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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 154 out of 10,493

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VAERS ID: 2052751 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-12-25
Submitted: 0000-00-00
Entered: 2022-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NOT KNOWN / 3 - / -

Administered by: Other       Purchased by: ?
Symptoms: Axillary mass, Herpes zoster, Immunisation, Off label use, Product use issue, SARS-CoV-2 test
SMQs:, Medication errors (broad), Opportunistic infections (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: Breast feeding (Gave birth September 2021)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Test Result: Negative ; Comments: No - Negative COVID-19 test
CDC Split Type: GBPFIZER INC202200028155

Write-up: Booster; tennis ball sized lump under my armpit; Shingles; off label use; Drug use in unapproved population; This is a spontaneous report received from a contactable Consumer from the Regulatory Agency. The reporter is the patient. Regulatory number: GB-MHRA-WEBCOVID-202201080838103620-CXR6W (MHRA). Other Case identifier(s): GB-MHRA-ADR 26452207 (MHRA). A 34 year-old female patient received bnt162b2 (COMIRNATY) (Batch/Lot number: not known) as dose 3 (booster), single for covid-19 immunisation. Relevant medical history included: "Breast feeding" (ongoing), notes: Gave birth September 2021. No other notable history. Patient has not had symptoms associated with COVID-19. The patient''s concomitant medications were not reported. Vaccination history included: Bnt162b2 (Dose 1), for COVID-19 immunization; Bnt162b2 (Dose 2), for COVID-19 immunization. The following information was reported: IMMUNISATION (medically significant), outcome "unknown", described as "Booster"; OFF LABEL USE (medically significant) with onset 2021, outcome "unknown", described as "off label use"; PRODUCT USE ISSUE (medically significant) with onset 2021, outcome "unknown", described as "Drug use in unapproved population"; HERPES ZOSTER (medically significant) with onset 25Dec2021, outcome "recovering", described as "Shingles"; AXILLARY MASS (medically significant), outcome "unknown", described as "tennis ball sized lump under my armpit". The day after booster, patient had a tennis ball sized lump under armpit and a raised patch of skin on breast. A few days later patient started to feel pain/burning on skin under her shoulder blade on the same side. 5-6 days later the shingles spots appeared in that location. GP confirmed shingles. The patient underwent the following laboratory tests and procedures: sars-cov-2 test: negative, notes: No - Negative COVID-19 test. Patient has not tested positive for COVID-19 since having the vaccine. Patient is not enrolled in clinical trial. No follow-up attempts are possible, information about batch number cannot be obtained. No further information is expected.; Sender''s Comments: Linked Report(s) : GB-PFIZER INC-202200046800 Child case


VAERS ID: 2052944 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-12-21
Onset:2021-12-25
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2022-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0000/4A / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Glossodynia, SARS-CoV-2 test
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20211225; Test Name: COVID-19 virus test; Test Result: Negative ; Result Unstructured Data: No - Negative COVID-19 test
CDC Split Type: GBMODERNATX, INC.MOD20224

Write-up: Tongue pain; This case was received via regulatory authority (Reference number: GB-MHRA-ADR 26460699) on 12-Jan-2022 and was forwarded to Moderna on 12-Jan-2022. This regulatory authority case was reported by a consumer and describes the occurrence of GLOSSODYNIA (Tongue pain) in a 46-year-old female patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) (batch no. 0000/4A) for an unknown indication. No Medical History information was reported. On 21-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 GLOSSODYNIA (Tongue pain) (seriousness criterion medically significant). On 30-Dec-2021, GLOSSODYNIA (Tongue pain) had resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 25-Dec-2021, SARS-CoV-2 test: negative (Negative) No - Negative COVID-19 test. The action taken with mRNA-1273 (Moderna CoviD-19 Vaccine) (Unknown) was unknown. No concomitant medication was reported. No treatment medication was reported. Patient did not had symptoms associated with COVID-19. 4 days after the vaccine, patient woke up and could not move tongue without extreme pain. Swallowing and talking was extremely painful and eating was impossible for 3 days. Patient was not tested positive for COVID-19 since having the vaccine. Patient was not enrolled in clinical trial. Company comment: This regulatory authority case concerns a 46-year-old female patient with no reported medical history who experienced serious unexpected event of glossodynia, that occurred approximately 4 days after the 3rd dose of the mRNA-1273 . The rechallenge was not applicable due to occurrence after the 3rd dose. The regulatory authority assessed the rechallenge as unknown. The benefit-risk relationship of mRNA-1273 is not affected by this report. Seriousness as per regulatory authority.; Sender''s Comments: This regulatory authority case concerns a 46-year-old female patient with no reported medical history who experienced serious unexpected event of glossodynia, that occurred approximately 4 days after the 3rd dose of the mRNA-1273 . The rechallenge was not applicable due to occurrence after the 3rd dose. The regulatory authority assessed the rechallenge as unknown. The benefit-risk relationship of mRNA-1273 is not affected by this report. Seriousness as per regulatory authority.


VAERS ID: 2053065 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-12-16
Onset:2021-12-25
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2022-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3005686 / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Extrasystoles, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: GBMODERNATX, INC.MOD20224

Write-up: Palpitations; Heartbeats skipped; This case was received via Regulatory Authority (Reference number: GB-MHRA-ADR 26471152) on 14-Jan-2022 and was forwarded to Moderna on 14-Jan-2022. This regulatory authority case was reported by a consumer and describes the occurrence of PALPITATIONS (Palpitations) and EXTRASYSTOLES (Heartbeats skipped) in a 54-year-old male patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) (batch no. 3005686) for an unknown indication. No Medical History information was reported. On 16-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 EXTRASYSTOLES (Heartbeats skipped) (seriousness criterion medically significant). On an unknown date, the patient experienced PALPITATIONS (Palpitations) (seriousness criterion medically significant). At the time of the report, PALPITATIONS (Palpitations) and EXTRASYSTOLES (Heartbeats skipped) had not resolved. The action taken with mRNA-1273 (Moderna CoviD-19 Vaccine) (Unknown) was unknown. Concomitant Medication use information was not provided by reporter. Patient had booster with no heart palpitations then after 9 days regular occurrence all day, every day since the booster. Patient had heart palpitations all life and heart were checked when 20 years old and told ok. Patient not had regular and severe ever.Patient was not had symptoms associated with COVID-19. Not had a COVID-19 test. Patient was not tested positive for COVID-19 since the vaccine. Patient was not enrolled in clinical trial. Treatment Medication use information was not provided by reporter. Company Comment - This regulatory authority case concerns a 54 year old male patient with medical history of palpitations, who experienced the serious (medically significant) unexpected events of palpitations and extrasystoles. The event extrasystoles occurred 9 days after the third dose of mRNA-1273 vaccine, the event palpitations occurred on an unknown date after the third dose of mRNA-1273 vaccine. Patient''s medical history of palpitations remains a confounder. The rechallenge was not applicable as there are no plans for future dosing; Sender''s Comments: This regulatory authority case concerns a 54 year old male patient with medical history of palpitations, who experienced the serious (medically significant) unexpected events of palpitations and extrasystoles. The event extrasystoles occurred 9 days after the third dose of mRNA-1273 vaccine, the event palpitations occurred on an unknown date after the third dose of mRNA-1273 vaccine. Patient''s medical history of palpitations remains a confounder. The rechallenge was not applicable as there are no plans for future dosing. The benefit-risk relationship of the mRNA-1273 vaccine is not affected by this report.


VAERS ID: 2053290 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-07-27
Onset:2021-12-25
   Days after vaccination:151
Submitted: 0000-00-00
Entered: 2022-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20220105; Test Name: COVID-19 virus test; Test Result: Positive
CDC Split Type: HKPFIZER INC202200084639

Write-up: confirmed case of Covid-19/imported case with mutant strain of n501y and t478k; confirmed case of Covid-19/imported case with mutant strain of n501y and t478k; This is a spontaneous report received from non-contactable reporter(s) (Other HCP) from License Party and Regulatory Authority. Other Case identifier(s): HK-Fosun-2022FOS000809. A 21 year-old female patient received bnt162b2 (COMIRNATY), administration date 27Jul2021 (Batch/Lot number: unknown) as dose 2, single and administration date 06Jul2021 (Batch/Lot number: unknown) as dose 1, single for covid-19 immunisation. The patient''s relevant medical history and concomitant medications were not reported. The following information was reported: VACCINATION FAILURE (medically significant), COVID-19 (medically significant) all with onset 25Dec2021, outcome "unknown" and all described as "confirmed case of Covid-19/imported case with mutant strain of n501y and t478k". It was reported that on 25-Dec-2021, the patient had symptoms. On 05-Jan-2022, the patient arrived from another country by flight. On the same day, the patient tested positive. The patient was confirmed as COVID-19 with mutant strain of N501Y and T478K. The adverse event was considered serious (important medical event). The patient underwent the following laboratory tests and procedures: sars-cov-2 test: (05Jan2022) positive. The outcome of the events was unknown. Bnt162b2 (COMIRNATY) is under agreement with BioNTech SE Causality assessment of the events COVID-19 and vaccination failure per reporter and per company was reported as possible. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.


VAERS ID: 2053374 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-12-25
Onset:2021-12-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Pain in extremity, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: ITMODERNATX, INC.MOD20224

Write-up: Adverse reaction to the ''Moderna'' covid vaccine, incessant headaches, tingling and heavy legs with still persistent pain and motor difficulty; Adverse reaction to the ''Moderna'' covid vaccine, incessant headaches, tingling and heavy legs with still persistent pain and motor difficulty; Adverse reaction to the ''Moderna'' covid vaccine, incessant headaches, tingling and heavy legs with still persistent pain and motor difficulty; This case was received via the RA (Reference number: IT-MINISAL02-826783) on 14-Jan-2022 and was forwarded to Moderna on 14-Jan-2022. This regulatory authority case was reported by a consumer and describes the occurrence of HEADACHE (Adverse reaction to the ''Moderna'' covid vaccine, incessant headaches, tingling and heavy legs with still persistent pain and motor difficulty), PAIN IN EXTREMITY (Adverse reaction to the ''Moderna'' covid vaccine, incessant headaches, tingling and heavy legs with still persistent pain and motor difficulty) and PARAESTHESIA (Adverse reaction to the ''Moderna'' covid vaccine, incessant headaches, tingling and heavy legs with still persistent pain and motor difficulty) in a 47-year-old male patient who received mRNA-1273 (Spikevax) for COVID-19 vaccination. No Medical History information was reported. On 25-Dec-2021, the patient received dose of mRNA-1273 (Spikevax) (Intramuscular) .5 milliliter. On 25-Dec-2021, the patient experienced HEADACHE (Adverse reaction to the ''Moderna'' covid vaccine, incessant headaches, tingling and heavy legs with still persistent pain and motor difficulty) (seriousness criterion disability), PAIN IN EXTREMITY (Adverse reaction to the ''Moderna'' covid vaccine, incessant headaches, tingling and heavy legs with still persistent pain and motor difficulty) (seriousness criterion disability) and PARAESTHESIA (Adverse reaction to the ''Moderna'' covid vaccine, incessant headaches, tingling and heavy legs with still persistent pain and motor difficulty) (seriousness criterion disability). At the time of the report, HEADACHE (Adverse reaction to the ''Moderna'' covid vaccine, incessant headaches, tingling and heavy legs with still persistent pain and motor difficulty), PAIN IN EXTREMITY (Adverse reaction to the ''Moderna'' covid vaccine, incessant headaches, tingling and heavy legs with still persistent pain and motor difficulty) and PARAESTHESIA (Adverse reaction to the ''Moderna'' covid vaccine, incessant headaches, tingling and heavy legs with still persistent pain and motor difficulty) had not resolved. No concomitant medications were reported. No treatment details were reported.; Sender''s Comments: This case concerns a 47-year-old male patient, with medical history, who experienced the serious (disabling or Incapacitating) unexpected events of headache, pain in extremity and paraesthesia. The events occurred approximately within 1 day after the 3rd dose of mRNA-1273, Moderna COVID-19 Vaccine. The rechallenge was considered unknown. The benefit-risk relationship of mRNA-1273, Moderna COVID-19 Vaccine is not affected by this report. Event seriousness assessed as per Regulatory Authority reporting, however there was no sufficient information in the source document supporting that the events resulted in Disabling or Incapacitating.


VAERS ID: 2053615 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-12-24
Onset:2021-12-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049F21A / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Vaccination complication
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: THMODERNATX, INC.MOD20224

Write-up: Adverse effect from covid vaccine Moderna; This case was received via Agency Regulatory Authority (Reference number: MOD-2022-229) on 10-Jan-2022 and was forwarded to Moderna on 11-Jan-2022. This regulatory authority case was reported by an other health care professional and describes the occurrence of VACCINATION COMPLICATION (Adverse effect from covid vaccine Moderna) in a 35-year-old male patient who received mRNA-1273 (COVID-19 Vaccine Moderna) (batch no. 049F21A) for an unknown indication. No Medical History information was reported. On 24-Dec-2021 at 10:00 AM, the patient received third dose of mRNA-1273 (COVID-19 Vaccine Moderna) (unknown route) 1 dosage form. On 25-Dec-2021, after starting mRNA-1273 (COVID-19 Vaccine Moderna), the patient experienced VACCINATION COMPLICATION (Adverse effect from covid vaccine Moderna) (seriousness criterion medically significant). At the time of the report, VACCINATION COMPLICATION (Adverse effect from covid vaccine Moderna) was resolving. For mRNA-1273 (COVID-19 Vaccine Moderna) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were reported. On 24 Dec 2021 at 10.00 am, the third dose of Moderna was given. On 25 Dec 2021 at 8.00 am, the vaccine recipient started to have fever,headache and body pain. He visited the physician in the hospital to receive antibiotics and drugs for related symptoms to take at home. After about 7.00 pm, he had headache, vomited 5 times and fatigue. So he returned to the hospital. Company Comment: This case concerns a 35-year-old male patient with no medical history, who experienced the unexpected serious event of Vaccination Complication, the event was reported as medically significant by the regulatory authority. The event occurred in 22 hours after receiving the third dose of mRNA-1273 Vaccine. The rechallenge was reported as not applicable by the regulatory authority. No clinical or treatment details were given. It was reported that the outcome of the event was resolving. The benefit-risk relationship of mRNA-1273 Vaccine is not affected by this report.; Sender''s Comments: This case concerns a 35-year-old male patient with no medical history, who experienced the unexpected serious event of Vaccination Complication, the event was reported as medically significant by the regulatory authority. The event occurred in 22 hours after receiving the third dose of mRNA-1273 Vaccine. The rechallenge was reported as not applicable by the regulatory authority. No clinical or treatment details were given. It was reported that the outcome of the event was resolving. The benefit-risk relationship of mRNA-1273 Vaccine is not affected by this report.


VAERS ID: 1978974 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-12-23
Onset:2021-12-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Muscle spasms, Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Dystonia (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: Lexapro 10 mg. 1 po qd
Current Illness: None
Preexisting Conditions: Anxiety
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Mild Vaginal cramping with significant spotting. Period is not due to start for 2 weeks and there is no chance of pregnancy. Symptoms started at 05:07. It is now 07:47 and I am still spotting.


VAERS ID: 1979200 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-12-23
Onset:2021-12-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 064H21A / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Hypotension, Loss of consciousness, Pyrexia, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Hypotensive, passed out, fever, vomiting


VAERS ID: 1979217 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-12-22
Onset:2021-12-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 07QH21A / 3 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft, Abilify, Lisinopril. CBD for pain relief
Current Illness: None
Preexisting Conditions: Chronic back pain
Allergies: Na
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen axillary lymph nodes


VAERS ID: 1979220 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-12-22
Onset:2021-12-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33Q258D / 3 LA / SYR

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

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

Write-up: Swollen lymph nodes in neck and arm pits


VAERS ID: 1979222 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-12-23
Onset:2021-12-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Strong tingling sensation in the fingers of both hands


VAERS ID: 1979226 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-23
Onset:2021-12-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 069H21A / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenopia, Dental paraesthesia, Paraesthesia oral
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Corneal disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluconazole 400 mg q PM, multivitamin, vitamin D.
Current Illness: Valley fever, chronic
Preexisting Conditions: Valley Fever
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: 0705: 3rd dose of Moderna given 0717: Employee reported tingling to lips, teeth, tongue, and right eye heaviness. 25 mg po Benadryl administered per protocol. O2 98 RA, HR 99. 0734: Employee reports that tingling decreased and only present in lips and teeth. 0745: Employee reports symptoms resolved.


VAERS ID: 1979237 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-12-23
Onset:2021-12-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Brain neoplasm, Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Non-haematological tumours of unspecified malignancy (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: metformin, flomax, januvia, losartan, amlodipine
Current Illness:
Preexisting Conditions: remission from prostate cancer, diabetes, high blood pressure
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Wife called the next day after the vaccine, said patient had a seizure at 830am. they called ambulance. I spoke to wife hour later to get info to fill report out, they discovered patient has brain tumor, so they believe unrelated to vaccine.


VAERS ID: 1979253 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-21
Onset:2021-12-24
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1611 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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: Vitamin C, MultiVitamin, Magnesium
Current Illness:
Preexisting Conditions:
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen arm pit on same side as injection


VAERS ID: 1979258 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-12-24
Onset:2021-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / N/A LA / IM

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

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

Write-up: 15 y/o received a Adult Pfizer Booster shot.


VAERS ID: 1979261 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-13
Onset:2021-12-24
   Days after vaccination:225
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 3 LA / IM

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

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

Write-up: The patient received their first vaccine on 1/15/21 via long term care facility and their second dose on 4/15/21 at Pharmacy. The patient then came in for an additional dose on 5/13/21. The patient''s caregiver called on 12/24/21 to schedule a booster dose at which time she was told the patient had already received 3 doses and would not need an additional dose. The patient is not reporting any symptoms and is asking for a booster shot, but the 3rd dose (05/13/21) was given early.


VAERS ID: 1979270 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: New York  
Vaccinated:2021-12-24
Onset:2021-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), 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: Pt had fainting in past when receiving previous vaccinations, not specific to any particular vaccination
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Synacope, pt briefly got light headed and slightly nauseated, almost fainted. Had history of fainting when receiving vaccination. Fully recovered w/o complaints within 15 minutes of onset.


VAERS ID: 1979282 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-12-24
Onset:2021-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1611 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Oral discomfort, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Patient stated she had an adverse event with 1st dose of Pfizer and was treated with Benadryl, at 2nd dose she required Epinephr
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Penicillin, Flagyl, Levaquin & Tamiflu
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within 3 minutes patient experienced Shortness of breath, mouth on fire, tingling all over body, feeling like she would pass out. Administered 0.3mg Epinephrine via auto injector. Within 30 seconds patient begins to recover. Verbalizes she is feeling better.


VAERS ID: 1979286 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-24
Onset:2021-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

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

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

Write-up: Fainted for a few seconds about 15 minutes after vaccination


VAERS ID: 1979294 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-12-23
Onset:2021-12-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011320A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 2 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Body temperature increased, Chills, Headache, Hyperhidrosis, Impaired work ability, Myalgia, Nausea, Neck pain
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Temp 101.3. Chills,sweating, headache, neck pain, muscle pain, joint pain, nausea 20 hours after injection. I had to call in sick to work Moderna COVID-19 vaccine EUA


VAERS ID: 1979312 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-12-24
Onset:2021-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855190 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Asthenia, Feeling abnormal, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Dementia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Foggy head, stomach tight, pins and needles feeling in hands, overall body weakness


VAERS ID: 1979325 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-08
Onset:2021-12-24
   Days after vaccination:291
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: binax rapid antigen positive for covid 12/24/21
CDC Split Type:

Write-up: tested positive for covid 12/24/21- asymptomatic, known exposure from family


VAERS ID: 1979326 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: New York  
Vaccinated:2021-12-22
Onset:2021-12-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Heart rate increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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:
Current Illness:
Preexisting Conditions:
Allergies: nka
Diagnostic Lab Data: they monitored oxygen levels and heartbeat while in hospital
CDC Split Type:

Write-up: Patient presented with trouble breathing and rapid heartbeat ten minutes after the vaccine was administered , rescue squad was contacted and they arrived about 30 minutes later. She continued to experience symptoms until they arrived and they took to er for observation for about and hour. Decided may have been anxiety attack as she was only observed and then released when she felt fine again


VAERS ID: 1979327 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Female  
Location: New York  
Vaccinated:2021-12-23
Onset:2021-12-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: none
CDC Split Type:

Write-up: 2ND DOSE GIVEN 13 DAYS AFTER FIST DOSE. [ wrong time interval] PARENT (mom) BROUGH CHILD ON THE 23RD of december 2021 for 2nd vaccine dose. dad came the next day to pharmacy . Child is doing fine. She was cleared by the emergency room according to the dad. No side effects


VAERS ID: 1979328 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-01-26
Onset:2021-12-24
   Days after vaccination:332
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: tested positive for covid 9/23/21
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: binax rapid antigen pos for covid 12/24/21
CDC Split Type:

Write-up: tested positive for covid 12/24/21- asymptomatic


VAERS ID: 1979338 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-12-24
Onset:2021-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855835 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: While waiting during his 15 minutes, patient began sweating and asked for ice pack. When I tended to him he was seated in a chair and briefly fainted. He was lowered to the floor and slowly regained consciousness. EMS was called and patient did leave with EMS.


VAERS ID: 1979342 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-12-22
Onset:2021-12-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33130BA / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site reaction, Rash, Rash erythematous
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:
CDC Split Type:

Write-up: Painful red rash on arm near and around the injection site.


VAERS ID: 1979350 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-12-22
Onset:2021-12-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1411 / 3 LA / IM

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

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

Write-up: Site: Swelling at Injection Site-Mild


VAERS ID: 1979354 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-24
Onset:2021-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028K21A / N/A LA / IM

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

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

Write-up: Error: Patient Too Young for Vaccine Administered-


VAERS ID: 1979361 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-12-23
Onset:2021-12-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1611 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Muscular weakness, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Mild fever, extreme muscle weakness, headache


VAERS ID: 1979365 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: New York  
Vaccinated:2021-12-24
Onset:2021-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 2 LA / IM

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

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

Write-up: mother of child stated she had pediatric dose for first dose and requested the same for second dose Nurse practitioner administered the pediatric dose Rejection noted by Clinical lead and system report generated. Child age 12 yrs received adult 0.3cc dose at 12/4 visit, not pediatric dose- incorrect does of pediatric dose 0.2cc give today 12/24/2021; Stated dose accepted and no need for revaccination.


VAERS ID: 1979366 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-12-24
Onset:2021-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8757 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Eye movement disorder, Pallor, Syncope, Throat tightness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: PT BECAME PALE/DIZZY/LIGHTHEADED, COLLAPSED OUT OF CHAIR ONTO FLOOR WITHOUT INJURY. GRABBED HER THROAT AND STATED HER THROAT WAS CLOSING. HER EYES ROLLED BACK IN HER HEAD THIS OCCURRED AT 12:24PM (9 MINUTES POST INJECTION) A DOSE OF 0.3MG EPINEPHRINE WAS ADMISTERED BY AUTO INJECTION INTO RIGHT THIGH AT 12:24PM. PT WAS RESPONSIVE AND TALKING SHORTLY AFTER. EMT ARRIVED AND NO OTHER MEDICAL ACTION WAS TAKEN.


VAERS ID: 1979372 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-12-24
Onset:2021-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 3 LA / IM

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

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

Write-up: Patient received booster shot in 4 months instead of at 6 months. Patient got booster shot 2 months early


VAERS ID: 1979384 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-24
Onset:2021-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / N/A - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NNE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: TOOK HIM TO THE ER VITALS WERE LOW
CDC Split Type:

Write-up: PATIETN FELT DISSNIEY AFTER THE BOOSTER PFIZER DOSE LIGHT HEADED HAD TROBLE BREATHING AND TINGLING IN HIS HANDS


VAERS ID: 1979388 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: New York  
Vaccinated:2021-12-24
Onset:2021-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 3 LA / IM

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

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

Write-up: At 2:48 p.m., nurse with patient called for assistance and for RRT to be called. Patient had syncope episode lasted 1-1.5 minutes. Patient placed on floor and legs elevated immediately. Covid vaccine was administered at 2:46 p.m. VS at 2:50 p.m. 130/68-76-95-99%RA. Patient awake and verbal. Patient states he has not eaten today. Patient give orange juice, crackers, and water. RRT arrived at 2:55 p.m. MD assessed. Patient with no c/o, states he feels better. MD asked patient if he wanted to be evaluated in ER patient and patient''s mother declined. Patient accompanied to appointment by mother and grandmother. RRT left clinic at 3:00 p.m. Patient remained in clinic until 3:30 p.m. VS obtained at 3:28 p.m. 97/68-65-99%RA. Patient''s mother states his systolic blood pressure is normally in the 90''s. Patient and mother educated if any adverse reaction occurs to go to ER. Patient left clinic at 3:30 p.m. with no c/o accompanied by mother and grandmother.


VAERS ID: 1979392 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-12-24
Onset:2021-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Head discomfort, Immediate post-injection reaction, Impaired driving ability, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow)

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

Write-up: PATIENT RECEIVED FIRST PFIZER COVID VACCINE. IMMEDIATELY FELT DIZZY AND NAUSEOUS AND HER HEAD WAS HEAVY. PT STATED SHE HASN''T EATEN ALL DAY. SO WE GAVE HER WATER AND SOME CRACKERS. IT''S BEEN 30 MINUTES AND SHE STILL FEELS DIZZY AND HEAVY HEADED. PATIENT DENIES WANTING AN AMBULANCE. PATIENT ADVISED NOT TO DRIVE. SHE IS LOOKING FOR SOMEONE TO PICK HER UP. SHE STATED SHE DRANK WATER AND TOOK TYLENOL BEFORE COMING TO GET VACCINE.


VAERS ID: 1979393 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-12-24
Onset:2021-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Hypertension, Vaccine positive rechallenge
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (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: Pfizer- high blood pressure
Other Medications: N/A
Current Illness: High blood pressure
Preexisting Conditions: High blood pressure
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had extreme high blood pressure, up to 160/108. also had high bp with second dose, pt sat still until felt okay, on blood pressure meds, told to take regular bp med and contact pcp


VAERS ID: 1979399 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-12-24
Onset:2021-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1611 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: INSULIN
Current Illness: NONE KNOWN
Preexisting Conditions: TYPE 1 DIABETES
Allergies: NO KNOWN ALLERGIES.
Diagnostic Lab Data: NONE YET
CDC Split Type:

Write-up: PFIZER DOSE #3 ADMINISTERED UNDER MINIMUM AGE (PATIENT IS 15 YEAR 9 MONTHS OLD, AND MINIMUM AGE IS 16 FOR 3RD DOSE)


VAERS ID: 1979409 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-12-24
Onset:2021-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pruritus, Injection site rash
SMQs:, Hypersensitivity (narrow)

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

Write-up: After waiting for observation patient left with family. Returned approx.. 1 hour stating a ring shaped rash developed around the injection location. Patient indicated that the rash was itchy as well


VAERS ID: 1979421 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-12-24
Onset:2021-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 1 RA / IM

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

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

Write-up: Vaccine administered without incident. Following administration patient began to feel week and nauseous. Patient was observed in vaccination area for approximately 5 minutes. Patient was feeling better and was moved to post vaccination observation area. A few minutes later patient vomited. Patient was cared for and after a few more minutes stated he was feeling much better. Patient was observed longer and left without further incident.


VAERS ID: 1979423 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-12-24
Onset:2021-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013H21B / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Patient was dizzy, nauseous, sweating after 15mts of getting the vaccine. He drank bottled water and had a sucker. After a while ,he was feeling better.


VAERS ID: 1979433 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-12-24
Onset:2021-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041J21A / 1 LA / IM

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

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

Write-up: Patient passed out about 5 minutes after receiving vaccine. Hit his head on the floor requiring stitches. Paramedics arrived and the patient passed out again.


VAERS ID: 1979435 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-24
Onset:2021-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / 4 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Inappropriate schedule of product administration, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: RX 1. metformin 500 2. metoprolol ER 25 mg 3. Telmisartan 40mg 4. Rybelsus 7 5. Farxiga 10
Current Illness: none
Preexisting Conditions: Diabetes Hypertension
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient walked into my pharmacy for Pfizer booster shot and she presented her vaccine information on the phone to pharmacy crew . She already received 2 Pfizer vaccinations on March followed by Moderna on May. The crew who helped patient failed to document her 3rd shot on the voucher that was created by us. I found out this was her 4th shot after I injected Pfizer booster shot. I have been following up with her conditions all day, she has not complained any particular adverse effects so far. I informed her to report back to me if there are any other adverse reactions that she might experience in the future.


VAERS ID: 1979436 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-12-24
Onset:2021-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855835 / 1 LA / IM

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

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

Write-up: FAINTED WITHIN 8 MINUTES OF IMZ


VAERS ID: 1979438 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-12-24
Onset:2021-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Hyperhidrosis, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: The first dose of Moderna was given in the left arm. Five minutes after the vaccine, patient began to sweat profusely. His t-shirt was soaked with sweat. His face looked pale, and skin was clammy. I asked him how he felt. The patient responded, "I feel a bit lightheaded." I had the patient remain seated. I took his blood pressure. The first reading was BP 81/50 with a HR of 54. Second reading was around 77/51 with a HR of 47. I asked the patient again how he was feeling. He responded he was "ok." I gave the patient a bottle of water and had him relax for an extra 20 minutes. After 20 minutes, patient claimed to be feeling better. I measured the BP 2 more times, first reading was at 117/84 and the second reading was 117/88. The patient again said he felt better and was ready to leave. I told the patient to have a close relative monitor him for any irregularities and to seek medical attention if he started to feel lightheaded or dizzy.


VAERS ID: 1979540 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-12-24
Onset:2021-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain in extremity, Throat irritation
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: Patient reported leg pain and itchy throat about 30 minutes after receiving a Pfizer Covid vaccine. He did not seem distressed. After sitting in the observation area for 30 more minutes, he reported that his legs felt fine and his throat was getting better. Patient''s mother opted to give him some diphenhydramine and take him home. Recommended close observation and that patient''s mother contact his physician or seek immediate care if symptoms worsened.


VAERS ID: 1979543 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-12-24
Onset:2021-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / 2 LA / IM

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

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

Write-up: a patient 12 years old came in for the second dose and after 5 minutes of giving her dose she had a split second syncope while she was waiting for her post vaccination observation time. She was ok after that split second and waited for 30 minutes with her dad. While waiting dad mentioned that she had experienced similar syncope last time with her non-covid vaccine as she gets very very nervous and anxious with immunizations. They were checked upon continuously and she was doing ok. After 30 minutes her dad confirmed she was ok and they left.


VAERS ID: 1979544 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-12-22
Onset:2021-12-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 064H21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: MMR age 10, black out/seizure once
Other Medications: Excedrin, celexa 40 mg, weekly vitamin D
Current Illness: Sinus/head cold 3 weeks prior, at home test said was not covid. It lasted 4-5 days no fever, no body aches.
Preexisting Conditions: BMI 31%, GAD/ mild depression
Allergies: Sulfa
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Rash began on front of neck upon waking and slightly itchy. The rash has progressed over entire neck (looked more like hives) I took Benadryl twice today.


VAERS ID: 1979550 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-12-23
Onset:2021-12-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1620 / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Contusion, Headache, Muscle spasms, Nausea, Tenderness
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Dystonia (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Ambien, Propafenone, Escitalopram, Diltiazem, Tylenol, Fluticasone, Cod liver oil, Vit-d, Black elderberry, Motrin and Rizateiptan
Current Illness: None
Preexisting Conditions: Migraines, Central Regional Pain Syndrome and arrhythmias
Allergies: Flacinide
Diagnostic Lab Data: None this far
CDC Split Type:

Write-up: Headache, nausea, extensive right leg charley horse and pain/tenderness just below hips with bruising


VAERS ID: 1979551 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-24
Onset:2021-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33036BD / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Immediate post-injection reaction, Presyncope
SMQs:, Anticholinergic syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Patient had a vasovagal reaction following previous vaccinations.
Other Medications: None.
Current Illness: None.
Preexisting Conditions: None.
Allergies: No known Allergies.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Client stated she has a history passing out after vaccinations. Immediately following vaccination of Pfizer booster to left deltoid, patient had a vasovagal reaction. Patient was placed in a supine position with legs elevated and supportive care was given by Doctor and clinical staff. Patient recovered instantly and was monitored for an additional 30 minutes before she left in stable condition, accompanied by her parents.


VAERS ID: 1979552 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-24
Onset:2021-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 331308A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall, Heart rate increased, Immediate post-injection reaction, Nausea, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), 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: lightheadedness and nausea with flu shot
Other Medications: one a day mulitivitamin
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: BP reading
CDC Split Type:

Write-up: Pt presented as anxious in anticipation of receiving a shot. He reported of having lightheadedness and nausea in past experiences. Immediately following completion of injection, patient experienced tremors and body shakes. Then he fell out of his chair with continued shaking. Within seconds, he got up and got back in the chair. BP registered at 118/78. Pt was alert and aware of his surrounding. Pt was asked and responded with no shortness of breath, no difficulty breathing, and slightly increased heartrate. Pt was given some water and some chocolate. He continued with some lightheadedness and nausea. He recovered after couple minutes and stayed for another 20 minutes to be monitored. He left the pharmacy and called after 10 minutes to inform us he was home safe. He continued to feel fine and no other symptoms.


VAERS ID: 1979556 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-12-20
Onset:2021-12-24
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041J21A / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site rash
SMQs:, Hypersensitivity (narrow)

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

Write-up: Patient reported to another associated she has a rash on her arm where she received the vaccination.


VAERS ID: 1979558 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-12-10
Onset:2021-12-24
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain
SMQs:, Anaphylactic reaction (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I have had a heavy chest pain all day today. It feels like pressure on my chest and hurts to inhale deeply.


VAERS ID: 1979808 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: New York  
Vaccinated:2021-12-24
Onset:2021-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 070H21A / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lips and my face around my lips stated swelling after 12 hours booster shot
Current Illness: No
Preexisting Conditions: No
Allergies: I don?t know
Diagnostic Lab Data: No
CDC Split Type:

Write-up: No symptoms at the site


VAERS ID: 1979809 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-10
Onset:2021-12-24
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045J21A / 3 LA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308486 / 1 RA / IM

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

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

Write-up: Patient fainted after getting second vaccination (Moderna booster dose 0.25ml).


VAERS ID: 1980190 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-12-24
Onset:2021-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Diarrhoea, Erythema, Hot flush, Immediate post-injection reaction, Muscle spasms, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Pseudomembranous colitis (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec
Current Illness: None
Preexisting Conditions: Raynauds.
Allergies: Penicillin, shell fish. Also any seafood when mixed with dairy. Corn. Allergic to many trees, grass,roach, cat and dog
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: As soon as i got the shot I felt a rush of heat, then itchy started to turn red but no hives yet. About 7 minutes later i felt a sharp cramp and knew i was having allergy reaction, my scalp and rest of my body got really itchy. I rush out of the store. Went home to severe diarrhea. After that the itching got worse with hives. Took a Zyrtec, the itching lasted another 1.5 hours after taking Zyrtec. Throughout the day every time I ate I had cramps and ache in my stomach.


VAERS ID: 1980871 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-23
Onset:2021-12-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 068H21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Noticed heart palpitations on the day after vaccine (about 24 hours later). Don''t remember noticing on day of vaccination.


VAERS ID: 1980877 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Unknown  
Location: Ohio  
Vaccinated:2021-12-17
Onset:2021-12-24
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain upper, Chest pain, Chills, Dizziness, Dyspnoea, Fatigue, Malaise, Nausea, Oropharyngeal pain, Pain in extremity, Pyrexia, Throat irritation
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Tdap as a child. Extreme pain in arm, dizziness, fainting hours after event. Vomiting.
Other Medications: CBD oil, Tylenol, generic Androgel testosterone 1.62% gel
Current Illness: sinus infection
Preexisting Conditions: anemia, asthma, austism spectrum
Allergies: Ceftriaxone, Chlorhexidine, Loratadine, Amoxicillin, Penicillin, fragrances, sulfites/sulfa drugs, benzoate preservatives
Diagnostic Lab Data:
CDC Split Type:

Write-up: Intial reaction was within 2 minutes of shot, with dizziness and sore, itchy throat and difficulty breathing with intense stomach pain. It lasted just under 15 minutes. The second reaction included a sore, itchy arm, very painful down the arm. Patient had trouble breathing, got fever and chills and nauseated. Dizziness, general fatigue and feeling quick ill. Chest pain was present. Duration is unknown, as the reaction is ongoing. Took Tylenol for pain and had no antihistamine that could be safely taken.


VAERS ID: 1980905 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-12-22
Onset:2021-12-24
   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 - / UNK RA / -

Administered by: Private       Purchased by: ?
Symptoms: Neck pain, 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: Levothyroxine 100mcg
Current Illness:
Preexisting Conditions: Hasimoto''s thyroiditis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: constant ringing in the Right Ear, Stabbing pain in the neck Right side


VAERS ID: 1980913 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-24
Onset:2021-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3198 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling cold, Flushing, Hyperhidrosis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Chills-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: Flushed / Sweating-Mild, Additional Details: ems was called to have patient checked, pt is okay and went home with mom. Patient felt lightheaded and felt like she was going to faint.


VAERS ID: 1980915 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-12-24
Onset:2021-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 068H21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild


VAERS ID: 1980917 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-12-24
Onset:2021-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1611 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Dizziness, Flushing, Hyperhidrosis, Hypotension, Syncope, Unresponsive to stimuli, Visual impairment
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Chills-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Hypotension-Mild, Systemic: Visual Changes/Disturbances-Medium, Systemic: Weakness-Mild


VAERS ID: 1980918 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-12-24
Onset:2021-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3197 / 3 LA / IM

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

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

Write-up: Error: Booster Given Too Early-


VAERS ID: 1980919 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-24
Onset:2021-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 070H21A / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anaphylactic reaction, Blood pressure decreased, Dizziness, Oxygen saturation decreased, Syncope, Unresponsive to stimuli, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Allergic: Anaphylaxis-Mild, Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: drop in BP and O2sat and vomiting-Medium


VAERS ID: 1980920 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-12-22
Onset:2021-12-24
   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 - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Joint stiffness, Musculoskeletal stiffness, Pyrexia, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 5mg flexeril, amethyst 90-20
Current Illness:
Preexisting Conditions: Fibromyalgia, chronic fatigue syndrome, ehler danlos
Allergies: Latex, haloperidol, tramadol
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever of 104? F starting 12h from injection. Fever broken 24 h after injection after taking 1000mg acetaminophen & 500mg NSAID. 72h after injection, onset of cervical joint stiffness and swelling on left side (injection side) locking neck in place & preventing head rotation to the right.


VAERS ID: 1980926 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-12-23
Onset:2021-12-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067H21A / 3 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Injection site hypoaesthesia, Pain, 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Birth control
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Felt no pain on the day of vaccination. The next day I woke up in the morning and my right arm went numb from the shoulder down to my elbow. Moving any part of my arm was painful. It was also mildly swollen. The next day the area affected decreased to the shoulder and halfway down my arm. It is still painful to move and touch.


VAERS ID: 1980929 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-12-22
Onset:2021-12-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dry mouth, Dry throat, Dysphagia, Oropharyngeal pain, Speech disorder, Tongue discomfort
SMQs:, Anticholinergic syndrome (broad), Dementia (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), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: J&J as the first shot at the age of 38. Side effects included sore arm, fever, chills, sweating, shivering and headache.
Other Medications: Vitamin D; Vitamin C; Ezetimibe; Simvastatin; Levothyroxine
Current Illness: None
Preexisting Conditions: Hypothyroidism
Allergies: Prednisone
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe dry mouth resulting in the following: I have difficulty swallowing food. My tongue is on fire. I have difficulty speaking. I have a sore throat resulting from a dry throat.


VAERS ID: 1980930 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-12-23
Onset:2021-12-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 070H21A / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Blood pressure increased, Fatigue, Headache, Injection site pain, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypertension (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Systemic muscle aches Systemic joint pain Fever 99.4 degrees Mild headache Fatigue Elevated blood pressure 145/85 Injection site soreness Symptoms began within 24 hours and peaked at 30 hours. Muscle and joint pain continues at 40 hours.


VAERS ID: 1980941 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Vermont  
Vaccinated:2021-12-23
Onset:2021-12-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067H21A / 3 RA / IM
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin Calcium 80 mg, Lisinopril 2.5 mg, Metoprolol Succ
Current Illness: N/A
Preexisting Conditions:
Allergies: N/A Pennicillian
Diagnostic Lab Data:
CDC Split Type:

Write-up: 12 hours post injection: Fever, overall body ach 24 hours raised rash throughout body ,headache, fever, tired


VAERS ID: 1980947 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-12-23
Onset:2021-12-24
   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 FL3197 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Body temperature increased, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Covid Biontech
Other Medications: Multivitamin, Zyrtec, Sertraline, Fish Oil, Move Free (otc joint health), vitamin D3, magnesium
Current Illness: None
Preexisting Conditions: seasonal allergies, depression (mild), hx of afib (successful treated 3 yrs prior with left atrial ablation)
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Elevated temperature 103 + F Severe body (muscle & joint) pain Symptoms started approx 12 hrs after injection and subsided approx 40 hrs after injection. Partially responded to treatmen with acetaminophen.


VAERS ID: 1980952 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-21
Onset:2021-12-24
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (AFLURIA QUADRIVALENT) / SEQIRUS, INC. - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Seizure


VAERS ID: 1980955 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-12-23
Onset:2021-12-24
   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 FD7128 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lymph node pain, Lymphadenopathy
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen and sore left axillary lymph nodes


VAERS ID: 1980961 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-12-23
Onset:2021-12-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Diarrhoea, Dizziness, Malaise
SMQs:, Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: adderal 5mg, advair 250/50, hydroxizine 50mg
Current Illness: none
Preexisting Conditions: asthma, borderline diabetes, ADD Received a bone marrow transplant 8/99 for ALL Philadelphia chromosome positive, unrelated donor 08/99. Have had a weakened immune system sinvce
Allergies: Wellbutrin, levaquin crustaceans cashews
Diagnostic Lab Data:
CDC Split Type:

Write-up: Diarrhea, feeling very dizzy, weak, general feeling of illness


VAERS ID: 1980962 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-09
Onset:2021-12-24
   Days after vaccination:290
Submitted: 0000-00-00
Entered: 2021-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 1 - / -

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

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

Write-up: Hospitalized


VAERS ID: 1980972 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-12-23
Onset:2021-12-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045J211A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Chills, Headache, Malaise, Myalgia, Nausea, Pain in extremity, Somnolence
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tamsulosin, Allpurinol, Lisinipril, Prozac, Vit B
Current Illness: NONE
Preexisting Conditions: Prostatitis, Gout, Hypertension,
Allergies: No known allergies
Diagnostic Lab Data: No
CDC Split Type:

Write-up: Two days (so far) of Severe Malaise, Chills, Muscle Aches, Headache, Sleepiness, Sore Arm, Back Pain, One short episode of nausea


VAERS ID: 1980977 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-12-23
Onset:2021-12-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain
SMQs:

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

Write-up: Pain/soreness in arm pit and under arm of injection site


VAERS ID: 1980980 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-12-21
Onset:2021-12-24
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067H21A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pruritus, 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: Same response to shot #2 administered 4/28/21
Other Medications: Birth control
Current Illness: None
Preexisting Conditions: None
Allergies: Vancomycin and Bactrim
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash and itching on right arm


VAERS ID: 1980982 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-12-23
Onset:2021-12-24
   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 EL9266 / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Induration, Injection site erythema, Muscle swelling, Pain, Pain in extremity
SMQs:, 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: multi vitamin
Current Illness: none
Preexisting Conditions: migraines
Allergies: fish
Diagnostic Lab Data:
CDC Split Type:

Write-up: very painful arm starting in evening and into next day (12-24-21) after injection. I took tylenol and salt bath which lessened the pain. Left arm deltoid muscle slightly larger than the right arm deltoid. (I''m right-handed). My left arm was very hard too much because of the pain starting evening 12-23 through mid day 12-24. Noticed redness in a triangle shape - point starting at injection site - when I showered 12-25-21. Pain still present but not as severe as day before. I put neosporin on site and will continue to monitor as this is Christmas day and not needing immediate emergent medical attention.


VAERS ID: 1980991 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-12-23
Onset:2021-12-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Nausea, Vertigo
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow)

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

Write-up: Extreme and intense vertigo, dizziness, nausea lasting all day.


VAERS ID: 1980993 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-12-22
Onset:2021-12-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067H21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Injection site erythema, Injection site pain, Injection site pruritus, Injection site reaction, Limb discomfort, Pain, Tenderness
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Olmesartan 40 mg tab; hydroxychloroquine 200 mg tab; meloxicam 7.5 mg tab; amberen for menopause; jarrow bone up bone health system; jarrow formulas glucosamine + chondroitin + MSM capsules and Rhumate.
Current Illness: Flu shot in October 2021.
Preexisting Conditions: Sjogren''s Syndrome
Allergies: Gabapentin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Redness, burning, constant itching heaviness in a wide area beyond the injection site. Temperature was a 100.2 for a day and a half. Left side below armpit was tender to the touch for 1 day. I did not have these symptoms with the first 2 shots. This is a complete dose :5 ml, not a booster. I had the usual fatigue severe body aches and chills. I am continuing to have this burning itch on my arm.


VAERS ID: 1981011 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-12-22
Onset:2021-12-24
   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 - / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Palpitations, Ventricular extrasystoles
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Cardiomyopathy (broad), Hypokalaemia (broad)

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

Write-up: Racing heart on 12/24/2021, PVCs continuing into 12/25/2021


VAERS ID: 1981014 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-12-24
Onset:2021-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asphyxia, Chest pain, Hypopnoea, Panic attack, Panic reaction
SMQs:, Acute central respiratory depression (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Respiratory failure (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: CBD oil, probiotic, vitamin D, B12, 5 HTP
Current Illness:
Preexisting Conditions: eating disorder (bulimia, anorexia), anxiety, depression
Allergies: peanuts, Macrobid (antibio)
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Panic attack approximately 6-7 hours after shot. Quick pain in chest, shallow breathing, asphyxia, panic.


VAERS ID: 1981019 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: New York  
Vaccinated:2021-12-23
Onset:2021-12-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Flank pain, Loss of consciousness, Nausea, Paraesthesia, Sleep disorder, Thirst, Tunnel vision, Vaccination site pain
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Optic nerve disorders (broad), Retinal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Received vaccine around 5:00 pm. That night I had chills, a lot of soreness in my left arm (vaccination site) and tingling in my left hand. Slept terribly, very thirsty, woke up around 8:45 am, and went to restroom. While refilling water bottle, I got nauseous and started having tunnel vision. I thought this is probably what it feels like before people faint. The next thing I knew, I passed-out. I woke up probably a minute later in the bathtub with no recollection of how I got there but with major soreness on my side. I was very nauseous for the next few hours (and also terrified). Never fainted before and no fear of needles currently.


VAERS ID: 1981055 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: New York  
Vaccinated:2021-12-22
Onset:2021-12-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid, vitamin D, magnesium, plant-based calcium
Current Illness: None
Preexisting Conditions: Hypothyroid
Allergies: Dextromethorphan
Diagnostic Lab Data:
CDC Split Type:

Write-up: Though I did not have this for my first two shots, I got an allergic chest rash a day or two after my booster. I did not feel sick, but a chest rash is my allergic reaction to the medication dextromethorphan.


VAERS ID: 1981093 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-12-23
Onset:2021-12-24
   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 FK5127 / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: I just looked at her arm, two days later and it?s swollen snd red BELOW the injections site. And sore too. But it?s a big lump. This is not COVID arm because it?s only been 48 hours I?ll be calling her doctor on Monday to discuss


VAERS ID: 1981107 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-12-15
Onset:2021-12-24
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Computerised tomogram, Haemorrhagic stroke, Intensive care, Magnetic resonance imaging head
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
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: Several. Can find out as follow-up. I think a blood thinner, very low dose of anti-anxiety medication, supplements including, turmeric, Zinc with copper, methylated B vitamins.
Current Illness: Early dementia
Preexisting Conditions: Osteoporosis
Allergies: Can find out for follow-up Had done ok with the initial 2 Moderna Vaccines
Diagnostic Lab Data: Repeated Brain MRIs and Catscans starting on date of admission (12/24/21) to Hospital to the neuro ICU.
CDC Split Type:

Write-up: Major hemorrhagic stroke


VAERS ID: 1981117 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-12-22
Onset:2021-12-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211021A / 3 RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 LA / SYR

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

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

Write-up: Fever of 102 degrees, heavy chills (shaking), headache, severe fatigue. Lasted 30 hours. Returned to normal health Sunday morning.


VAERS ID: 1981126 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-12-23
Onset:2021-12-24
   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 F13197 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Headache, Lymphadenopathy, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: fever for 2 days, age 21, date given:3/31/21, Pfizer Covid vaccine lot no:ER8733
Other Medications: Ibuprofen 200mg for fever
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: fever, headache, and very sore arm (feels like lymph nodes in underside of arm are swollen)


VAERS ID: 1981127 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-12-24
Onset:2021-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 068H21A / N/A UN / IM

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

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

Write-up: Covid Moderna booster given by LPN was given to patient who is 17 years and 8 months. No adverse effect noted.


VAERS ID: 1981130 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: New York  
Vaccinated:2021-12-23
Onset:2021-12-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Lip swelling, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: After booster shot of Moderna: headache, muscle pain, fever ,SWELLING LIPS(I received a filler on lips 2 months ago before the booster shot). The third day I am taking claritin, I plan to visit a doctor or go to urgent care, because after 3 days there is no improvement


VAERS ID: 1981132 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-12-16
Onset:2021-12-24
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / -

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

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

Write-up: Full body rash. primarily on the torso and arms.


VAERS ID: 1981141 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-12-23
Onset:2021-12-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lymph node pain, Lymphadenopathy
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: levothyroxine
Current Illness: none
Preexisting Conditions: hypothyroidism
Allergies: rash with penicillin and latex
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Sore and swollen lymph nodes in left armpit area started about 28 hours after the shot and have continued since.


VAERS ID: 1981145 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-12-24
Onset:2021-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939909 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Headache, Injection site pain, Mobility decreased, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna 2nd dose 4/8/2021 same symptoms however they were 100% worse and included uncontrolled total body shakes.
Other Medications: Doxepin, Montelukast, Zyrtec, Nasacort
Current Illness: None
Preexisting Conditions: None
Allergies: Morphine, Demerol, Medrol, Latex
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Severe muscle joint pains/aches, chills and headache. Injection site pain unable to move arm without considerable pain.


VAERS ID: 1981167 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-12-17
Onset:2021-12-24
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1620 / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Hepatitis second shot, date unknown and brand name unknown
Other Medications: Lisinopril 20mg QD, Carvedilol 3.25mg BID, Loratidine 10mg QD, Fluoxetine 10mg QD, CQ10 100mg QD, since 50mg QD, Vit C 500mg 1 tab daily, Vit D3 5000IU daily , echinacea 400mg 1 tab daily, Centrum Silver 1 tab daily, eye health complex by
Current Illness: Sore joints
Preexisting Conditions: PVC?s, mild cardiomyopathy, hypertension, high cholesterol , allergic rhinitis, arthritis, decreased hearing and vision
Allergies: PCN, adhesive, msg , thimerisol
Diagnostic Lab Data: I had to go to the ER 12/25/21 because no other clinics open. I saw a PA and nurse. I was given Acyclovir and lidocaine cream and a hydrocodone for pain. No lab work.
CDC Split Type:

Write-up: 1 week after receiving a Pfizer COVID-19 booster I developed Shingles under my left breast and across the left side of my back. I had a Shingles immunization 12/08/2014. I believe the booster triggered the shingles. A person in the ER also got shingles 1 week after her booster and she too had a Shingles shot before the booster.


VAERS ID: 1981184 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-12-24
Onset:2021-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 068H21A / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Error: Patient too young for vaccine administered.


VAERS ID: 1981194 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-16
Onset:2021-12-24
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 3 RA / IM

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

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

Write-up: COVID-19 positive after vaccination.


VAERS ID: 1981197 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-02
Onset:2021-12-24
   Days after vaccination:175
Submitted: 0000-00-00
Entered: 2021-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: PCR test 12/24/2021 positive.
CDC Split Type:

Write-up: Positive exposure (community) 12/19/2021. Became symptomatic (multiple) 12/22/2021.


VAERS ID: 1981201 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-12-22
Onset:2021-12-24
   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 33130BA / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Disorientation, Fatigue, Lymph node pain, Lymph node palpable, Lymphadenopathy
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Daily Multivitamin
Current Illness: None
Preexisting Conditions: Pre-diabetic
Allergies: None
Diagnostic Lab Data: None at the moment. I will be seeking a medical professional''s opinion if the situation does not resolve itself in a couple of weeks or if symptoms worsen. I just wanted to report the side effects since I did not have an issue with the first two doses.
CDC Split Type:

Write-up: This was the booster I received. Symptoms: Extreme fatigue and disorientation 20 hours after I received the injection. It resolved in 12 hours. I noticed some tenderness in my collarbone area about 48 hours after the injection. The supraclavicular lymph nodes are swollen on the left-side. The lump(s) are palpable on the surface and move around when pressure is exerted (pretty gross). It has been four days, and the area is still the same.


VAERS ID: 1981215 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-12-23
Onset:2021-12-24
   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 - / 3 LA / IM

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

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

Write-up: Red, itchy macular rash developed over torso, bilateral arms and legs the day after vaccine administered. No other symptoms.


VAERS ID: 1981220 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-12-17
Onset:2021-12-24
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Headache, Malaise, Myalgia, Rash erythematous, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Broke-out in hives. Large red bumps on limbs and minor bumps on face. Severe muscle and joint pain. Malaise. Headache. No fever. 98 degree steady.


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