFE TESTED POSITIVE FOR COVID-19 SEVERAL DAYS BEFORE. HIS TEST WAS NEGATIVE AT THAT TIME. HE WAS TESTED AGAIN IN THE ER AND WAS POSITIVE FOR COVID-19. HE IS A FORMER SMOKER. HE WAS STARTED ON 2L OF O2. HE WAS DIAGNOSED WITH ACUTE HYPOXEMIC RESPIRATORY FAILURE, COVID-19 VIRUS INFECTION AND PNEUMONIA DUE TO COVID-19 VIRUS.


VAERS ID: 1782702 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820096 / 1 - / IM

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

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

Write-up: unknown


VAERS ID: 1782720 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820096 / 1 - / IM

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

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

Write-up: none


VAERS ID: 1782730 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820096 / UNK - / IM

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

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

Write-up: none


VAERS ID: 1782787 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 2 - / IM

Administered by: Other       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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient received a dose of Moderna Covid-19 vaccine on 10/9/2021 as the 2nd dose after receiving Pfizer''s covid-19 vaccine on 9/18/2021 as the 1st dose in the series. Pfizer was available at the clinic on that date.


VAERS ID: 1782823 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-01
Onset:2021-10-09
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none known
Current Illness: none known
Preexisting Conditions: none known
Allergies: none known
Diagnostic Lab Data: PCR + for Covid 10/9/2021
CDC Split Type:

Write-up: Client was vaccinated with Pfizer vaccines for Covid in May and June, 2021. Tested PCR + for Covid on 10/9/2021, asymptomatic. Father tested + with symptoms several days prior.


VAERS ID: 1782890 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 1 LA / IM

Administered by: Public       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 falsified DOB when registering for vaccination by stating the minor was born 08/10/2009. Guardian consented to the vaccination. Verified with statistical records that the patient''s actual DOB is 08/10/2010, which made the vaccine a contraindication. No known adverse reactions noted.


VAERS ID: 1782937 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-12
Onset:2021-10-09
   Days after vaccination:211
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 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 due to covid Hospitalized in local HCP


VAERS ID: 1782949 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Axillary pain, Injection site pain, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (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? 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: painful and swollen lymph under left armpit, a day or second day after Pfizer booster shot, and moderate to severe painful arm at site of injection.


VAERS ID: 1783058 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Florida  
Vaccinated:2021-10-02
Onset:2021-10-09
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / -

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

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

Write-up: Seven days after my second dose I developed debilitating hives. I''ve had it for 4 days. Took Zyrtec twice. it seems like when the Zyrtec effect goes away it starts again.


VAERS ID: 1783063 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301258A / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, 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? 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: Fever of over 101 degrees Fahrenheit for 6 hours and persistent fatigue for 4 days.


VAERS ID: 1783107 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 1 LA / IM

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

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

Write-up: Severe hives throughout body. Patient continues to take benadryl every 8 hours


VAERS ID: 1783113 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 LA / IM
FLUA4: INFLUENZA (SEASONAL) (FLUAD QUADRIVALENT) / SEQIRUS, INC. 312843 / N/A LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Patient came to the pharmacy on 10/13/21 to show us the reaction she had in the arm she received 2 vaccines in. It was her left arm and she had a bruise the size of a chicken egg that was starting to turn yellow. Additionally she has a faint light pink rash that extended from the bruise down the arm to almost the elbow joint more towards the inside of the arm/bicep area. Patient stated the bruise formed within 24 hours of the vaccination. Then later (unknown time frame) she started to notice the pink rash (and was warm to the touch). She has yet to contact her primary care doctor in regards to the reaction. She did receive an injection in the right arm today 10/13/21 and that is when the nurse stated the patient needed to contact us. I did confirm the injection was in the appropriate site on the arm (deltoid muscle).


VAERS ID: 1783175 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 LA / IM

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

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

Write-up: Patient is 16 YO female, arrived to clinic with mother for third dose Pfizer on 10/09/2021 at 11:00 am. Patient''s second dose Pfizer was not reviewed and verified by staff. Patient was administered the Pfizer third dose today. Per staff, patient and mother left Clinic with no adverse events. Writer reviewed patient''s prevaccination Checklist for COVID-19 Vaccines and noticed that patient''s age group is not eligible for the booster COVID-19 vaccine at this time. Mother contacted and confirmed that patient''s second dose was administered on 06/12/2021. Mother stated that patient is not experiences any adverse events at this time; however, it appears that patient may be catching a cold. Patient was scheduled with Healthcare Provider for a post vaccination follow up to address any concerns and questions. Per patient''s visit with Healthcare Provider, mother stated that patient is having nasal congestion. Writer follow up today and mother stated that patient is doing better and that nasal congestion has improved. Mother instructed to monitor symptoms and follow-up with PCP as needed.


VAERS ID: 1783185 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 LA / IM

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

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

Write-up: Patient is 14 YO male, arrived to clinic with mother for third dose Pfizer on 10/09/2021 at 11:00 am. Patient''s second dose Pfizer was not reviewed and verified by staff. Patient was administered the Pfizer third dose today. Per staff, patient and mother left Clinic with no adverse events. Writer reviewed patient''s prevaccination Checklist for COVID-19 Vaccines and noticed that patient''s age group is not eligible for the booster COVID-19 vaccine at this time. Mother contacted and confirmed that patient''s second dose was administered on 06/12/2021. Mother stated that patient is not experiences any adverse events at this time; however, it appears that patient may be catching a cold. Patient was scheduled with a HCP at a local HCF for a post vaccination follow up to address any concerns and questions. Per patient''s visit with HCP, mother stated that patient is having nasal congestion. Writer follow up today and mother stated that patient is doing better and that nasal congestion has improved. Mother instructed to monitor symptoms and follow-up with PCP as needed.


VAERS ID: 1783191 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 LA / IM

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

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

Write-up: Patient is 15 YO female, arrived to clinic with mother for third dose Pfizer on 10/09/2021 at 11:00 am. Patient''s second dose Pfizer was not reviewed and verified by staff. Patient was administered the Pfizer third dose today. Per staff, patient and mother left Clinic with no adverse events. Writer reviewed patient''s prevaccination Checklist for COVID-19 Vaccines and noticed that patient''s age group is not eligible for the booster COVID-19 vaccine at this time. Mother contacted and confirmed that patient''s second dose was administered on 06/12/2021. Mother stated that patient is not experiences any adverse events at this time; however, it appears that patient may be catching a cold. Patient was scheduled with doctor for a post vaccination follow up to address any concerns and questions. Per patient''s visit with doctor, mother stated that patient is experiencing nasal congestion. Writer follow up today and mother stated that patient is doing better and that nasal congestion has improved. Mother instructed to monitor symptoms and follow-up with PCP as needed.


VAERS ID: 1783203 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-09-27
Onset:2021-10-09
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Computerised tomogram, Magnetic resonance imaging, Transient global amnesia
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Calcium, magnesium, multivitamin, CoQ10, Vit D, Vit B12
Current Illness:
Preexisting Conditions: Osteoarthritis
Allergies:
Diagnostic Lab Data: 10/9/2021 CT scan Multiple blood tests 10/10/2021 MRI
CDC Split Type:

Write-up: Transient Global Amnesia


VAERS ID: 1783205 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cough, Injection site mass, Injection site swelling, Injection site warmth, Pyrexia, Respiratory tract congestion, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Iron supplement; multivitamin; atenolol; spironolactone; amlodipine; Lumigan; pantoprazole; Singulair; albuterol; levothyroxine
Current Illness:
Preexisting Conditions: Crohn''s disease; asthma; high blood pressure; thyroid condition; anemic
Allergies: Naldecon
Diagnostic Lab Data: N/A
CDC Split Type: vsafe

Write-up: I have had a lot of congestion, coughing uncontrollably, injection site was swollen and warm to touch next day, I have a big lump two inches from my left shoulder, runny nose, fever low grade. Went to urgent care was given prescriptions for symptoms, cough medicine bromphen 5-10 ml, ibuprofen for swelling and ice on lump, doxycycline 1 tab twice a day for 7 days, nasal spray, fluticasone 50 mcg, prednisone 20mg 2 tab by mouth for 5 days.


VAERS ID: 1783218 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-10-04
Onset:2021-10-09
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Chest pain, Computerised tomogram thorax abnormal, Dyspnoea, Dyspnoea exertional, Hiatus hernia, Lung consolidation, Muscle strain, Pleural effusion, Pulmonary embolism, Pulmonary infarction
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: back pain
Preexisting Conditions: back pain, arthritis
Allergies: none
Diagnostic Lab Data: CT PE report from 10/13/21: TRACHEA AND AIRWAYS: Trachea and central airways are patent. LUNGS AND PLEURA: Small left pleural effusion. Dense consolidation of the basilar left lower lobe and lingula consistent with areas of pulmonary infarction. Right lung is clear. No pneumothorax. No suspicious pulmonary nodules. THYROID GLAND: Normal. MEDIASTINUM, PULMONARY HILA AND AXILLAE: No mediastinal, hilar or axillary lymphadenopathy. CARDIOVASCULAR: Heart is normal in size, no pericardial effusion. Mild flattening of the interventricular septum consistent with right heart strain. Pulmonary Arteries Image quality: Satisfactory Bilateral pulmonary emboli are present involving the right and left pulmonary arteries with extension into the lobar segmental and subsegmental arteries bilaterally (series 9 images 187 and 210). RV/LV ratio in the setting of PE (axial): 1.2 UPPER ABDOMEN: Small hiatal hernia, otherwise normal. SOFT TISSUES: Normal. BONES: Normal. IMPRESSION: Bilateral pulmonary emboli as described above. CT evidence of right heart strain and areas of pulmonary infarction within the basilar left lower lobe and lingula.
CDC Split Type:

Write-up: 50 yo patient with minimal past medical hx (no cardiac disease or prior VTE) presented with dyspnea on exertion and CP after receiving pfizer vaccine booster shot on 10/4/21. SOB and CP developed 5 days after shot was administered. Found to have bilateral pulmonary emboli with signs of right heart strain. started on anticoagulation.


VAERS ID: 1783219 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 3 LA / SYR
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR - / N/A RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Immunodeficiency, Pain in extremity
SMQs:, 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: COVID Dose 2, did a report on it, Afib
Other Medications: Amlodipine; diclofenac sodium; fluoxetine; losartan; Pravastatin; vit D2; CBD oil; Centrum women''s vitamin for 50+; hair, skin and nail vitamin; magnesium; probiotic; amiodarone; Eliquis
Current Illness: A-Fib; had finished antibiotic 9/18/2021; erythromycin
Preexisting Conditions: Both hips replaced; complete hysterectomy; tonsil and adenoids out; Cataract removals in both eyes; surgery to correct severe stenosis in neck
Allergies: Penicillin; nickel
Diagnostic Lab Data: No
CDC Split Type: vsafe

Write-up: At about 02:30 the next morning, on the 9th, I woke myself up with my teeth chattering. I couldn''t stop my teeth from chattering. I wasn''t cold or feel cold. I wasn''t cold to the touch. I wasn''t running a fever. Put on an additional blanket. I was awake about an hour and 15 minutes with it. I fell back asleep. I was fine when I woke up the next morning. I do have dental implants. Because of the rods, when my face were chattering, it was loud enough to wake me up. I have never had that before. I have been chilled before, but I didn''t feel cold this time. I did have a flu shot as the same time as the booster but in a different arm. I was a little bit sore the next day but my arm wasn''t too bad. It was just a little achy but my flu shot arm felt more stiff and sore than the COVID 3rd dose arm felt.


VAERS ID: 1783405 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-10-09
Onset:2021-10-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: multiple allergens
Other Medications: diphenhydramine, cetirizine, EpiPen, allergy injections
Current Illness: no
Preexisting Conditions: mulitple allergies
Allergies: bees Allergen food panel, cbc w diff, banana, chicken meat, peach, pineapple, mixed nut profile IgE ordered
Diagnostic Lab Data:
CDC Split Type:

Write-up: hives approximately 5 min after dose. Treated with diphenhydramine-resolved


VAERS ID: 1783772 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-30
Onset:2021-10-09
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram, Dizziness, Fibrin D dimer increased, Hyperhidrosis, Injection site erythema, Injection site swelling, Injection site warmth, Palpitations, Presyncope, Tachycardia
SMQs:, Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin C Advil prn
Current Illness: N/A
Preexisting Conditions: Asthma ventricular Tachycardia
Allergies: sulfa drugs, penicillin
Diagnostic Lab Data: ED visit 10/10/21: elevated D-dimer; negative CTA for PE heart rate in 130s
CDC Split Type:

Write-up: Moderate/severe swelling, redness and warmth around injection site (diameter of an orange).- lasted 7 days dizziness, sweating, near syncope and tachycardia/palpitations- 2 episodes lasting 1-2 minutes


VAERS ID: 1783801 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Decreased appetite, Hypersomnia, Injection site erythema, Limb discomfort, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Depression (excl suicide and self injury) (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: Prescription: losartan, potassium, lamotrigine, 325 mg aspirin, levothyroxine, escitalopram, simvastatin OTC: cetirizine, fish oil, flaxseed oil, calcium with Vitamin D3, multivitamin
Current Illness: None
Preexisting Conditions: otosclerosis, osteoarthritis, osteoporosis, depression, four benign meningiomas, high blood pressure
Allergies: penicillin, vancomycin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 24 hours after the shot (Saturday 10/9), I laid down to take a short nap. When I woke up three hours later, I had a fever of 101.9 and my limbs felt really, really heavy. No appetite. Slept until 2:00 am and had a temp of 102.9 and drank more water. Felt like my limbs just hang. No energy at all. Slept through Sunday, too. Only drank water every time I woke up. Slept until 10:00 am on Monday, but was feeling better and my temp was only 99. Had soup for lunch and by 2:00 pm, I felt fine and was ready for a walk with my neighbor. I had a red oval on my upper arm, about 1" by 3" long that included the shot site. That''s gone now, too.


VAERS ID: 1783828 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-10-08
Onset:2021-10-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Chills, Dizziness, Headache, Immunodeficiency, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular 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: Levothyroxine
Current Illness: None
Preexisting Conditions: Hashimotos Disease
Allergies: Bactrim
Diagnostic Lab Data:
CDC Split Type:

Write-up: I had a high fever, chills, dizziness, headache for 3 days. Note that this was the booster shot, and the ONLY side effect from the first and second doses was a sore arm for about a day. Whoever said the booster was the same as the second vaccination is sorely mistaken.


VAERS ID: 1784215 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-06
Onset:2021-10-09
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       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: lisinopril simvastatin
Current Illness:
Preexisting Conditions:
Allergies: eggs
Diagnostic Lab Data:
CDC Split Type:

Write-up: low sounding buzz in ears


VAERS ID: 1784810 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-10-02
Onset:2021-10-09
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Asthenia, COVID-19, Chest X-ray normal, Decreased appetite, Dysstasia, Extra dose administered, Fatigue, Gait inability, Hypophagia, Hypovolaemia, Laboratory test abnormal, Loss of personal independence in daily activities, Pyrexia, SARS-CoV-2 test positive, Tachycardia, Thrombocytopenia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Haematopoietic thrombocytopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Tumour lysis syndrome (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (broad), Dehydration (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL 8 HOUR) 650 MG extended release tablet allopurinol (ZYLOPRIM) 300 MG tablet amoxicillin (AMOXIL) 500 MG tablet aspirin 81 MG tablet atorvastatin (LIPITOR) 20 MG tablet Blood Glucose Monitoring Suppl (CONTOUR NEXT EZ)
Current Illness:
Preexisting Conditions: Peripheral vascular disease Symptomatic cholelithiasis Morbid obesity due to excess calories COVID-19 COVID-19 virus infection Platelets decreased Diabetic neuropathy Cataract, age-related Tinnitus of both ears Benign essential tremor CKD (chronic kidney disease) stage 3, GFR 30-59 ml/min Dyslipidemia Type 2 diabetes mellitus Hyperuricemia w/o signs of inflam arthrit and tophaceous dis Osteoarthritis Environmental and seasonal allergies Hyperpigmented skin lesion Xerosis cutis Overweight (BMI 25.0-29.9) Generalized weakness
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized 10/9/2021; COVID-19 positive 10/9/2021; fully vaccinated DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Inability to perform activities of daily living Fatigue, unspecified type COVID-19 COVID-19 virus infection Weakness HOSPITAL COURSE: 74-year-old male with past medical history significant for diabetes type 2, dyslipidemia, diabetic neuropathy/nephropathy, hypothyroidism, lacunar infarction in the left upper extremity w/ tremor who presented to the hospital with complaints of generalized weakness associated with fever, poor appetite/oral intake and inability to stand up/ambulate. He is fully vaccinated against COVID w/ Pfizer and recently received a booster. In ER patient was tachcyardic but otherwise hemodynamically stable on RA. Labs indicative of volume depletion and AKI. CXR neg for infiltrates. He did test positive for COVID-19. Patient had poor appetite and initially required dextrose IVF for intermittent hypoglycemia.PT/OT initially recommended SAR but patient''s appetite and strength improved. He was re-evaluated 10/13 and had improved greatly so PT/OT then recommended home with HHC. Of note, he did have thrombocytopenia but looking back he had had thrombocytopenia back through 2019. Anticipate this was likely from viral COVID infection but messaged patient''s PCP to repeat labs and follow up. ROS Patient feels better today. Ate most of his dinner last night, ate some breakfast this morning. Did well with PT. Feels better overall. Less weak.


VAERS ID: 1784893 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-04
Onset:2021-10-09
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Diarrhoea, Dizziness, Headache, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), 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: Zetia and Levothyroxind
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe dizziness,nausea,vomiting,diarrhea and headache


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