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From the 1/21/2022 release of VAERS data:

Found 1,049,249 cases where Vaccine is COVID19 and Patient Did Not Die

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 151 out of 10,493

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VAERS ID: 1980999 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: New York  
Vaccinated:2021-12-23
Onset:2021-12-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Montelukast, Quercetin, Fish Oil/Omega 3s, Multivitamin, NAC, P-5-P
Current Illness: None.
Preexisting Conditions: None.
Allergies: None that I am aware of.
Diagnostic Lab Data: Not available, please see Item 18.
CDC Split Type:

Write-up: After having a rather uneventful first two doses (very minimal side effects), I decided to get my booster shot ~8 months after my two dose series. Being about two days now from that 3rd dose, I have been experiencing chest pain and shortness of breath. At the time of me writing this it is Christmas so I am unable to go to any sort of doctor or medical facility to get examined. However, I will be getting examined in the following week so long as my symptoms continue to persist. The Chest pain is quite persistent and I feel it almost directly in the middle of my chest and I wanted to get ahead of the curve and report it to the system. If the symptoms do persist, I will write a follow up report contingent upon my diagnosis.


VAERS ID: 1981003 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-12-23
Onset:2021-12-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthma, Fatigue, Peripheral swelling, Rash erythematous
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fatigue began 18 hours after injection. Acute asthma attack starting 36 hours after injection. Symptoms managed with nebulizer and Xopenex inhalation. Red swollen rash on inside of both forearms. Symptom started 33 hours after injection and has not resolved. Autoimmune response.


VAERS ID: 1981024 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Florida  
Vaccinated:1990-07-25
Onset:2021-12-25
   Days after vaccination:11476
Submitted: 0000-00-00
Entered: 2021-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Abnormal behaviour, Anticoagulant therapy, Cardiac arrest, Cardiogenic shock, Cardioversion, Chest X-ray abnormal, Computerised tomogram head normal, Computerised tomogram spine, Confusional state, Echocardiogram abnormal, Ejection fraction decreased, Lung infiltration, Myocardial necrosis marker, Nasal injury, Pulse absent, Restlessness, Resuscitation, Sedative therapy, Sleep disorder, Syncope, Tachypnoea, Toxicologic test, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Akathisia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None reported per family
Current Illness: none,
Preexisting Conditions: none
Allergies: no known allergies
Diagnostic Lab Data: EF 10%
CDC Split Type:

Write-up: 31-year-old male with no reported past medical history was brought in by EMS actively receiving CPR. EMS states patient''s family noted patient''s was running in the house for an unknown reason and then managed to wall, was noted not to have a pulse at that time, and family began CPR. EMS also states upon arrival patient was noted to be in VFib received for shocks, epinephrine x4, bicarb x2, and Narcan 0.4 prior to arrival. No other history obtained due to patient''s medical condition at this time. 31-year-old male with no significant past medical history who received his booster dose of Pfizer COVID vaccination on Tuesday (12/21/21). As per his wife, he continue to work out for his job during the week. In the early hours of the morning, he suddenly woke up from sleep and was very restless and confused. He was knocking things off the side of the bed and eventually stood up and walked into the wall and injured his nose. Subsequently, he collapsed and had a witnessed cardiac arrest. EMS arrived in approximately 5 minutes and he was noted to be in VFib cardiac arrest. He had a very prolonged VFib arrest and required a total of 15 electric shocks combined between EMS and ER services. He also had multiple rounds of epi. He was eventually cardioverted to sinus rhythm. On my arrival to bedside, he was tachypneic to mid 20s and currently on Versed and fentanyl infusions for sedation and dopamine at 10 mcg/k. Chest x-ray shows diffuse bilateral lung infiltrates. Status post cardiac arrest and ensuing cardiogenic shock: ROSC achieved after prolonged CPR. Cardiology and EP consults were requested and Dr. agreed to perform an EP study to rule out a primary malignant cardiac arrhythmia as a potential etiology for his sudden cardiac arrest. Primary cardiac etiologies such as myocarditis and congenital malignant arrhythmias should also be considered in the differential diagnosis. Bedside echocardiogram showed a depressed EF of 15-20% with no significant RV dilatation. Pulmonary embolism cannot be ruled out at this point. Will start heparin and perform a CT angiogram of his lungs once he is hemodynamically stable. Meanwhile, recommend starting therapeutic heparin infusion. Continue cycle cardiac enzymes. CT head and CT spine showed no acute pathologies. Urine tox screen pending.


VAERS ID: 1981032 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-12-25
Onset:2021-12-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Tinnitus
SMQs:, Hearing impairment (narrow), 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: Tamsulosin 0.4mg capsules, one capsule by mouth twice daily.
Current Illness:
Preexisting Conditions: Crohn''s Disease
Allergies: Shellfish
Diagnostic Lab Data:
CDC Split Type:

Write-up: Consistent tinnitus Shoulder joint pain as if I have been doing heavy lifting all day.


VAERS ID: 1981036 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-15
Onset:2021-12-25
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, Arterial disorder, Catheterisation cardiac abnormal, Chest discomfort, Coronary angioplasty, Coronary arterial stent insertion, Coronary artery dilatation, Coronary artery stenosis, Intensive care
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Other ischaemic heart disease (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: 70-year-old man with no significant cardiac history. He was visiting relatives for the holidays today when he developed acute onset chest discomfort. He presented to the local ER and was found to have inferior STEMI. He was emergently transferred directly to the Hospital. There was noted to be a subtotal lesion in the distal right coronary artery. The right coronary artery is a moderate caliber dominant vessel which supplies a moderate area of myocardium and is 99% stenosed in the distal segment. The lesion was predilated with a 2.5 mm balloon, stented with a 2.5 mm drug-eluting stent, and postdilated with a 2.75 mm noncompliant balloon with multiple inflations to burst rated atmospheres. There was excellent angiographic result with reduction in stenosis from 99% to 0% residual and continued TIMI-3 flow down the vessel. Admitted to ICU for recovery.


VAERS ID: 1981045 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: New York  
Vaccinated:2021-12-24
Onset:2021-12-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD7218 / 3 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chills, Dizziness, Headache, Injection site pain, Mobility decreased, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (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: First Pfizer COVID shot, date 5/28/21, already reported on this site. Headache, soreness around injection site area extending en
Other Medications: Vitamin D (4000 IU), iron (45 mg slow release), 600 units calcium
Current Illness: None
Preexisting Conditions: None
Allergies: Lactose sensitivity
Diagnostic Lab Data: None, did not seek medical attention as these side effects were considered normal for booster vaccine.
CDC Split Type:

Write-up: Headache which had started a few hours after shot became pounding headache overnight. Soreness in arm about 3 inches in diameter around injection site. These were same symptoms as in first shot. Second shot side effects were only soreness in arm. Difference is chills this third shot, in middle of night, around 1:00 AM ET. Could not stop shaking for about 5 minutes and body locked in fetal position. Spent all of the day in bed until headache cleared around 4:45 PM ET on 12/25. Drank about 30 oz water within 15 minutes of getting shot; kept drinking water and earl grey caffeinated tea during 12/24 and got up sporadically to drink water when not dizzy with headache. Ate one small banana morning of 12/25 and took reported vitamins.


VAERS ID: 1981060 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-23
Onset:2021-12-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 3 AR / IM

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

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

Write-up: Upon waking the day after the booster I observed extreme redness similar to a sunburn that was bilaterally affecting all major lymph node regions of the head/neck, axillary regions, groin regions as well as the insides of arm where they bend and belly button. His upper back is also broken out in a rash that spans down to the mid thoracic region.


VAERS ID: 1981063 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-12-19
Onset:2021-12-25
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Balance disorder, Dizziness
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Armour Thyroid 60 mg, Vitamin D 4000 IU, probiotic
Current Illness: Cold a few weeks prior
Preexisting Conditions: Hashimoto?s Thyroiditis
Allergies: shellfish
Diagnostic Lab Data: None yet
CDC Split Type:

Write-up: Overcome with extreme dizziness to the point where I almost lost balance as I was making dinner in my kitchen. Same episode happened about an hour later, although not as extreme and I was sitting down holding my baby. Now feeling mildly dizzy and need to lay down. I ate and drank water since the event happened.


VAERS ID: 1981082 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-12-20
Onset:2021-12-25
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Menstrual disorder
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: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Menstrual cycle came 2 weeks early


VAERS ID: 1981101 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-12-23
Onset:2021-12-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Crying, Mood swings
SMQs:, Dementia (broad), Depression (excl suicide and self injury) (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: Spironolactone
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: intense mood swings/crying out of nowhere all day, 2 days following the vaccine. this happened with my second shot as well, but on a more minor scale. not normal at all for me.


VAERS ID: 1981110 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: New York  
Vaccinated:2021-12-21
Onset:2021-12-25
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose normal, Condition aggravated, Respiratory arrest, Seizure, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
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: Keppra -2x a day at 1.4 ML
Current Illness: No
Preexisting Conditions: He has epilepsy (2 incidences of seizures when he was 2 years old) but had not had a seizure in over 6 years He also has severe, nonverbal autism
Allergies: No
Diagnostic Lab Data: Called 911 on holiday morning because he wasn?t breathing. Two ambulances/4 EMTs arrived. No fever, pulse was fine, blood pressure and oxygen were fine, blood sugar check was fine.
CDC Split Type:

Write-up: Pt had a breakthrough seizure 4 days after vaccination after not having a seizure in over 6 years. Was also vomiting.


VAERS ID: 1981121 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-12-23
Onset:2021-12-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / 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: None
Current Illness: No
Preexisting Conditions: No
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sever right ankle pain after waking up


VAERS ID: 1981169 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-12-23
Onset:2021-12-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211021A / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Aspartate aminotransferase increased, Blood glucose normal, Blood sodium normal, Dyspnoea, Electrocardiogram abnormal, Feeling cold, Heart rate increased, Lip discolouration, Peripheral swelling, Pyrexia, Sinus tachycardia, Skin discolouration, Tachycardia, Tremor
SMQs:, Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: GERD
Allergies: N/A
Diagnostic Lab Data: All tests conducted on 12/25: Elevated glucose of 133 Elevated AST of 42 Low sodium of 136 EKG showed sinus tachycardia with a rate of 110 bpm
CDC Split Type:

Write-up: Severe coldness and shaking, lips, nose and arms turned purple and swollen. Heavy breathing. Feet swollen. Went to ER and had elevated heart rate of bpm 120 and fever of 101.4. Tachycardic.


VAERS ID: 1981186 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-26
Onset:2021-12-25
   Days after vaccination:90
Submitted: 0000-00-00
Entered: 2021-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / 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? 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: COVID-19 positive despite getting vaccine.


VAERS ID: 1981198 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-12-23
Onset:2021-12-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3594 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lymph node pain
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: depression
Allergies: none
Diagnostic Lab Data: none, but i would have gone to the doctor if not for the information my friend shared with me.
CDC Split Type:

Write-up: Two days after receiving the vaccine I woke up with a painful lump under my left arm. With Cancer running in my family I immediately thought "oh no! I have to get this checked!". A few hours later I spoke with a friend and mentioned that I got the booster shot. She proceeds to tell me that her, her husband, and her sister all had painful lumps under their arm. that''s when i made the connection to the vaccine and i am angry! I took the time to read through the CDC website, googled what to expect yet it was not mentioned anywhere as a common side effect -- which it is! Only after she told me about it did I see articles about it. Why the lack of transparency?? This type of information lack is exactly what fuels anti-vaxxers. I do not need to get my medical information from friends, please help re-establish trust in medicine by making known information available to the public. getting important information through back-channels is infuriating to say the least. Thank you!


VAERS ID: 1981209 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-01-13
Onset:2021-12-25
   Days after vaccination:346
Submitted: 0000-00-00
Entered: 2021-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: +COVID results via rapid on 12/26/21
CDC Split Type:

Write-up: COVID positive


VAERS ID: 1981244 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-24
Onset:2021-12-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / 3 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Inflammation, Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 got Pfizer covid 19 booster shot at our pharmacy Friday 12/24/21. He came this morning & complained that he started to have pain & felt there''s "a little ball" under right arm (injection site) and inflammation since last night 12/25/21. Pt took 2 of Tylenol 500mg yesterday but not helping much. I recommended patient to see MD to have it examined for more details and take Ibuprofen OTC today.


VAERS ID: 1981256 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-25
Onset:2021-12-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1611 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Lip swelling, Pruritus, Swollen tongue, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: nka
Diagnostic Lab Data:
CDC Split Type:

Write-up: HIVES,SWALLOWN LIPS, ITCHING,REDNESS ,SWALLON TOUNGUE


VAERS ID: 1981264 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-12
Onset:2021-12-25
   Days after vaccination:316
Submitted: 0000-00-00
Entered: 2021-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6505 / 2 LA / 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? 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 positive; admitted to the hospital; supplemental oxygen; dexamethasone; remdesivir


VAERS ID: 1981277 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-12-22
Onset:2021-12-25
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33130BA / 3 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 1 AR / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anticoagulant therapy, Chest pain, Echocardiogram abnormal, Feeling abnormal, Heart rate increased, Hyponatraemia, Hypotension, Malaise, Pericarditis, Pyrexia, Troponin increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations: Dose #2 pfizer
Other Medications: None known
Current Illness: Scalp dermatitis
Preexisting Conditions: Possible past Lyme Disease, dysthymia
Allergies: Possible banana, wheat, dairy, rice allergies (Doctor has specific info)
Diagnostic Lab Data: Pericarditis via echocardiogram 12/26 as per nurse via phone. Abnormal elevated troponin levels on admittance. Hyponatrimia. Low blood pressure 88/60?. Heart rate (resting) as high as 94 bpm.
CDC Split Type:

Write-up: Shot #3 at pharmacy 12/22/2021- Patient reported feeling very unwell 12/25/2021 around 8 am complaining of " feels like I''m having a heart attack". Fever of 101.1 around 4 pm same day. Requested to go to ER 12/26/21 around 12 am due to terrible chest pain. He is still in ER at Medical Clinic. DX is pericarditis. No prior history of cardiac events. Moderate malaise during 12/21 to 12/24. Being treated currently with heparin, toradol, nitroglycerin, K+.


VAERS ID: 1981280 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-30
Onset:2021-12-25
   Days after vaccination:270
Submitted: 0000-00-00
Entered: 2021-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / 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? 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 positive; dexamethasone; supplemental oxygen; remdesivir


VAERS ID: 1981312 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-12
Onset:2021-12-25
   Days after vaccination:257
Submitted: 0000-00-00
Entered: 2021-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID PCR Positive 12/25/21
CDC Split Type:

Write-up: Admitted to hospital with breakthrough COVID infection 12/25/21


VAERS ID: 1981396 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-12-24
Onset:2021-12-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033H21A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, 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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is given a Moderna Booster Vaccine, but he is supposed to get a Pfizer Booster due to his age (Moderna is approved for 18 years old and up while he is now 17 years old). He was contacted on 12/26/2021 and stated that he was only tired and has recovered from the tiredness.


VAERS ID: 1981551 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-25
Onset:2021-12-25
   Days after vaccination:214
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: Janssen 5/25. Positive on 12/26


VAERS ID: 1981555 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-03
Onset:2021-12-25
   Days after vaccination:297
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: Janssen 3/3. Positive on 12/25


VAERS ID: 1981618 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-21
Onset:2021-12-25
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 - / -

Administered by: Other       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+ test
CDC Split Type:

Write-up: covid vaccine breakthrough


VAERS ID: 1981647 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: Wyoming  
Vaccinated:2021-12-22
Onset:2021-12-25
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 2 RA / 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: Multiple Vitamin Supplement, Albuterol
Current Illness: none
Preexisting Conditions: Asthma
Allergies: NKDA, several food allergies
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Three days after administration hives developed wide spread, has been treated with benadryl every 4 hours with hives returning 3.5 hours after benadryl administration.


VAERS ID: 1981650 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-15
Onset:2021-12-25
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, 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:
CDC Split Type:

Write-up: Breakthrough COVID case.


VAERS ID: 1981673 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-15
Onset:2021-12-25
   Days after vaccination:193
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID positive test 12/25/21
CDC Split Type:

Write-up: COVID vaccine breakthrough case


VAERS ID: 1981674 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-23
Onset:2021-12-25
   Days after vaccination:277
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: positive covid test in fully vaccinated patient


VAERS ID: 1981684 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-27
Onset:2021-12-25
   Days after vaccination:332
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, 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:
CDC Split Type:

Write-up: Fully vaccinated, not boosted, COVID infection breakthrough with unrelated inpatient patient stay.


VAERS ID: 1981685 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-22
Onset:2021-12-25
   Days after vaccination:278
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, 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:
CDC Split Type:

Write-up: Fully vaccinated, not boosted with COVID Infection breakthrough and inpatient hospital stay. Immunosuppressed with organ transplant


VAERS ID: 1981711 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-06-04
Onset:2021-12-25
   Days after vaccination:204
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 2 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 1 AR / IM

Administered by: Private       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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had 2 doses of Moderna COVID vaccine on 6/4/21 and 4/30/21, and was hospitalized for COVID pneumonia on 12/25/21, and remains hospitalized today, 12/27/21


VAERS ID: 1981713 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-22
Onset:2021-12-25
   Days after vaccination:306
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: Patient fully vaccinated with Pfizer (1/25/21, 2/22/21). Patient hospitalized on 12/25/21 and found to be COVID positive.


VAERS ID: 1981720 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-31
Onset:2021-12-25
   Days after vaccination:269
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hypertension, Atrial Fibrillation
Allergies:
Diagnostic Lab Data: COVID 19 test positive Tylenol Inpatient
CDC Split Type:

Write-up: Event occurred after 2nd vaccine. Patient was diagnosed of COVID-19


VAERS ID: 1981780 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-31
Onset:2021-12-25
   Days after vaccination:269
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Seeds, Shellfish, Shrimp
Diagnostic Lab Data: COVID 19 test positive Tylenol, ascorbic acid, remdesivir, Inpatient
CDC Split Type:

Write-up: Event occurred after 2nd vaccine. Patient was diagnosed of COVID 19


VAERS ID: 1981897 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-12-21
Onset:2021-12-25
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1611 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Chills, Confusional state, Dizziness, Electrocardiogram, Fatigue, Injection site bruising, Injection site erythema, Injection site pain, Injection site pruritus, Injection site swelling, Lethargy, Pyrexia, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Site: Bruising at Injection Site-Severe, Site: Itching at Injection Site-Medium, Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Severe, Site: Swelling at Injection Site-Severe, Systemic: Chills-Mild, Systemic: Confusion-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: Exhaustion / Lethargy-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Fever-Mild, Additional Details: Patient taken to the emergency room, they run EKG, chest x-ray and blood work. According to mom, they found no sign and symptom of myocarditis. Patient is still febrile (101)at day 6 of vaccination. At the EMS the patient was diagnosed for prolonged immune response.


VAERS ID: 1981911 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-15
Onset:2021-12-25
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Deep vein thrombosis, Ultrasound Doppler abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (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: Atorvastatin, Lamotrigine, Lisinopril, Novolin
Current Illness: Diabetes, Hypertension, high cholesterol
Preexisting Conditions: Diabetes, Hypertension, high cholesterol
Allergies: None
Diagnostic Lab Data: blood work and ultrasound of the RLE
CDC Split Type:

Write-up: Right lower extremity DVT


VAERS ID: 1981942 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-12-22
Onset:2021-12-25
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 068H21A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Eyelid ptosis, Fatigue, Headache, Pain, Vertigo
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (narrow), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow)

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

Write-up: Pt. states that after receiving the 3rd dose of Moderna 12/22/2021, started experiencing symptoms 12/25/2021 pain of the right side of the back side of the head, fatigue, shortness of breath, vertigo, and droopy eyes. Self-treating with Tylenol for pain, no noted Primary visit/communications. Still continuing to experience symptoms.


VAERS ID: 1981958 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-12-24
Onset:2021-12-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Fatigue, Injection site erythema, Injection site warmth, Peripheral swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: red yeast rice, vitamin D, melalecka vitamin supplement pack which includes cardiomega, replenex, coQ10, omega3 supplement, and probiotic) claritin and aleve taken after reaction occurred.
Current Illness: none
Preexisting Conditions: elevated cholesterol
Allergies: erythromycin, tomatoes, milk, oranges, chocolate, bee stings
Diagnostic Lab Data: none yet
CDC Split Type:

Write-up: Swelling began after 24 hours, sometime on Saturday. Patient mainly felt fatigue in the afternoon and evening on Saturday, but started ice pack and took one tablet aleve 220mg Saturday. On Sunday the redness increased up to a 4-5 inch diameter swollen reddened area. From Sunday to Monday the red swollen area increased to about a 6 inch diameter area that covers the full middle area of her outer arm. Patient reports no fever, but the injection site is red and hot. Patient came to the pharmacy at 1pm Monday to discuss the reaction. Patient says she took claritin yesterday and I suggested she switch to zyrtec today and continue cold compresses that she has been doing since Saturday and contact her doctor tomorrow if no improvement or worsening.


VAERS ID: 1981962 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-13
Onset:2021-12-25
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Pruritus, 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: ''COVID Arm'' after 2nd Moderna vaccine on 5/20/21 when I was 33
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Itchiness, small hives that flare up throughout the day, worse at night and sometimes only become red when itched. These hives move (wrist, hairline, scalp, eyebrow, above eye, neck, back, hips, groin, arm, shoulder, back of thigh, etc.) every 1 or so. No rhyme or reason and no exposure to new foods, products, chemicals. No other symptoms aside from skin reaction.


VAERS ID: 1981986 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-16
Onset:2021-12-25
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / -

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: None
Current Illness: 24 stomach bug
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hives all over body week after booster


VAERS ID: 1982061 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-12-23
Onset:2021-12-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 320308D / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Headache, Lymphadenopathy, Neck pain, Oropharyngeal pain
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: PPD skin test
Other Medications: Ginger tea, Goody''s powder
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Lymph node swelling on left side, pain on left side neck. Left sided headache, sore throat left sided


VAERS ID: 1982100 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-12-21
Onset:2021-12-25
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arrhythmia, Asthenia, Blood pressure increased, Dizziness, Electrocardiogram, Heart rate increased, Myalgia, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Cardiac arrhythmia terms, nonspecific (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Armour Thyroid, Amlodipine Besylate, Aspirin (low-dose), Hydralazine (BID); Klor-con M20 Potassium (1500 mg qd) as needed; Magnesium (400 mg qd, as needed); Vitamin D3; MK-7 (Vitamin K2) (100 mcg, qd); One-a-Day Men''s 50+ Multivitamin (qd)
Current Illness: None
Preexisting Conditions: High blood pressure; had Quadruple bypass February 2019.
Allergies: Cortisone; Iodinated Contrast Medium for CT scan; Benadryl; Raw Celery (not allergic to cooked celery); coriander seeds; Hay fever.
Diagnostic Lab Data: Blood Pressure, Pulse rate, EKG.
CDC Split Type:

Write-up: No adverse event at the time of injection, except normal muscle soreness. Early in the morning of 25 December, three and a half days after the injection, at approximately 06:00 hours, just prior to the event, I had experienced some arrhythmia, which usually signals low electrolyte levels; so I took one potassium pill (Klor-Con M20, 1500 mg). immediately after taking the potassium, I began trembling and feeling weak. Suddenly, and without warning, I began shaking violently, and my blood pressure and pulse began to rise rapidly, getting faster and faster, accompanied by severe lightheadedness, as if I were about to lose consciousness. There was no chest pain. I fought the urge to pass out and managed, with difficulty, to call 911 on my mobile phone. By the time the EMTs arrived, the feeling that I was going to pass out had abated somewhat, and my thoughts were not as cloudy, but I was still shaky and weak. I managed to go outside when the ambulance arrived and walk to the ambulance that was parked at the curb. The EMTs took me into the ambulance, where they took my blood pressure (BP) and heart rate (pulse), and did an EKG. My initial BP was, I think, around 197/99, and my pulse was, if I recall correctly, around 125 (slower than it was when the episode began). The EKG was normal. By the time they took my BP, Pulse, and EKG, everything was dropping. When my pulse rate dropped to 90, and my BP had stabilized, they asked if I wanted to go to the hospital to have them examine me, and I said no. After the EMTs left, and I sat down in my home, and I began to feel better. I monitored my blood pressure and pulse. My BP steadily dropped and leveled off at 137/77, with a pulse rate of 79 bpm (beats per minute). At 07:30 hours, I took my regularly scheduled dose of Hydralazine (vasodilator). By 08:30 hours, my BP had dropped to and leveled off at 124/75, with a pulse rate of 72 bpm. My BP remained at 124/75 after the event ended. I am not sure if the event was an adverse effect of the Pfizer COVID-19 vaccine; but I think it was, because I have never had such an event happen to me before. It seems to have caused a depletion of potassium; because after the potassium began to get into my blood stream, the symptoms began to abate. By the time I took the dose of Hydralazine, the symptoms had disappeared, and I felt calm and relaxed. As I said at the beginning of this narrative, there was never any chest pain at all. It was not a heart attack or other heart event, except for the dangerously fast pulse. Today I had another attack of weakness, but my pulse did not exceed 90-95 beats per minute; and the symptoms abated a few minutes after eating two bananas and the potassium from them began to get into my system. The reason why I cannot say for sure that it is caused by the COVID-19 vaccine is because I have a tendency to not eat right at times, and I don''t consume enough foods high in electrolytes to keep my electrolytes optimized. When my electrolytes get low, I am usually warned by a couple of arrhythmias, at which point I either eat foods high in electrolytes, like potato, sweet potato, or banana; or I''ll take a Klor-con M20 potassium pill. Either of those solutions will begin to act within 20-30 minutes, and will raise my potassium level and stop any symptoms. I also take a magnesium supplement, plus a multivitamin with magnesium, Vitamin A, and B complex. For the two days prior to the event, I had not eaten much, just one meal a day for the two days prior to the event. Whether the low electrolytes was brought on by the vaccine or was just the result of not consuming enough electrolytes, I am not certain. What I am certain of is that I have NEVER had such a severe episode until after I received the Pfizer booster shot.


VAERS ID: 1982145 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: New York  
Vaccinated:2021-12-15
Onset:2021-12-25
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

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

Write-up: Hives


VAERS ID: 1982179 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-09-26
Onset:2021-12-25
   Days after vaccination:90
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 LA / SC

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Computerised tomogram thorax, Deep vein thrombosis, Pulmonary embolism, Ultrasound Doppler abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Verapamil, Omeprazole, Escitalopram, Fish oil, Vitamin B2, Magnesium, CoQ10
Current Illness: Barrett''s esophagus, HTN, migraines
Preexisting Conditions: Barrett''s esophagus, HTN, migraines
Allergies: None
Diagnostic Lab Data: Venous ultraviolet and pulmonary CT.
CDC Split Type:

Write-up: DVT/PE; IV Heparin; Xarelto.


VAERS ID: 1982204 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-12-23
Onset:2021-12-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 069H21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood creatine phosphokinase MB, C-reactive protein increased, Chest pain, Chills, Electrocardiogram normal, Troponin I increased
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: elevated troponin I (3.5, normal <0.4ng/ml), elevated CKMB (22.3), elevated CRP (19.2), done 12/27/2021 at our hospital; EKG normal;
CDC Split Type:

Write-up: Onset of central chest pain intermittently off and on with chills 12/25, 12/26 and 12/27 with vaccination 12/23


VAERS ID: 1982932 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-04
Onset:2021-12-25
   Days after vaccination:296
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030B21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ?Multivitamins Tablet 1 tablet Orally every other day ?Ginkgo Biloba Capsule 1 tablet Orally every other day ?Krill Oil Omega-3 300 MG Capsule Orally every other day ?Ibuprofen 600 MG Tablet (Prior Auth: Rx Ref#:000005064651) Oral
Current Illness: none
Preexisting Conditions: hx Radiation for Acne. Hypothyroidism (sees endocrine). HTN (3/11). Asthma (2015). Spinal stenosis. Rectocele.
Allergies: Adhesive: rash Visipaque: CT dye Lisinopril: cough Amlodipine Besylate: GI perfumes/scents: rash vinegar: cough
Diagnostic Lab Data:
CDC Split Type:

Write-up: nasal draiange, fever . starting 12/25/21


VAERS ID: 1982964 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-08-21
Onset:2021-12-25
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: fully vaccinated with booster tested postiive for covid-19


VAERS ID: 1984207 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-12-15
Onset:2021-12-25
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041J21A / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Pruritus, Swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (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: Birth control pill (radiance)
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Full body hives that started on neck and have spread through arms, legs, etc. Very itchy, burning and swollen. Over the counter antihistamines and Benadryl not working. Started on steroids today but no relied so far. Going to the doctor tomorrow.


VAERS ID: 1984563 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-12-17
Onset:2021-12-25
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Exposure during pregnancy, Laboratory test, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (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: Prenatal vitamin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 12/27 - OB ran labs. Results TBD
CDC Split Type:

Write-up: 2nd pregnancy. Due with boy. 22 weeks pregnant at time of shot. On 12/25, broke out in full body hives starting behind ears and scalp and worked way down body. Still ongoing. Dr prescribed antihistamine, topical steroid and Pepcid. Waiting to start oral steroids given risk to pregnancy.


VAERS ID: 1984577 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-12-23
Onset:2021-12-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Vertigo
SMQs:, Vestibular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pantoprazole 40mg daily Albuterol inhaler 1-2 puffs prn Advair 1 inhalation bid
Current Illness: None
Preexisting Conditions: Asthma
Allergies: PCN Tylenol
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Vertigo. Antivert 25 mg every 4-6 hours x 72 hours Minimum relief


VAERS ID: 1984612 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-11-30
Onset:2021-12-25
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asymptomatic COVID-19, Fall, SARS-CoV-2 test positive, Syncope, Upper limb fracture
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Unexplainable syncope x2, 40 min apart. Fractured arm due to fall. Also positive Covid test after receiving vaccine. No symptoms.


VAERS ID: 1984644 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-12-24
Onset:2021-12-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 060H21A / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: red rash age 69 4/1/21 moderna second shot
Other Medications: Atorvastatin 20mg tab 1 nightly; aspirin 81 mg nightly; Preservison areds2 1 nightly; Vitamin D3 5000IU 1 nightly; multivitamins for 50+ 1 nightly
Current Illness: none
Preexisting Conditions: cardiovascular condition
Allergies: antihistamines
Diagnostic Lab Data: none
CDC Split Type:

Write-up: red rash all over my body, face swelled and eye almost swelled closed steroid injection at emergency care and rx for predisone 20 mg tabs 2 daily for 5 days


VAERS ID: 1984683 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-07
Onset:2021-12-25
   Days after vaccination:232
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, COVID-19, Diarrhoea, Nausea, SARS-CoV-2 test positive, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Rectal bleeding Endometriosis Abnormal mammogram B12 deficiency Hypothyroidism Abnormal mammogram Fatigue Multinodular goiter (nontoxic) Vitamin D deficiency Weight gain Hyperglycemia Endocrine function study abnormality Cancer of thyroid Irregular menses
Allergies: anabolic steroids, buspirone, cetirizine, contrast dye Levaquin, methylprednisone, prednisone, propofol, shellfish, sulfadiazine, walnuts, zoloft
Diagnostic Lab Data:
CDC Split Type:

Write-up: 12/28/21: This is a 36yo patient with PMH of POTS, epiploic appendagitis s/p appendectomy, cholecystectomy, lupus, endometriosis, hypothyroidism, fatty liver, and gastroparesis who presented to the ED with abdominal pain, nausea, vomiting, and diarrhea. She is found to be COVID-19 positive and GI is consulted for her abdominal pain, nausea, vomiting, and diarrhea. Please note: Patient received first dose Pfizer vaccine on 4/16/2021 Lot # ER8730 and the second dose on 5/7/2021 Lot # ER8732


VAERS ID: 1984758 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-12-23
Onset:2021-12-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059H21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dysphonia, Electrocardiogram normal, Erythema, Heart rate increased, Interchange of vaccine products, Pharyngeal swelling, Speech disorder, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hypersensitivity (narrow), Medication errors (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Fish oil pills, acidophilus, vitamin C
Current Illness: None
Preexisting Conditions: None
Allergies: No. Allergic to wasp stings
Diagnostic Lab Data: EKG, was negative - 12/27/21.
CDC Split Type:

Write-up: I previously received the Johnson and Johnson vaccine 3/3/31 and went to a Pharmacy to get a Moderna booster shot. Two days after injection on 12/25/21 I developed a few hives on the outside my both of my forearms. 50mg of Benadryl seemed to calm the reaction but give never completely faded. Later that night on the 25th some additional hives developed on my waist and backs of my knees. I took 50mg of Benadryl before bed. The next morning I woke with hives on all parts of both arms, beneath both arms around my crotch and waistline, back, shoulders, chest, neck and some redness on my face. Began prescription of 60mg of Prednisone and took first dose at approximately 12 noon. Benadryl was last taken at about 8pm. The next morning at 7am I woke with hives covering a significant amount of my body. Took daily dose of prednisone and took 50mg of Benadryl. At appx. 11am I took more Benadryl but reaction was only slightly impacted. Went out to eat lunch from 2-3 and people I was with noted my face and neck increasing in redness over the course of an hour. Took 50mg of Benadryl around 3-3:15. At 3:30 the decision was made to go to a local emergency department. While waiting to be seen by doctor I experienced chest tightness and my throat began to swell, speaking became difficult and my voice was lowered to a very low register. Quick evaluation when checking in to ED showed a 143 bpm heart rate. Upon seeing the doctor they administered epinephrine and Benadryl via IV and that calmed the reaction for some time but within 10-15 minutes hives retuned around my shoulders, chest, crotch. back, and down my arms. More Benadryl was given after about 30 minutes from original dose via IV. This calmed reaction again but it did not completely subside. Shortly after, I was released. I''ve continued taking 50mg of Benadryl every 4 hours and have seen a great reduction in symptoms but the hives continue to pop back up in smaller numbers especially with any lapses in taking Benadryl every 4 hours.


VAERS ID: 1984774 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-25
Onset:2021-12-25
   Days after vaccination:303
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Dyspnoea, Oropharyngeal pain, Pain, Pyrexia, Respiratory tract congestion
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)

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: AV block, dual-chamber pacemaker placement 8/2015. Vasovagal syncope. Gastroesophageal reflux disease. Hyperlipidemia.
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: fever 102 F, congestion, sore throat, chills, shortness of breath, and body aches starting 12/25/21.


VAERS ID: 1984796 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-23
Onset:2021-12-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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: Hives after Janssen vaccine in April 2021, age 44
Other Medications: Ibuprofen
Current Illness:
Preexisting Conditions:
Allergies: Possible delayed hypersensitivity to IV contrast
Diagnostic Lab Data:
CDC Split Type:

Write-up: I developed hives on my torso (front and back) and arms approximately 36 hours after the vaccine. The symptoms that appeared after my 12-23-21 vaccine persist today (12-28-21).


VAERS ID: 1984808 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-12-22
Onset:2021-12-25
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Lymphadenopathy
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: N/A
Preexisting Conditions: N/a
Allergies: N/a
Diagnostic Lab Data: No doctor visit as this seems to be a known and rare side effect of the vaccination.
CDC Split Type:

Write-up: Swollen lymp nodes under armpit the very next day of vaccination. Chest pain took place 3 days after vaccination. Left side chest pain and more noticeable when deep breaths are taken. There are less chest pain now exactly 1 week after booster vaccination.


VAERS ID: 1984846 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-28
Onset:2021-12-25
   Days after vaccination:119
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, COVID-19, Chest pain, Cough, Diarrhoea, Nausea, SARS-CoV-2 test positive, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (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: diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: weeks h/o cough and atypical chest pain w/ the cough abdominal pain with N/V/D x 2 weeks tested positive for COVID on 12/25 required 2L O2


VAERS ID: 1984898 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-15
Onset:2021-12-25
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D / 2 - / -

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

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

Write-up: patient admitted through the ED with general fatigue , extreme weakness n/v and synocal epidsode


VAERS ID: 1984934 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-29
Onset:2021-12-25
   Days after vaccination:330
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH J733AB / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Productive cough, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ?Amoxicillin 500 MG Capsule 4 prior to dds appt as directed , Notes: prior to dental appts ?Daily Multiple Vitamins 2 tablets Oral Once a day, Notes: ?Diclofenac Sodium 1 % Gel apply 4 grams to affected area four times a day ?Dicl
Current Illness: none
Preexisting Conditions: HTN. GERD. Anxiety, intermittent. CAD. Hyperlipidemia. Chronic warfarin therapy due to prosthetic valves. Aortic valve/root replacement and mitral valve replacement. Laminectomy. Right total knee arthroplasty. Allergic rhinitis. 6/18/2021. Negative colonoscopy with history of 2 adenomatous polyps. Next one due in 5 years.. Left cataract 9/23/2021.
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fatigue, low grade fever, spitting up some clear cough, sputum, cough 4-5 times a day. starting 12/25/21


VAERS ID: 1984974 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-12-24
Onset:2021-12-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Chest pain, Chills, Dyspnoea, Headache, Lip blister, Neck pain, Nightmare, Oral mucosal blistering, Pyrexia, Vomiting
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Shivering, fever, vomiting, dyspnea that did not go away, nightmares, headache, chest pain, mouth and lip blisters, neck and back pain,


VAERS ID: 1984975 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-24
Onset:2021-12-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Disturbance in attention, Feeling abnormal
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad)

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

Write-up: Brain fog, confusion, lack of clarity


VAERS ID: 1985099 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-13
Onset:2021-12-25
   Days after vaccination:134
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Chills, Lethargy, Nausea, Pain, SARS-CoV-2 test positive, Tachycardia, Urinary tract infection
SMQs:, Acute pancreatitis (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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Cirrhosis post NASH, DM, heaptic encephalopathy, HTN, post polio syndrome
Allergies: NKA
Diagnostic Lab Data: SARS CoV 2 PCR COVID 19 detected on 12/25/21
CDC Split Type:

Write-up: Patient completed two doses of Pfizer COVID vaccines in August 2021. She came to ED with one day onset of tachycardia, lethergy, nausea, pain, chills and admitted to the hospital on 12/25/21. She was tested positive for COVID PCR. Hospital day 4, She has been on Ceftriaxone, but it is for urinary tract infection. She has not had respiratory symptoms, and she has been on room air.


VAERS ID: 1985119 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-27
Onset:2021-12-25
   Days after vaccination:242
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: General symptom, Laboratory test
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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Was tested and urgent care on 12/21. Came in to ED on 12/25 for worsening symptoms. Hx of asthma


VAERS ID: 1985147 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-10-28
Onset:2021-12-25
   Days after vaccination:58
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 3 AR / IM

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

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

Write-up: Tested positive for Covid on 12/26/2021 after receiving 2 Covid vaccinations and a booster vaccination several months before. No treatment required at this time.


VAERS ID: 1985217 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-11
Onset:2021-12-25
   Days after vaccination:289
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cough, Feeling of body temperature change, Headache
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: Meloxicam, Rhopressa 0.02 % Solution 1 _drop into affected eye in the evening Ophthalmic before bed,Combigan 0.2-0.5 % Solution 1 _drop into affected eye Ophthalmic Twice a day, ProAir HFA 108 (90 Base) MCG/ACT Aerosol Solution 2 puffs as n
Current Illness: None.
Preexisting Conditions: Hypertension, Chronic pain - joints, psych disease - sees psych -MD, OCD, Hx substance abuse as recent as 2010, glaucoma 2010 - follows closely with OPHTHO (Stockenstrom), Depression, Asthma, Insomnia, 1/28/2011 Pneumovax, 5/2017 CSA / Pain Contract, 1/2018 Care Coordinator letter, 3/2018 opioid Refill letter sent, 4/2018 ER visit for fall, low back pain, wrist pain, 12/2018 CARE COORD letter, 3/2019 Eye exam.
Allergies: PENICILLIN DRUGS, Naproxen.
Diagnostic Lab Data:
CDC Split Type:

Write-up: headache, cough, hot/cold feeling. starting 12/25/21.


VAERS ID: 1985228 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-06
Onset:2021-12-25
   Days after vaccination:263
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030B21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Cough, Facial discomfort, Fatigue, Headache, Oropharyngeal pain, Pain
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: Acyclovir 400 MG Tablet 1 tablet as needed Orally once a day, Taking Lisinopril 20 MG Tablet 1 tablet Orally Once a day, Taking ALPRAZolam 0.5 MG Tablet TAKE 1 TABLET BY MOUTH
Current Illness: none
Preexisting Conditions: Hosp for fall- head injury, left shoulder seperation, genital herpes Dx: 2010, Anxiety, Normal colonoscopy 2019, due 2024 secondary to family history, LGSIL 2013, normal colposcopy, Left breast cyst 2016.
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: cough, sore throat, headache, chills, body aches, fatigue, having facial pressure. starting 12/25/21


VAERS ID: 1985440 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-12-24
Onset:2021-12-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PL0007 / 2 LA / SYR

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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Slight Cough
Preexisting Conditions: Vitiligo
Allergies: None
Diagnostic Lab Data: None
CDC Split Type: vsafe

Write-up: 12/25/2021 evening once we checked her in to ER. The doctor saw that she had hives and she had Benadryl 10ml 2 hours afterward it starting fading. They started slowing disappearing after she was discharged the hives were disappearing. They were all gone by the next morning 12/26/2021. First time we had seen hives on her body, no new foods or nothing new introduced. We took her to follow up care December 27th with the Doctor since all hives were gone. I showed pictures to the Doctor, and we were referred to an allergist. I have not yet made appointment.


VAERS ID: 1985471 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-12-01
Onset:2021-12-25
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041J21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary mass, Peripheral swelling, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ciprofloxacin, fluticasone, levotirizine, meloxicam, metformin, olmesartan hctz, potassium, pravastatin
Current Illness:
Preexisting Conditions:
Allergies: Morphine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt reported itching and lumps on left arm and left armpit.


VAERS ID: 1985763 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-16
Onset:2021-12-25
   Days after vaccination:253
Submitted: 0000-00-00
Entered: 2021-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Headache, Oropharyngeal pain, Pain, Respiratory tract congestion, Rhinorrhoea
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: ?PARoxetine HCl 40 MG Tablet take 1 tablet by mouth once daily Orally ?Losartan Potassium 50 MG Tablet 1 tablet Orally Once a day
Current Illness: none
Preexisting Conditions: Anxiety. Hypertension. NSVD x2. HTN.
Allergies: Lisinopril: cough - Side Effects
Diagnostic Lab Data:
CDC Split Type:

Write-up: runny nose, body aches, sore throat, congestion, slight body aches, headaches, . starting 12/25/21


VAERS ID: 1987973 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-11-20
Onset:2021-12-25
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 3 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Bell's palsy, Facial paralysis, Hypoaesthesia, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hearing impairment (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: hospital visit, diagnosis, and begin treatment on 12/26/2021
CDC Split Type:

Write-up: Bell''s Palsy... classic symptoms... numbness, drooping, nerve/muscular weakness on right side of face. Hospital visit after 36 hours of first signs. Given diagnosis then immediately began taking Anti-viral medication (Acyclovir 800mg 5x daily for 7 days), Steroid (Prednisone 20mg 3-3, 2-3,1-3 / 9days), eye gel nightly for dry eye that won''t blink or close correctly


VAERS ID: 1988350 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:2021-12-25
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204B21A / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, COVID-19, SARS-CoV-2 test, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20211225; Test Name: Body temperature; Result Unstructured Data: 102 F; Test Date: 20211226; Test Name: COVID-19 PCR test; Result Unstructured Data: Positive.
CDC Split Type: USJNJFOC20211258412

Write-up: CONFIRMED CLINICAL VACCINATION FAILURE; CONFIRMED COVID-19 INFECTION; This spontaneous report received from a patient concerned a white, not Hispanic or Latino male of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (dose number in series 1) (suspension for injection, route of admin not reported, batch number: 204B21A, expiry: UNKNOWN) dose was not reported, 1 total administered on left arm on 30-AUG-2021 for prophylactic vaccination. No concomitant medications were reported. On 25-DEC-2021, the patient started having chills and fever up to 102 F, also complained of sore throat, head congestion and upset stomach that appeared a day after. On 26-DEC-2021, the patient went to see his Health Care Professional (HCP) on 26-DEC-2021, where he was evaluated and Polymerase chain reaction (PCR) was performed, resulting positive (confirmed covid-19 infection and confirmed clinical vaccination failure). Laboratory data included: Body temperature (NR: not provided) 102 F. Laboratory data included: COVID-19 PCR test (NR: not provided) Positive. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from confirmed covid-19 infection, and the outcome of confirmed clinical vaccination failure was not reported. This report was serious (Other Medically Important Condition). This report was associated with product quality complaint: 90000208844.; Sender''s Comments: V0 20211258412-COVID-19 VACCINE AD26.COV2.S-confirmed clinical vaccination failure. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS.


VAERS ID: 1988644 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-12
Onset:2021-12-25
   Days after vaccination:257
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Cough, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (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? 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: Fever; cough; vomiting; generalized weakness


VAERS ID: 1988664 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-26
Onset:2021-12-25
   Days after vaccination:243
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Blood creatinine increased, Blood glucose increased, Blood potassium decreased, Blood sodium decreased, Blood urea increased, Chest X-ray abnormal, Cough, Decreased appetite, Fall, Laboratory test abnormal, Lung opacity, Pyrexia, Upper-airway cough syndrome
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Arthritis (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Hypokalaemia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HTN, Afib, DM, glaucoma, gout, GERD, urinary retention
Allergies: sulfa drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: 12/25/21: Patient presents to the ED with weakness and loss of appetite for several days. Patient''s son, who lives with patient, reports for the past few days, his father has not been eating much. he reports generalized weakness, resulting in multiple falls. Patient complains of bilateral hip and bilateral knee pain but states it is manageable. He did have a low grade fever a couple days ago but none since. He also has an increased non productive cough and chronic post-nasal drip. His son did have COVID about 1 month ago, but had done his best to stay away from the patient. Upon arrival to the ED, pt VS are stable, labs show Na 133, k 3.4, BG 280, BUN 32 and creatinine 1.69. CXR shows partial groundglass opacity. Patient received first dose Pfizer vaccine on 2/23/2021 Lot # EL9265 and the second dose on 3/16/2021 Lot # EN6205


VAERS ID: 1988687 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-25
Onset:2021-12-25
   Days after vaccination:214
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Covid + on 12/25/2021
CDC Split Type:

Write-up: Breakthrough Case


VAERS ID: 1988767 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-20
Onset:2021-12-25
   Days after vaccination:308
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 29K20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 2 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA FJ1620 / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cough, Headache, Rhinorrhoea
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: ?Turmeric 500 MG Capsule as directed Orally ?Co-Enzyme Q-10 30 MG Capsule 1 capsule with a meal Orally Once a day ?Vitamin D 1000 UNIT Tablet 1 tablet Orally twice a day ?Clobetasol Propionate 0.05 % Ointment 1 application Externa
Current Illness: none
Preexisting Conditions: PVCs. HTN. Hyperlipidemia. Hyperglycemia - glucose intolerance. Melanoma of back. Glaucoma. Adenomatous colon polyps. Arthritis in both knees.
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: cough, runny nose, headache starting 12/25/21


VAERS ID: 1988830 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-27
Onset:2021-12-25
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Raynaud's phenomenon
SMQs:, Immune-mediated/autoimmune disorders (narrow)

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

Write-up: Raynauds in hands left greater than right


VAERS ID: 1988902 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-27
Onset:2021-12-25
   Days after vaccination:242
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Malaise, SARS-CoV-2 test
SMQs:, COVID-19 (broad)

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

Write-up: Was tested and urgent care on 12/21. Came in to ED on 12/25 for worsening symptoms. Hx of asthma


VAERS ID: 1988998 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-06-07
Onset:2021-12-25
   Days after vaccination:201
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, SARS-CoV-2 test positive
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), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (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: Admitted 61 y.o. female with hx of OSA, COPD (home O2), Metabolic syndrome, CAD s/p pci - HFpEF, COVID-19 positive 12/17 who presented with acute on chronic respiratory failure.


VAERS ID: 1989167 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-01
Onset:2021-12-25
   Days after vaccination:268
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Splenic infarction, Splenic rupture
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), Acute central respiratory depression (narrow), Accidents and injuries (narrow), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized acute hypoxic respiratory failure with splenic infarct and rupture.


VAERS ID: 1989194 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-09-28
Onset:2021-12-25
   Days after vaccination:88
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301TT8A / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Chills, Dyspnoea, Feeling abnormal, Feeling cold, Influenza virus test negative, Night sweats, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin 1000MG twice a day, Paroxetine 20MG one daily, amlodipine 5/20MG one a day.
Current Illness: N/A
Preexisting Conditions: Diabetes
Allergies: Levaquin and shrimp
Diagnostic Lab Data: 12/26/2021 Rapid flu test Negative, COVID came back positive.
CDC Split Type: vsafe

Write-up: It was about 5PM Dec 25th, 2021. I just ate a lot and after that I was shivering and cold at night. I was shivering so bad at one point I couldn''t hold my phone. The next morning I felt horrible I decided to go into a walk in clinic because I was having a hard time breathing so I thought it was pneumonia because I''ve had it years ago. I was tested for COVID and the results came back positive on the 27th. I loss the taste and smell. My oxygen Sunday was 97 and today was 99. At night I sweat a lot and I shiver.


VAERS ID: 1989218 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-04
Onset:2021-12-25
   Days after vaccination:296
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19 pneumonia, Gastrointestinal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Hospitalized with GI bleed and COVID 19 pneumonia.


VAERS ID: 1989294 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-24
Onset:2021-12-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Pain, Pyrexia, SARS-CoV-2 test
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: PCR COVID-19 test pending
CDC Split Type:

Write-up: Body aches, chills, fever, fatigue and headache No treatment


VAERS ID: 1989340 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-12-13
Onset:2021-12-25
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012C21A / 2 LA / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Mechanical urticaria, 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: none
Current Illness: congestion
Preexisting Conditions: none
Allergies: none known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Intially after shot #2 & #3, I felt just fatigue and a headache but both symptoms subsided within 24 -36 of the shot. I also have a delayed reaction to shot #3 (moderna Booster) where on 12 days after the booster, I have hives and dermographia in random parts of my body and it is not going away


VAERS ID: 1989527 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-12-24
Onset:2021-12-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 330258D / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Gait disturbance, Headache, Loss of personal independence in daily activities, Pain
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amitriptyline, librax, botox for migraines, magnesium, multivitamin, Pravastatin, singular, tizanidine, atenolol, alprazolam
Current Illness: No
Preexisting Conditions: IBS, migraines, alopecia
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Elevated temperatures 99.8 every day since injection. Extreme body aches and exhaustion. I am only able to walk very slow because of the body pain. I have not been able to leave my house due to the excutating pain. Extreme headaches, level 7. I do suffer from migraines, my migraines are by my right occipital nerve. The headaches I am currently having are an all over brain ache, pulsating pain. Advil and tylenol are providing no relief. The CDC page said side effects only last a day or 2, I am now on day 5 of side effects and I am not seeing any relief.


VAERS ID: 1989528 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-12-14
Onset:2021-12-25
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Blood test, Peripheral swelling, Rash, SARS-CoV-2 test, Throat irritation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Acid reflux /gerd / Barrets esophagus corrected by surgery
Allergies: Nkda
Diagnostic Lab Data: 29 December 21 covid 19 molecular test completed and is currently processing. 2 er visits blood work completed 26 Dec 21 er visit 1 hospital 27 Dec 21 visit 2 hospital 29 Dec 21 follow up with primary care facility
CDC Split Type:

Write-up: Skin rash starting 25 December 21 since then rash has spread to all over body. On 27 December In joint pain begins. 28 December 21 feet and hands started to swell also scratchy throat was noticed.29 December 21 scratchy throat goes away swelling continues . I''m in sure if this is vaccine related but it happened around the time I got the moderna booster


VAERS ID: 1992426 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-12-17
Onset:2021-12-25
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 3 RA / SYR

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

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

Write-up: HIVES . INTENSE ITCHING AND BURNING SENSATION.


VAERS ID: 1992441 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-12-21
Onset:2021-12-25
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 OT / IM

Administered by: Other       Purchased by: ?
Symptoms: Hepatic enzyme increased, Influenza virus test negative, Lethargy, Loss of consciousness, Muscle twitching, Pyrexia, SARS-CoV-2 test negative, Streptococcus test negative, White blood cell count increased, X-ray
SMQs:, Torsade de pointes/QT prolongation (broad), Liver related investigations, signs and symptoms (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ibuprofen (in the evening of his first vaccination because his legs were hurting)
Current Illness: None
Preexisting Conditions: None
Allergies: N/A
Diagnostic Lab Data: Flu, Covid, Strep tests - negative X-ray White blood cell count was over 17, 000 Liver enzyme count was extremely high
CDC Split Type: vsafe

Write-up: Lethargic 103.8 fever Passed out Arm twitching He woke up in the morning with these symptoms and was sent to the ER. He was then admitted to the hospital. He stayed there overnight. He was given a 10 day course of antibiotics. He was diagnosed with possible pneumonia of the right middle lobe. He will go back to the doctor on 01/04/2022 as well.


VAERS ID: 1992553 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-23
Onset:2021-12-25
   Days after vaccination:93
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Colonoscopy, Diarrhoea, Endoscopy, Laboratory test
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid, omeprazole, hydrocortisone, gabapentin, Atarax, Sulindac, albuterol, fluticasone propionate L-lysine, Tylenol, probiotic, iron, vitamins E, D, B, K-2, calcium, magnesium, ubiquinol, fish oil, joint formula
Current Illness: None
Preexisting Conditions: Sjogren?s Syndrome Celiac disease Addison?s disease Thyroiditis
Allergies: Shellfish, milk, gluten Keflex, erythromycin, statins
Diagnostic Lab Data: Colonoscopy and endoscopy. 11/12/2021 Every lab test imaginable to rule out causes for diarrhea
CDC Split Type:

Write-up: Diarrhea 9/25/2021 - 12/18/2021 (12 weeks)


VAERS ID: 1992695 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-12-13
Onset:2021-12-25
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 3 RA / SYR

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

Write-up: Hives itchy skin 12 days after booster shot given.


VAERS ID: 1992786 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-11-17
Onset:2021-12-25
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test normal, Chest X-ray normal, Chest discomfort, Computerised tomogram normal, Dizziness, Electrocardiogram normal, Vertigo
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan potassium; metoprolol tartrate; hydrochlorothiazide; amlodipine besylate; cranberry; D mannose; berberine; flora women''s care probiotic; potassium chloride; zinc; C; Juice Plus; iron; D3; chamomile; marshmallow root
Current Illness: No
Preexisting Conditions: HBP
Allergies: None
Diagnostic Lab Data: Blood, chest x-ray, CT scan 12/25 (normal). EKG 12/27 (no change).
CDC Split Type: vsafe

Write-up: 12/25 experienced dizziness, small chest discomfort, and vertigo. Went directly ER and there they gave me a few tests: Blood, Chest X-ray, CT scan (head). Was given Antivert for dizziness and was kept overnight for observation. 12/26 after a night of observation everything came back OK, and was ordered a EKG. On 12/27 EKG was done and no issues detected. Was discharged and given Antivert and Lexapro for the duration. 12/29 ENT after exam was referred to audiologist. No appointment yet set. 01/06 Follow up with PCP.


VAERS ID: 1992996 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-09
Onset:2021-12-25
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Ophthalmic herpes zoster
SMQs:, Ocular infections (narrow), Opportunistic infections (narrow)

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

Write-up: Herpes zoster ophthalmicus


VAERS ID: 1993600 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-24
Onset:2021-12-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Shortness of Breath, Heavy breathing, minor but uncomfortable pain around chest area.


VAERS ID: 2000761 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-12-21
Onset:2021-12-25
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: 73-year-old female with a history of amyloidosis and myeloma in remission on maintenance Velcade every 2 weeks and Zometa every 3 months. She received her intial Covid vaccine- Moderna- on Tuesday of this week
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: [Moderna Covid Vaccine] use for COVID-19 under Emergency Use Authorization (EUA): pt developed covid pneumonia after receiving moderna covid shot


VAERS ID: 1994834 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-22
Onset:2021-12-25
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Contusion
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (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: FLUOXETINE; VITAMIN D [VITAMIN D NOS]; SHAROBEL; VITAMIN C COMPLEX [ASCORBIC ACID;RUTOSIDE]; VITAMIN B COMPLEX
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20214

Write-up: Patient reports noticing little bruises not like petechia, a little bit bigger but really small in weird spots first noticed 25DEC2021 yesterday and then noticed a couple more on the upper body; This spontaneous case was reported by a nurse and describes the occurrence of CONTUSION (Patient reports noticing little bruises not like petechia, a little bit bigger but really small in weird spots first noticed 25DEC2021 yesterday and then noticed a couple more on the upper body) in a 34-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 013F21A) for COVID-19 vaccination. Concomitant products included NORETHISTERONE (SHAROBEL) for Birth control pill, FLUOXETINE, VITAMIN D [VITAMIN D NOS], ASCORBIC ACID, RUTOSIDE (VITAMIN C COMPLEX [ASCORBIC ACID;RUTOSIDE]) and VITAMIN B COMPLEX for an unknown indication. On 22-Dec-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 25-Dec-2021, the patient experienced CONTUSION (Patient reports noticing little bruises not like petechia, a little bit bigger but really small in weird spots first noticed 25DEC2021 yesterday and then noticed a couple more on the upper body). The patient was treated with IBUPROFEN (MOTRIN [IBUPROFEN]) from 22-Dec-2021 to 23-Dec-2021 for Adverse event, at an unspecified dose and frequency. At the time of the report, CONTUSION (Patient reports noticing little bruises not like petechia, a little bit bigger but really small in weird spots first noticed 25DEC2021 yesterday and then noticed a couple more on the upper body) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Patient is not on any blood thinners.


VAERS ID: 1994869 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-12-25
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Axillary pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20214

Write-up: this morning g I awoke with swelling; pain in my armpit of the injection arm; This spontaneous case was reported by a pharmacist and describes the occurrence of SWELLING (this morning g I awoke with swelling) and AXILLARY PAIN (pain in my armpit of the injection arm) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 25-Dec-2021, the patient experienced SWELLING (this morning g I awoke with swelling) and AXILLARY PAIN (pain in my armpit of the injection arm). At the time of the report, SWELLING (this morning g I awoke with swelling) and AXILLARY PAIN (pain in my armpit of the injection arm) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medication were reported. No treatment medication were reported.


VAERS ID: 1994930 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-23
Onset:2021-12-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Vaccination site erythema, Vaccination site mass
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20214

Write-up: hard lump at the injection site; redness at the injection site; This spontaneous case was reported by a pharmacist and describes the occurrence of VACCINATION SITE MASS (hard lump at the injection site) and VACCINATION SITE ERYTHEMA (redness at the injection site) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 23-Dec-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 25-Dec-2021, the patient experienced VACCINATION SITE MASS (hard lump at the injection site) and VACCINATION SITE ERYTHEMA (redness at the injection site). At the time of the report, VACCINATION SITE MASS (hard lump at the injection site) and VACCINATION SITE ERYTHEMA (redness at the injection site) had not resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant products were not provided. The patient reported no pain injection. Treatment medications were not reported.


VAERS ID: 1995039 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-04-18
Onset:2021-12-25
   Days after vaccination:251
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B21-2A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Decreased appetite, Feeling abnormal, Mobility decreased
SMQs:, Dementia (broad), Parkinson-like events (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: ENBREL
Current Illness: Lyme disease (Chronic); Psoriatic arthritis; Raynaud''s disease
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20214

Write-up: He was hit hard & the last several days he has been flat on his back & can barely move; started feeling off/wasn''t myself; had no appetite; This spontaneous case was reported by a consumer and describes the occurrence of FEELING ABNORMAL (started feeling off/wasn''t myself), DECREASED APPETITE (had no appetite) and MOBILITY DECREASED (He was hit hard & the last several days he has been flat on his back & can barely move) in a 72-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 033F21A, 037C21A and 042B21-2A) for COVID-19 vaccination. Concurrent medical conditions included Psoriatic arthritis, Raynaud''s disease and Lyme disease (Chronic). Concomitant products included ETANERCEPT (ENBREL) for an unknown indication. On 18-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-May-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 23-Dec-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 25-Dec-2021, the patient experienced FEELING ABNORMAL (started feeling off/wasn''t myself) and DECREASED APPETITE (had no appetite). On 26-Dec-2021, the patient experienced MOBILITY DECREASED (He was hit hard & the last several days he has been flat on his back & can barely move). At the time of the report, FEELING ABNORMAL (started feeling off/wasn''t myself), DECREASED APPETITE (had no appetite) and MOBILITY DECREASED (He was hit hard & the last several days he has been flat on his back & can barely move) had not resolved. No Treatment information was provided. On 26Dec2021 he was hit hard & the last several days he has been flat on his back & can barely move. He has periodic flare ups from the Chronic Lyme & Psoriatic Arthritis that usually last 48 to 72 hours, but this has been going on the last several days. He made an appointment with his doctor, then canceled it after reading online there is nothing that can be done for him. He also called a local ER that told him that he could come in but there is nothing that they could do for him. He feels it is just a waiting game now.


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