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

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



Case Details (Reverse Sorted by Onset Date)

This is page 158 out of 3,524

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VAERS ID: 1333551 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: not known
Current Illness: No known illness
Preexisting Conditions: no known health conditions
Allergies: No known allergies
Diagnostic Lab Data: EMT came on the seen took her away for evalution
CDC Split Type:

Write-up: Patient reported feeling dizzy about 5 minutes after vaccination was administered


VAERS ID: 1333568 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / SYR

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

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

Write-up: Fever and body ache for 2 days after getting the shot.


VAERS ID: 1333660 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Work       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: Inadvertently administered Pfizer Covid-19 vaccine to 11 year old boy. Mom was present with child and , when child and mom were asked via an interpreter if he was 12 they both stated yes. RN did not register client, he was checked in by the interpreter, while RN was vaccinating other family members. Currently no adverse outcome. Family was called and informed. Dose 2 due after 12th birthday.


VAERS ID: 1334563 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 LA / IM
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. 1691180 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: C-reactive protein increased, Chest pain, Chills, Electrocardiogram ST segment abnormal, Electrocardiogram abnormal, Fatigue, Intensive care, Myocarditis, Respiratory viral panel, SARS-CoV-2 antibody test positive, SARS-CoV-2 test negative, Tachycardia, Troponin increased
SMQs:, Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: past history of Wolff-Parkinson-White (WPW) sp ablation 2019
Allergies: none
Diagnostic Lab Data: Troponin 16.72 (5/19), CRP 10.6 (5/19), COVID-19 IgG Ab positive (5/17), SARS-CoV2 NP swab not detected (5/17), Viral Respiratory PCR negative (5/18)
CDC Split Type:

Write-up: Recevied vaccine on 5/14 around 6 pm. Started noticing chest pain, chills and fatigue on 5/15 around 6 pm. Evaluated by ED on 5/17 subsuquently admitted to PICU with intermittent chest pain and elevated troponin in the setting of recent Covid vaccination as well as a history of WPW status post ablation with recent onset of intermittent tachycardia. EKG demonstrates nonspecific ST segment changes and has elevated troponin which likey points to myocarditis as a diagnosis. Continues with elevated troponin level, no medication intervention at this time, no longer having chest pain


VAERS ID: 1334643 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Dizziness, Fatigue, Headache, Hemiparesis, Joint lock, Musculoskeletal stiffness, Palpitations, Respiratory tract congestion
SMQs:, Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Vestibular disorders (broad), Arthritis (broad)

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

Write-up: employee states J&J covid vaccine. Now with right leg weakness, stiffness, and "locking". Headache, dizzy, weakness, congestion, fatigue, racing heart. Contacted PCP advised employee contact occupational health to report symptoms


VAERS ID: 1334668 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 1 LA / IM

Administered by: Pharmacy       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: 1334766 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Florida  
Vaccinated:0000-00-00
Onset:2021-05-15
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Diarrhoea, Eating disorder, Headache, Taste disorder, Vomiting
SMQs:, Acute pancreatitis (broad), Taste and smell disorders (narrow), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Diabetes
Preexisting Conditions: Comments: The patient did not have any known drug allergy. he had not taken any over-the-counter medications.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210532556

Write-up: DIARRHEA; THROWING UP; MOUTH FEELS LIKE GARBAGE; NOT EATING; HEADACHE; WEAKNESS; This spontaneous report received from a patient concerned a 58 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included diabetes, and other pre-existing medical conditions included the patient did not have any known drug allergy. He had not taken any over-the-counter medications. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: unknown) dose was not reported, administered on 14-MAY-2021 for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On 15-MAY-2021, the patient experienced diarrhea. On 15-MAY-2021, the patient experienced throwing up. On 15-MAY-2021, the patient experienced mouth feels like garbage. On 15-MAY-2021, the patient experienced not eating. On 15-MAY-2021, the patient experienced headache. On 15-MAY-2021, the patient experienced weakness. The action taken with covid-19 vaccine was not applicable. The patient had not recovered from diarrhea, throwing up, mouth feels like garbage, headache, weakness, and not eating. This report was non-serious.


VAERS ID: 1334772 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-05-15
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210534616

Write-up: PAIN IN THE ARM SINCE VACCINATED; This spontaneous report received from a patient concerned a male of unspecified age. The patient''s weight, height, and medical history were not reported. patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 15-MAY-2021 for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot number. No concomitant medications were reported. On 15-MAY-2021, the subject experienced pain in the arm since vaccinated. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from pain in the arm since vaccinated. This report was non-serious.


VAERS ID: 1336002 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aphonia, Asthenia, Chills, Dizziness, Dyspnoea, Heart rate increased, Hyperhidrosis, Hypersomnia, Impaired work ability, Insomnia, Lymphadenopathy, Neck mass, Pain, Skin ulcer, Thirst, Vomiting
SMQs:, 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), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lorsartan, synthyroid, hydrochloride 25, metformin, vitamin d 50000, cranberry, proabotic
Current Illness: Tetanus vaccine 14 days before
Preexisting Conditions: Severe allergies, asthma, hypoglycemia
Allergies: Shellfish, bees, steroids
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen glands in neck and loss of voice, weak, lightheaded, vomiting, chills, body aches, extreme thirst, constant sleep, heart rate high within 48 hours. At 48 hours, severe breathing issues and small sores on upper arms and chest. Now on day 5, shortness of breath continues, spells of sweating, no sleep for 2 days, and a fluid filled Knoton lower front neck. Had to miss a day and a half of work so far this week


VAERS ID: 1336035 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / SYR

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

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

Write-up: Adverse Event: Hives, redness and itching around chest Treatment: Benedryl, Allergy Medicine, Tylenol Outcome: Stopped itchiness


VAERS ID: 1336137 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 59267-1000-01 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Presyncope, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic 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? 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: (Vasovagal Response) Fainted as walking to court yard. Parent was able to assist w/o fall. Pt laid down and elevated feet. No additional treatment needed. (Initial BP 80/62 ? BP 96/68)


VAERS ID: 1336139 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 59267-1000-01 / 1 LA / IM

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

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

Write-up: (Vasovagal Response) Felt tired and ?felt like fainting? immediately after shot. Pt laid down and elevated feet. No additional treatment needed. (Initial BP 87/58)


VAERS ID: 1336140 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 59267-1000-01 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Limb injury, Presyncope, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: (Vasovagal Response) Fainted when standing up after getting vaccine. Hit shoulder on table. C/o of mild pain to shoulder, but no additional complaints. Laid down and no additional treatment needed.


VAERS ID: 1336141 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 59267-1000-01 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Presyncope, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic 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? 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: (Vasovagal Response) Felt faint and wanted to lay down when walking to court yard. Pt laid down and elevated leg. No additional treatment needed. (Initial BP 86/48 ? 5 mins 86/68, ? 10 mins 90/60)


VAERS ID: 1336142 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 59267-1000-01 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Presyncope, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: (Vasovagal Response and Mild Urticaria) ? Felt faint, had very mild rash on both arms. Pt said he saw a flash of ?blue light?. Possible to d/t laying out in the sun. Mom noted possible allergic reaction to cats at home. (Initial BP 100/62 ? 10 mins 118/68). Treatment: Diphenhydramine 50mg/ml injection on right arm.


VAERS ID: 1336144 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 59267-1000-01 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

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

Write-up: C/o Dizziness/ Headache ? Initial BP 89/62 ? 103/75


VAERS ID: 1336470 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-13
Onset:2021-05-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arteriogram coronary normal, Cardiac failure, Cardiac imaging procedure abnormal, Echocardiogram abnormal, Ejection fraction decreased, Magnetic resonance imaging heart, Myocarditis, N-terminal prohormone brain natriuretic peptide increased, Troponin increased, Wall motion score index abnormal
SMQs:, Cardiac failure (narrow), Myocardial infarction (narrow), Cardiomyopathy (narrow), Other ischaemic heart disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: Eggs
Diagnostic Lab Data: Elevated troponin I and NT-pro BNP. Echocardiogram on 5/16/21 revealed an ejection fraction of 35% with regional wall motion abnormalities. Coronary angiogram on 5/18/21 showed normal coronary arteries. Cardiac MRI on 5/19/21 showed clear evidence of myocarditis.
CDC Split Type:

Write-up: Patient developed myocarditis resulting in hospitalization at medical center. He was treated with medications for heart failure, symptoms resolved and he was discharged home with follow up in heart failure clinic.


VAERS ID: 1336545 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-07
Onset:2021-05-15
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Pityriasis rosea, 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: citalopram 40mg
Current Illness: none
Preexisting Conditions: none
Allergies: penicillin, contrast dye
Diagnostic Lab Data: none
CDC Split Type:

Write-up: pityriasis rosea, no tx, still have rash. abdomen, left upper arm and upper right thigh


VAERS ID: 1336563 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan, Zoloft, Vitamin E, Vitamin D.
Current Illness: None.
Preexisting Conditions: High blood pressure.
Allergies: None.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: She got her vaccine and had a headache which she still continues to have. It is not severe but is persistent. Normally she does not have any headaches. She does take Ibuprofen for the headaches.


VAERS ID: 1336639 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-13
Onset:2021-05-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cough, Dizziness, Fatigue, Headache, Nausea, Oropharyngeal pain, Pain, Pyrexia, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

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

Write-up: Sore throat, headache, body aches, fatigue, cough, dizziness, Fever and nausea. Still ongoing. Went to clinic to get COVID tested it was negative. Seen by a nurse practitioner, gave him meds for cough and nausea. Still hasn''t resolved 7 days later.


VAERS ID: 1336828 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / SYR

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

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

Write-up: Full body rash lasting longer than 1 week even with steroids. Currently put on stonger steroids and possibly needing further treatment.


VAERS ID: 1337141 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-05-13
Onset:2021-05-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Blood creatine phosphokinase increased, Chest pain, Dyspnoea, Echocardiogram, Electrocardiogram abnormal, Laboratory test, Pyrexia, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Not that I am aware of.
Diagnostic Lab Data: 5/16 - CKP above 1800 5/16 - abnormal EKG 5/16 - Troponin above 25 5/17 - Echocardiogram (we don?t have results of the test)
CDC Split Type:

Write-up: Patient presented high fever around 5pm the day of the vaccination. He continued with high fever and joint pain all Friday. He then presented with respiratory difficulties and chest pain when lying down on Saturday morning. He noticed that pain was less intense if he was seated upright. Pain became more intense around 10pm Saturday night. He was taken to am Emergency Room and was determined after evaluation that a cardio evaluation was granted due to abnormal labs and EKG results. Patient was transferred to secondary hospital. He was admitted for further evaluation and treatment.


VAERS ID: 1337530 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 RA / IM

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

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

Write-up: Headache and fever up to approx 102F for over 10 hours. Treated with ibuprofen and cold compresses.


VAERS ID: 1337561 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow)

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

Write-up: Bruising on arm


VAERS ID: 1337746 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816025 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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 vaccinated under age 18


VAERS ID: 1338373 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Blood test abnormal, Chest pain, Chills, Dizziness, Echocardiogram, Electrocardiogram, Fatigue, Headache, Injection site pain, Magnetic resonance imaging heart, Muscle spasms, Myocarditis, Nausea, Pyrexia, Tremor, Troponin increased
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Allergic to dairy, gluten sensitive
Diagnostic Lab Data: May 18: Blood Tests which detected elevated troponin levels, EKG, echocardiogram May 19: Echocardiogram, Cardiac MRI, and more blood tests May 20th: blood tests
CDC Split Type:

Write-up: 13 Hours After Dose: Chills set in, which caused back spasming and back muscle seizing in addition to shaking for approximately 20 minutes (it may have been convulsions). Also had a fever, nausea, dizziness, and injection site pain. 24-70 hours later: Fatigue and a headache 70 hours later: Woke up with major chest pains and went to ER. Testing eventually determined it to be myocarditis. Hospital stay was approximately 54 hours.


VAERS ID: 1338399 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Fall, Limb discomfort, Malaise, Pallor, Palpitations, Presyncope, Pulse abnormal, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: On 5/15, at 4:00pm while in the shower, patient had a pre-syncopal episode with dizziness, and heaviness in her arms and legs. Before she fell I was able to assist her to a sitting position. Her skin was pale and clammy, pulse thready 90bpm, bp 80/50. Symptoms improved after 15 minutes. On 5/21, at 10:00am was outside at a school sports activity. She began to feel slightly dizzy. She ran a short race and the dizziness was worse. She was pale, hr 120, bp 100/60. She drank fluids and rested but still felt unwell and a headache started so she came home. The headache evolved into a severe migraine with several episodes of vomiting. She also felt heart palpitations, which is unusual with her migraines. Hr was 100 and regular. Bp 100/60. Discussed with pediatrician, who patient had seen 5/20. Appointment scheduled with cardiology 5/26


VAERS ID: 1338613 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 5 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

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

Write-up: Client experienced a brief episode of chest tightness and shortness of breath immediately after receiving vaccine. She gave herself her own albuterol at 935. Her chest tightness resolved within 5 minutes and was able to leave by the end of her 15 minute wait time.


VAERS ID: 1338622 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

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

Write-up: Client became dizzy and lightheaded immediately after receiving her vaccination. No episode of syncope, shortness of breath or rash noted. She reported not having breakfast prior to coming for vaccine. She was offered water and her dizziness resolved within her 15 minute wait time from receiving her vaccine.


VAERS ID: 1338822 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Paraesthesia, Presyncope
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (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: medication for ADD (unknown name)
Current Illness: None
Preexisting Conditions: ADD
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Client had an episode of dizziness , presyncope immediately after receiving his vaccine. Denied shortness of breath or chest pain . He reported tingling in his hands. He had not had breakfast prior to arrival . He was offered water . His symptoms resolved within 15 minutes and he was able to leave after his symptoms were resolved.


VAERS ID: 1338830 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Feeling abnormal, Immediate post-injection reaction
SMQs:, Dementia (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HTN medications-unknown
Current Illness:
Preexisting Conditions: HTN, stents x 4 in 2013
Allergies: ?Dental procedure medication?- unknown name
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Client received her vaccine and immediately after injection she reported ?feeling weird and anxious?. VS: 1130 BP 192/82, 1134 138/79. She denied CP, SOB, dizziness or syncope. Her symptoms resolved within 15 minutes .


VAERS ID: 1338833 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Immediate post-injection reaction, Pain in extremity, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: Immediately after receiving her vaccination client developed blurry vision and R arm pain. Denied cp/syncope/dizziness. She reported that she had not had breakfast in the AM. She was offered water and her symptoms resolved within 15 minutes of being observed.


VAERS ID: 1339082 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Aphonia, Ear infection, Malaise, Oropharyngeal pain, Respiratory symptom
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

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

Write-up: Patient began to experience symptoms consistent with an upper respiratory infection one day after getting 1st dose of COVID-19 vaccine. By day four, she developed an ear infection and began antibiotics. It is now exactly one week after the shot and 3 days after starting antibiotics and she still feels miserable. She?s losing her voice, throat is sore, and both ears feel infected.


VAERS ID: 1340261 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-05-15
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Feeling abnormal, Headache, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Autoimmune disorder; Fibromyalgia; Hypothyroidism; Rheumatoid arthritis; Supraventricular tachycardia
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210540154

Write-up: DIZZY/LIGHT HEADED; STRANGE FEELING; OUT OF SORTS/DID NOT FEEL CONNECTED TO THE OUTSIDE WORLD; INCREASED PAIN; EXTREME HEADACHE; NAUSEOUS; This spontaneous report received from a patient concerned a female of unspecified age. The patient''s height, and weight were not reported. The patient''s concurrent conditions included rheumatoid arthritis, fibromyalgia, superventricular tachycardia, low thyroid, and autoimmune disease. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: unknown) dose was not reported, administered on 15-MAY-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 15-MAY-2021, the subject experienced dizzy/light headed. On 15-MAY-2021, the subject experienced nauseous. On 15-MAY-2021, the subject experienced out of sorts/did not feel connected to the outside world. On 15-MAY-2021, the subject experienced increased pain. On 15-MAY-2021, the subject experienced extreme headache. On 15-MAY-2021, the subject experienced strange feeling. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the dizzy/light headed, nauseous, out of sorts/did not feel connected to the outside world, increased pain, extreme headache and strange feeling was not reported. This report was non-serious.


VAERS ID: 1340737 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 LA / IM

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

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

Write-up: Patient experienced nausea and lightheadedness post vaccination, recovered and released


VAERS ID: 1341241 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-03
Onset:2021-05-15
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206AZ1A / 1 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aphasia, Blood cholesterol normal, Blood triglycerides normal, Cardiac telemetry normal, Cerebral infarction, Cerebrovascular accident, Computerised tomogram head normal, Coordination abnormal, Diffusion-weighted brain MRI abnormal, Dysphemia, Echocardiogram normal, Ejection fraction normal, Fatigue, Glycosylated haemoglobin normal, High density lipoprotein decreased, Impaired work ability, Low density lipoprotein normal, Magnetic resonance imaging head abnormal, SARS-CoV-2 test negative, White matter lesion
SMQs:, Dyslipidaemia (narrow), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Lipodystrophy (broad), Hypoglycaemia (broad), COVID-19 (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? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: HCTZ 25mg daily cetirizine 10mg daily
Current Illness: None
Preexisting Conditions: controlled HTN seasonal allergies
Allergies: codeine
Diagnostic Lab Data: MRI Brain:There is acute infarct in the left temporal lobe affecting the lateral temporal lobe, medial temporal lobe, operculum, insula, and left posterior frontal white matter. This is associated with intense restricted diffusion, and also ADC abnormality indicating the infarct is less than about 1-day-old. There is no associated hemorrhage, mass effect, shift. NO acute flow-limiting stenosis, no occlusion, aneurysm or dissection of the carotid and vertebral arteries in the neck. echo normal ejection fraction no thrombus CT head: no acute findings hgb aic 5.3 covid 19 pcr negative
CDC Split Type:

Write-up: Pt was vaccinated with the Johnson and Johnson Vaccine on 5/3/21. he presented to the emergency room with a stroke on 5/15/2021. 50-year-old male presents emergency department with difficulty finding words and difficulty getting his hands to do what he wants. Last known normal was 1030 the previous night when he went to bed. He has a past medical hx sign for controlled HTN, seasonal allergies and obesity with a bmi of 48. Family members noticed him having difficulty finding words the morning of admission and it got slightly worse throughout the day. According to his wife he was holding the phone and could not dial the right numbers. His hands were working but they could not follow instructions from what his brain wanted to do. On evaluation the patient felt as though he was stuttering and could not get the right words. No numbness or tingling. No weakness on one side or the other. wife and pt reported no prior problems with word finding or memory in the past and other than obesity and controlled HTN he was healthy. He does not smoke. he had no prior hx of atrial fibrillation. telemetry monitoring showed no atrial fibrillation. His LDL was 109, chol 167,trig 119, hdl 34. No prior hx of covid 19 infection. echo with normal EF, no thrombus. He received Physicial therapy and Occupational therapy and speech therapy. He was discharged home on 5/17 on an aspirin. He was called on 5/22 and is still experiencing expressive aphasia and word finding difficulty. He previously worked full time as a machinist and has not been able to go back to work. He is also complaining of fatigue still.


VAERS ID: 1341341 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-19
Onset:2021-05-15
   Days after vaccination:57
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Diabetic ketoacidosis
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations: Flu
Other Medications:
Current Illness:
Preexisting Conditions: Type 1 juvenile diabetic
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Diabetic ketoacidosis


VAERS ID: 1341851 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-04-26
Onset:2021-05-15
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Activated partial thromboplastin time normal, Anaemia, Anticoagulant therapy, Blood chloride increased, Blood creatinine increased, Blood electrolytes normal, Brain natriuretic peptide increased, Bronchial wall thickening, Cardiac failure, Cardiac ventricular thrombosis, Chest X-ray abnormal, Chest pain, Computerised tomogram thorax normal, Cough, Dyspnoea, Ejection fraction decreased, Fibrin D dimer increased, Full blood count normal, Lymphadenopathy, Platelet count normal, Pleural effusion, SARS-CoV-2 RNA, SARS-CoV-2 test negative, Troponin increased, Ultrasound Doppler normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol inhaler
Current Illness: None reported
Preexisting Conditions: uncomplicated COVID-19 upper respiratory infection (February 2021)
Allergies: None reported
Diagnostic Lab Data: Initial labs: CBC within normal ranges, including platelets 175 19*9/L Electrolytes within normal ranges except chloride 109 mmol/L and creatinine 1.69 mg/dL D-dimer 1950 FEU BNP 1765 pg/mL HS troponin 771.8 ng/L SARS-CoV-2 RNA negative PTT 31.1 seconds CXR: bilateral peribronchial cuffing CT PE: no evidence of pulmonary emboli; mild lymphadenopathy, small bilateral pleural effusions Bilateral lower extremity ultrasound: no evidence of DVT TTE: ejection fraction 7.7% Cardiac MR during hospitalization: dilated cardiomyopathy (LVEF 10%), two thrombi at left ventricular apex, trace bilateral effusions
CDC Split Type:

Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA: patient presented to urgent care reporting shortness of breath, cough, and chest pain. Transferred to emergency department then admitted to current facility for a management of new onset heart failure with possible etiologies of myocarditis or sarcoid. Also found to have LV thrombus, anemia, and lymphadenopathy. Patient initiated on medications to manage heart failure and anemia and anticoagulated. Patient improved and discharged to home medically stable.


VAERS ID: 1342019 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-13
Onset:2021-05-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Joint range of motion decreased, Pain, Pain in extremity
SMQs:, Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: I, am reporting this VAER on behalf of my brother who is currently incarcerated in a state correctional facility in PA. During a phone call a few days following his vaccine, he told me that his continues to experience shoulder pain and issues with range of motion following administration of the J&J COVID vaccine. When he first informed me, I asked him if the discomfort he was feeling was expected pain and discomfort at the injection site, to which he responded no. He reports that a couple days following administration upon stretching when waking he experienced shooting left upper arm/shoulder pain and reduced ROM the arm in which he received the vaccine. I am reporting this adverse event as he is still having this issue.


VAERS ID: 1342174 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / UNK - / -

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

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin xl, adderall
Current Illness:
Preexisting Conditions: carpal tunnel syndrome
Allergies: marcaine, sulfides
Diagnostic Lab Data: elevated pulse at vaccine site, visited at urgent care clinic
CDC Split Type:

Write-up: I experienced chest pain, elevated heart rate an shortness of breath instantly upon receiving the second dose of the Pfizer vaccine. It did not get better until hours later, and I am experiencing these symptoms intermittently over a week later.


VAERS ID: 1342184 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 2 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute myocardial infarction, Anaemia, Anion gap, Asthenia, Basophil count normal, Basophil percentage decreased, Blood calcium decreased, Blood chloride increased, Blood creatinine increased, Blood culture negative, Blood glucose normal, Blood potassium normal, Blood sodium normal, Blood urea increased, Bundle branch block right, Carbon dioxide decreased, Cardiomegaly, Computerised tomogram abdomen, Computerised tomogram head normal, Differential white blood cell count, Diverticulum, Electrocardiogram ST segment normal, Electrocardiogram abnormal, Eosinophil count increased, Eosinophil percentage decreased, Fall, Gastrointestinal haemorrhage, General physical health deterioration, Haematocrit decreased, Haemoglobin decreased, Hiatus hernia, Lung disorder, Lymphocyte count normal, Lymphocyte percentage decreased, Mean cell haemoglobin concentration normal, Mean cell haemoglobin normal, Mean cell volume normal, Mobility decreased, Monocyte count increased, Monocyte percentage decreased, Neutrophil count normal, Neutrophil percentage decreased, Packed red blood cell transfusion, Pericardial effusion, Platelet count normal, Pleural effusion, Pneumonia, Pulmonary venous hypertension, Red blood cell count decreased, Red cell distribution width normal, Rhabdomyolysis, Rib fracture, SARS-CoV-2 test negative, Sepsis, Syncope, White blood cell count normal
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (narrow), Acute renal failure (broad), Cardiac failure (broad), Agranulocytosis (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, arterial (narrow), Parkinson-like events (broad), Gastrointestinal haemorrhage (narrow), Pulmonary hypertension (narrow), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Ischaemic colitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (narrow), Osteoporosis/osteopenia (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Myelodysplastic syndrome (broad), Tumour lysis syndrome (narrow), Tubulointerstitial diseases (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (broad)

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: Benazapril 10mg daily, Flomax 0.4mg daily, Aricept 10mg daily and Namenda bid
Current Illness: none
Preexisting Conditions: HTN, ckd stage 3 , memory impairment, bph,
Allergies: none
Diagnostic Lab Data: Results for pt. as of 5/23/2021 19:24 5/20/2021 10:36 5/21/2021 06:34 WBC: 6.9 RBC: 2.59 (L) HGB: 7.9 (L) HCT: 23 (L) MCV: 90 MCH: 30.5 MCHC: 33.9 RDW: 14.1 PLATELET COUNT: 162 DIFFERENTIAL: AUTOMATED NEUTROPHILS: 61 LYMPHOCYTES: 16 MONOCYTES: 14 EOSINOPHILS: 6 (H) BASOPHILS: 1 NEUTROPHIL #: 4.2 LYMPHOCYTE #: 1.1 MONOCYTE #: 1.0 EOSINOPHIL #: 0.4 BASOPHIL #: 0.1 SODIUM: 142 POTASSIUM: 3.8 CHLORIDE: 115 (H) CO2: 19.5 (L) ANION GAP: 8 BUN: 64 (H) CREATININE: 1.51 (H) GLUCOSE: 104 (H) CALCIUM: 8.1 (L) Covid 19 neg Cardiomegaly. Bilateral pleural effusions. An element of pulmonary venous hypertension is question. There is no overt sign of pulmonary edema. Pericardial effusion. 3. There is mild interstitial density in the right lower lung there is some minor parenchymal abnormality at the left base. Bibasilar pneumonia cannot be excluded. 4. There are mildly displaced fractures of the right 8th, 9th, and 10th ribs which could be acute or early subacute Ct abd/pelvis No hydronephrosis. No urolithiasis. 2. Extensive diverticulosis, no diverticulitis. 3. Large hiatal hernia. 4. Interstitial density right lower lung likely reflects pneumonia. Left base is relatively clear. 5. Significant cardiomegaly. Small bilateral pleural effusions. Question pulmonary venous hypertension. 6. Pericardial effusion. blood cx neg CT head neg for acute abnl EKG reviewed: EKG reviewed and personally interpreted by me Cardiac rate (bpm): 97 bpm EKG rhythm: sinus rhythm Axis: left axis deviation QRS interval: right bundle branch block ST segment: ST segments normal
CDC Split Type:

Write-up: Patient was well 5/13/21 vaccinated 05/14/2021 with second Moderna COVID Vaccine and according to son pt rapidly declined with recurrent falls 5/15-seen in er 5/16 and sent home and cont to have worsening profound weakness presenting to the ER again 5/18 and admitted with Sepsis secondary to right lower lobe pneumonia, right 8th, 9th and 10th rib fractures, syncope/ rhabdomylosis and NSTEMI, profound weakness and new anemia with GIB needing 2 units prbcs. Pt was living independently alone pta with help from his son and was at his baseline up until getting his second vaccine. he was ultimately discharged to nursing home on 5/21/21. he was still too weak to walk or get out of bed at the time of discharge.


VAERS ID: 1342284 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 59676-0580-15 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blister, Herpes zoster
SMQs:, Severe cutaneous adverse reactions (broad), Hypersensitivity (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NP Thyroid - 90 mg; Levothyroxine .05mg; fish oil - 2400 mg; D3 vitamins - 5000 IU; CoQ10 300 mg; DHEA 17mg; Progesterone 200 mg
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Diagnosed 5/18/2021 by PA
CDC Split Type:

Write-up: Shingles on right side of stomach and lower back. Prescribed generic brand of Valtrex.


VAERS ID: 1342353 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-10
Onset:2021-05-15
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Activated partial thromboplastin time shortened, Alanine aminotransferase normal, Angiogram pulmonary, Anion gap increased, Anticoagulant therapy, Aspartate aminotransferase normal, Atelectasis, Basophil count decreased, Basophil percentage, Blood albumin decreased, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood calcium decreased, Blood chloride normal, Blood creatinine normal, Blood fibrinogen normal, Blood glucose normal, Blood lactic acid, Blood potassium normal, Blood sodium normal, Blood urea normal, Carbon dioxide decreased, Catheter directed thrombolysis, Catheter placement, Chest X-ray abnormal, Computerised tomogram thorax abnormal, Condition aggravated, Creatinine renal clearance decreased, Dyspnoea, Eosinophil count decreased, Eosinophil percentage, Full blood count abnormal, Glomerular filtration rate decreased, Haematocrit normal, Haemoglobin normal, Hypoxia, Immature granulocyte count, Influenza A virus test negative, Influenza B virus test, Intensive care, International normalised ratio increased, Interventional procedure, Lung opacity, Lymphocyte count normal, Lymphocyte percentage decreased, Mean cell haemoglobin concentration normal, Mean cell haemoglobin normal, Mean cell volume normal, Mean platelet volume increased, Metabolic function test, Monocyte count increased, Monocyte percentage, Myocardial strain, Neutrophil count increased, Neutrophil percentage increased, Nucleated red cells, Platelet count normal, Pleural effusion, Procalcitonin normal, Prohormone brain natriuretic peptide increased, Protein total decreased, Prothrombin time prolonged, Pulmonary embolism, Pulmonary oedema, Red blood cell count normal, Red cell distribution width normal, Respiratory syncytial virus test negative, SARS-CoV-2 test negative, Scan with contrast abnormal, Troponin T increased, Ultrasound Doppler, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (narrow), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haematopoietic leukopenia (narrow), Lactic acidosis (broad), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Allegra 100 mg p.o. daily Naproxen 220 mg q.12 hours p.r.n. HCTZ 25 mg p.o. daily Tramadol 50 mg p.o. t.i.d. p.r.n. Zanaflex 6 mg p.o. q.h.s. Wellbutrin 200 mg p.o. daily Lisinopril 40 mg p.o. daily
Current Illness: None known
Preexisting Conditions: Fibromyalgia Hypertension
Allergies: Penicillin
Diagnostic Lab Data: COMPLETED RADIOLOGY IMAGING STUDIES: SP Angio Pulmonary Select Bil [Auth (Verified)] (05/23 0846): FINAL IMPRESSION:Successful placement of EKOS infusion catheters into the bilateral lower lobe pulmonary arteries for TPA thrombolysis.PLAN:1. The patient will initiate TPA infusion through each of the EKOS catheters at a rate of 0.5 mg/hour/catheter and heparin running through each sheath at for overnight thrombolysis. 2. Fibrinogen and hemoglobin should be checked every 6 hours and thrombolysis should be discontinued if there are signs of bleeding or if fibrinogen should drop less than 100. 3. Systemic/peripheral intravenous heparin should be started after treatment with tPA completed. 4. The patient can be reevaluated tomorrow with echocardiogram. XR Chest 1V [Auth (Verified)] (05/23 0808): FINAL IMPRESSION: Interval development of right parahilar hazy interstitial and alveolar opacities with small right pleural effusionInterval placement of bilateral infusion catheters as described US Ext Lower Venous Duplex Bil [Auth (Verified)] (05/23 0802): FINAL IMPRESSION:Negative bilateral lower extremity venous thrombus presentation CT Chest PE W Contrast [Auth (Verified)] (05/22 1807): FINAL IMPRESSION: 1. Large volume acute bilateral pulmonary embolism with right heart strain. Possible small right upper lobe pulmonary infarcts.2. Moderate volume right pleural effusion with adjacent atelectasis and pulmonary edemaCRITICAL RESULTS: The finding of a new or significantly progressed pulmonary embolism was discussed with Dr XR Chest 1V [Auth (Verified)] (05/22 1704): FINAL IMPRESSION: Abnormal chest x-ray Fibrinogen Level 05/23/21 08:48 Fibrinogen 255 Hemoglobin 05/23/21 08:48 HGB 14.3 MCV 89 MCH 29 MCHC 33 CBC and Plt w Diff 05/23/21 00:52 Instr WBC 13.35 WBC 13.35 H RBC 4.85 HGB 14 HCT 43.2 MCV 89 MCH 29 MCHC 32 L RDW 13.7 Platelet 174 MPV 11.2 H NRBC Auto 0 NRBC Absolute 0 Auto Diff 05/23/21 00:52 Neutro Auto 73.1 Lymph Auto 16.4 Mono Auto 7.3 Eos Auto 1.7 Basophil Auto 1 Imm Gran Auto 0.5 Neutro Absolute 9.8 H Lymph Absolute 2.2 Mono Absolute 1 Eos Absolute 0.2 Basophil Absolute 0.1 Imm Gran Absolute 0.07 Comp Metabolic Panel 05/23/21 00:52 Sodium 136 Potassium 3.7 Chloride 106 CO2 18 L Glucose 106 H BUN 15 Creatinine 0.8 Calcium 7.9 L Total Protein 6 L Albumin 3.2 L Bili Total 0.8 Alk Phos 45 AST 19 ALT (SGPT) 11 AGAP 12 H Renal Function Index 05/23/21 00:52 GFR (CKD-EPI) 79.3 Creatinine Clearance Estimated CG 05/23/21 00:52 Est CrCl (CG) 79.7 Fibrinogen Level 05/23/21 00:52 Fibrinogen 253 Procalcitonin Level 05/23/21 00:52 Procalcitonin 0.04 Hemoglobin 05/22/21 23:08 HGB 14.4 MCV 89 MCH 29 MCHC 33 Glucose POC FHW 05/22/21 21:42 Glu POC FHW 107 H Troponin T QuaNT High Sensitivity 05/22/21 18:23 Trop T Qnt HS 36 H PTT 05/22/21 18:23 PTT 30 Fibrinogen Level 05/22/21 18:23 Fibrinogen 244 CBC and Plt w Diff 05/22/21 16:02 Instr WBC 16.37 WBC 16.37 H RBC 5.84 H HGB 16.8 H HCT 51.4 H MCV 88 MCH 29 MCHC 33 RDW 14 H Platelet 248 MPV 12.1 H NRBC Auto 0 NRBC Absolute 0 Auto Diff 05/22/21 16:02 Neutro Auto 76.2 Lymph Auto 13.7 Mono Auto 7.3 Eos Auto 1.3 Basophil Auto 0.9 Imm Gran Auto 0.6 Neutro Absolute 12.5 H Lymph Absolute 2.2 Mono Absolute 1.2 H Eos Absolute 0.2 Basophil Absolute 0.2 Imm Gran Absolute 0.1 Pro BNP Level 05/22/21 16:02 pro-BNP 5127 H Troponin T QuaNT High Sensitivity 05/22/21 16:02 Trop T Qnt HS 37 H Comp Metabolic Panel 05/22/21 16:02 Sodium 135 L Potassium 4.3 Chloride 100 L CO2 23 Glucose 90 BUN 19 Creatinine 1 Calcium 9.3 Total Protein 7.4 Albumin 3.9 Bili Total 0.7 Alk Phos 56 AST 24 ALT (SGPT) 14 AGAP 12 H Renal Function Index 05/22/21 16:02 GFR (CKD-EPI) 60.5 Creatinine Clearance Estimated CG 05/22/21 16:02 Est CrCl (CG) 63.8 Prothrombin Time with INR 05/22/21 16:02 PT 14 INR 1.18 H PTT 05/22/21 16:02 PTT 26.3 Lactic Acid/Reflex x2 if Greater Than 2 05/22/21 16:02 Lactic Acid 1.8 Coronavirus 2019 Influenza A,B RSV PCR 05/22/21 16:02 SARS COV2 PCR Negative Influenza A PCR Negative Influenza B PCR Negative RSV PCR Negative
CDC Split Type:

Write-up: Bilateral saddle pulmonary embolus 12 days post 2nd Moderna vaccination, Shortness of breath worsened 6 days after vaccination, lasting 1 week until presentation to hospital ED. Was found with severe hypoxemia, and bilateral PE and right heart strain requiring interventional radiology procedure and catheter directed thrombolytic therapy, subsequent treatment and follow-up in the ICU Initial Moderna vaccine given 04/12/2021: Vial number 0 3 0 B21A Second Moderna vaccine given 05/10/2021 file number 031 B 21A Patient described mild shortness of breath beginning 1 month prior to 1st vaccine, but significant and severe shortness of breath developing less than 1 week after 2nd vaccine


VAERS ID: 1342437 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Abdominal pain upper, Activated partial thromboplastin time shortened, Anti-cyclic citrullinated peptide antibody negative, Antinuclear antibody negative, C-reactive protein, Complement factor C3, Complement factor C4, Complement factor normal, Computerised tomogram abdomen abnormal, Fibrin D dimer, Gastrointestinal wall thickening, International normalised ratio normal, Mesenteritis, Petechiae, Platelet count normal, Prothrombin time normal, Rheumatoid factor negative, White blood cell disorder
SMQs:, Acute pancreatitis (broad), Haematopoietic leukopenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Metformin, atorvastatin, loratadine
Current Illness: Moderna vaccination, 4/14/21 and 5/14/21
Preexisting Conditions: None
Allergies: Pork
Diagnostic Lab Data: 5/22 (started on steroids 5/19): wbc: 17.25 platelets: 339 d-dimer: 938 fibrinogen: 412 C-reactive protein: 6.4 APTT: 27.1 PT: 11.1 INR: 1 CT impression: "1. Right 18 cm small bowel segment of circumferential moderate thickening and inflammatory mesentery with concern for ischemic enteritis. Additionally, consider possible inflammatory bowel or Crohn''s disease. " 5/17/21: C-reactive protein: 6 C3 complement: 167 C4 complement: 45 wbc: 7.03 platelets: 266 Anti-ANA (ab): negative Cyclic citrullinated peptide Ab IgG : negative, <8 Anti-Smith Ab: negative Rheumatoid factor: negative Sjogren''s SS-A and SS-B: negative
CDC Split Type:

Write-up: Petechiae to L leg and lower abdomen 1 day after vaccination. 1 week after vaccination pt developed epigastric abdominal pain and CT abdomen with impression of "1. Right 18 cm small bowel segment of circumferential moderate thickening and inflammatory mesentery with concern for ischemic enteritis. Additionally, consider possible inflammatory bowel or Crohn''s disease.


VAERS ID: 1342448 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-01
Onset:2021-05-15
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Epistaxis
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (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: My son is rarely sick. He came home from college, just after a few weeks from receiving the vaccine with a terrible cough and an unusual nosebleed. Every time he blows his nose, it is bloody. Never in 19 years have I observed this. My son is a college athlete and is extremely strong and healthy. These symptoms do not seem to be going away. The bloody nose is the most unusual effect and we are concerned this is an inflammatory side effect.


VAERS ID: 1342596 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 1 LA / IM

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

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

Write-up: Site: Itching at Injection Site-Mild, Site: Redness at Injection Site-Mild, Site: Swelling at Injection Site-Medium


VAERS ID: 1342601 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-04-23
Onset:2021-05-15
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dysuria, Fatigue, Malaise, Muscle fatigue, Muscle spasms, Myalgia, Urethral spasm
SMQs:, Rhabdomyolysis/myopathy (broad), Dystonia (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Muscle fatigue, pain, and spasms. General malaise and fatigue. Urethral spasms and burning. Symptoms lasted about 48 hrs and got better. I took IBU 600 mg x 2 doses


VAERS ID: 1342965 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

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

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

Write-up: Systemic: Numbness (specify: facial area, extremities)-Medium, Additional Details: Tingling sensation from back down to feet


VAERS ID: 1342975 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 1 LA / SYR

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

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

Write-up: Site: Itching at Injection Site-Mild, Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Severe, Site: Swelling at Injection Site-Severe


VAERS ID: 1343098 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 RA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: HPV- nausea
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Cefidinir, Amoxicillin: rashes
Diagnostic Lab Data: All tests came normal( urine, ECG)
CDC Split Type:

Write-up: 1/2 hour after having the Pfizer vaccine, she had nausea that is lasting until today and it doesn?t go away


VAERS ID: 1343251 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-14
Onset:2021-05-15
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Arthritis, Blood uric acid, Inflammation, Pain in extremity, Rheumatoid factor
SMQs:, Systemic lupus erythematosus (broad), Arthritis (narrow), Tendinopathies and ligament disorders (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydrochlorothiazide, Allegra, dymista
Current Illness: None
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data: Uric acid blood test done as well as rheumatoid panel. Both negative. Blood drawn May 18 2021
CDC Split Type:

Write-up: Inflamed joints. Big toe on left foot. Both thumb joints are inflamed and very sore. Right side thumb is worse. Knees inflamed.


VAERS ID: 1343306 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-09
Onset:2021-05-15
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram neck, Dysphagia, Dysphonia, Haematoma evacuation, Incisional drainage, Neck mass, Pharyngeal haematoma, White blood cell count normal
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ct scan revealed retropharyngeal hematoma. WBC was normal.
CDC Split Type:

Write-up: Patient found with hoarse voice, difficulty swallowing and lump in right neck. Ct scan revealed retropharyngeal hematoma. Required I&D of site with drain, speech therapy.


VAERS ID: 1343322 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-03
Onset:2021-05-15
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Herpes zoster, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (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: vitamin d, b complex, calcium/magnesium, probiotic
Current Illness: none
Preexisting Conditions: hashimotos
Allergies: none
Diagnostic Lab Data: Diagnosed with Shingles on 5/17
CDC Split Type:

Write-up: Bumps started appearing on my face 12 days after my vaccination which was diagnosed two days later as shingles.


VAERS ID: 1343366 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

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

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

Write-up: Aaron did not experience any adverse events - he was watched for 30 minutes post administration. This report is just for documentation of patient receiving Janssen over pfizer at the clinic. Mom requested patient receive one shot of the J and J like dad, and intern administered J and J thinking the 12 years and older eligibility pertained to both vaccines.


VAERS ID: 1343367 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-02
Onset:2021-05-15
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Diarrhoea, Fatigue, Feeling abnormal, Headache, Malaise, Muscular weakness, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Dementia (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Shingrix 1st vaccine, broke out in a rash on her chest and was not able to get the 2nd vaccine. This was about 2 years ago.
Other Medications: Xanax, Bisoprolol.
Current Illness: None.
Preexisting Conditions: AAA, high cholesterol, sleep apnea, history of 3 strokes in 10 days in 2018.
Allergies: Statin''s, Demerol, most of the Mycin''s. Erythromycin, super - antibiotics cannot take, Sulfa.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: She got her vaccine, a little diarrhea, a slight headache, foggy brain, overwhelming fatigue, slight nausea for a few days and then it stopped. She is having these symptoms again, and is having this for the third time which started a few days ago with the same reactoin, plus muscle weakness, just feeling sick like, crappy feeling.


VAERS ID: 1343375 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Fall, Migraine, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Suddenly my vision got super bright and I could hardly see, and then I couldn?t hold myself up and I slowly collapsed onto the ground. It only lasted a few minutes, and then I was perfectly fine. It came on very suddenly and didn?t last long, but it was extreme during those few minutes. It was also very hot that day. And I had a mild migraine headache in the morning, but that wasn?t very bad, and I get migraines fairly regularly.


VAERS ID: 1343490 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Influenza like illness, Myalgia
SMQs:, Rhabdomyolysis/myopathy (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:
Other Medications: Iron supplement
Current Illness: None
Preexisting Conditions: Hyper active thyroid (not currently taking presciption)
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Flu-like symptoms the entire next day. Achy joints, muscle pain, fatigue.


VAERS ID: 1343505 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-07
Onset:2021-05-15
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Approximately 8 days after receiving the vaccine, I broke out in a rash on all parts of the body. Most prominent areas were on the arms and legs.


VAERS ID: 1343629 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: left lower extremity swelling,


VAERS ID: 1343646 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pain in extremity, Pruritus, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), 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:
Current Illness:
Preexisting Conditions:
Allergies: nka
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt states the next day she had a painful left arm. She had a developed a red rash on her neck. She noticed a red rash on upper part of her right chest area. After she showered she noticed another red patch of bumps in other areas on her body. It is now more like hives and itching. The rash if from her scalp to her feet. Pt will contact her PCP.


VAERS ID: 1343774 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO182 / 2 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Nausea, Pain in extremity, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: One-a-Day for Men
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient was fine until sometime in the morning hours, approx. 12 hours after receiving vaccine. Began with a fever of 100.7, nausea, leg pain/joint pain. Patient took Motrin but fever rose to 102.5, continued with nausea, and leg pain. This lasted two full days.


VAERS ID: 1343799 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Protonic 40mg, Xanax 50mg, Vitamin D 2000units, Vitamin C 1000mg, Vitamin B121000mg,
Current Illness:
Preexisting Conditions: Crohn''s disease, Psoriasis. Fibromyalgia, Gastroparesis, anxiety,
Allergies: amoxicillin, yellow contrast dye
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt says she developed a migraine headache and low grade temp. By 5/17/21 she was not able to work for 3 days. She had extreme exhaustion. On 5/19/21 she was still exhausted feeling and had 27 episodes of diarhea. On 5/20/21 she was not able to eat w/out having diarhea and still very tired. By 5/22/21 she was feeling so bad she felt like she needed to go to the emergency room. She decided to take her dicyclomine medicine instead. This seemed to helped some but is waiting on her PCP to give her a CB.


VAERS ID: 1343873 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-11
Onset:2021-05-15
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Menstruation delayed
SMQs:, Fertility 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: No
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: My period came one week late. Not a big deal but wanted to report in the name of science.


VAERS ID: 1343884 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Injection site bruising, Injection site haemorrhage, Injection site reaction, Muscle twitching, Pain, Pain in extremity
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Dyskinesia (broad), Dystonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: supplements: Ginkgo & Hawthorn, Butcher''s Broom, Ningxia Nitro, Chlorophyll and digestive enzymes; betaine hydrochloride, alpha amylase, pepsin, bromelain, papain, bile salt, pancreatin, and lipase.
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: 10 days of almost constant muscle twitching below the injection site at the elbow area/ top of forearm. This uncontrollable muscle movement is almost constant. I have strong pain and fatigue if I use my arm. Additionally, the injection site bled and remains bruised after 10 days.


VAERS ID: 1343918 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-01-22
Onset:2021-05-15
   Days after vaccination:113
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

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

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

Write-up: Pt had a positive antigen covid test 5/18/21.


VAERS ID: 1344022 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-14
Onset:2021-05-15
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Metabolic encephalopathy
SMQs:, Noninfectious encephalopathy/delirium (narrow), Hypoglycaemia (broad)

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

Write-up: Patient presented to the ED and was subsequently hospitalized with acute metabolic encephalopathy.


VAERS ID: 1344084 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-05-13
Onset:2021-05-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Malaise, Pain, Pain in extremity, Peripheral swelling, Skin warm, Tenderness
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: SYNTHROID 100 MCG
Current Illness:
Preexisting Conditions: Thryoidectomy
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: HISTORY - Had major vein stripping surgery on both legs at age 28 and again at age 57. In between surgeries had sclerotherapy on both legs. Have experienced phlebitis before and know how to manage it. ADVERSE EVENT - The first day after vaccination sore arm and general malaise. The next day inflammation on both legs in multiple locations. (One outbreak is from ankle to knee.) Pain is worse when walking or standing. Legs are hot and sore to touch. Never experienced anything to that extreme degree before. Concern about blood clots. After 10 days it is finally starting to subside.


VAERS ID: 1344108 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-03-05
Onset:2021-05-15
   Days after vaccination:71
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Injection site pain, Menstrual disorder, Pregnancy test negative
SMQs:, Extravasation events (injections, infusions and implants) (broad), Arthritis (broad)

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

Write-up: Exacerbation of arthritis pain in injection shoulder. Seems to have increased overall joint pain. Missed menstrual cycle - negative pregnancy test.


VAERS ID: 1344135 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Menstruation irregular, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Fertility 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:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Very sore arm for 2 days; low grade temp 2 days; period late 10 days as of today (I guarantee I am not pregnant)


VAERS ID: 1344147 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Pharmacy       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: Patient''s father gave the date of birth which made her 12 years old and eligible to get the vaccine. When processing the vaccine to the insurance it was discovered that the patient is only 11 years old. Patient''s father stills confirms that she is 12 years old but has yet to bring us her birth certificate so we can confirm.


VAERS ID: 1344156 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Deep vein thrombosis, Headache, Musculoskeletal stiffness, Pain, Peripheral swelling, Pyrexia
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, venous (narrow), Dystonia (broad), Parkinson-like events (broad), Thrombophlebitis (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ibuprofen PRN, Nexium PRN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt developed aches, pain and headache and felt feverish day after receiving 2nd dose of Moderna vaccine. Continued on Sunday and on Monday developed leg stiffness and swelling. Patient presented to the ER with extensive lower leg DVT.


VAERS ID: 1344166 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-07
Onset:2021-05-15
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 1 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram, Angiogram cerebral normal, Anticoagulant therapy, Anxiety, Aortic valve incompetence, Blood cholesterol increased, Blood pressure increased, Blood thyroid stimulating hormone normal, CHA2DS2-VASc-score, COVID-19, Cerebrovascular accident, Chest X-ray normal, Computerised tomogram head normal, Dysarthria, Echocardiogram abnormal, Ejection fraction normal, Facial paralysis, Glycosylated haemoglobin increased, Hemiparesis, High density lipoprotein decreased, Low density lipoprotein increased, Mitral valve incompetence, Nausea, Neurological symptom, SARS-CoV-2 test positive, Tricuspid valve incompetence, Vitamin B12 increased
SMQs:, Acute pancreatitis (broad), Dyslipidaemia (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Pulmonary hypertension (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hearing impairment (broad), Lipodystrophy (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown- received vaccine at outside facility
Current Illness:
Preexisting Conditions: Hypertension, Atrial fibrillation
Allergies: Amitriptyline Demerol [meperidine] Inapsine [droperidol] Maxalt [rizatriptan] Methylprednisolone Morphine Nortriptyline Paxil [paroxetine Hcl] Phenergan [promethazine] Trazodone Wellbutrin [bupropion Hcl] Zanaflex [tizanidine] Zoloft [sertraline] Zyprexa [olanzapine]
Diagnostic Lab Data:
CDC Split Type:

Write-up: 71 yo R handed female PMHx of obesity, anxiety, depression, HTN, afib, and COVID infection who presented to ED on 5/15/2021 with stroke like symptoms. She presented with right sided weakness, facial droop and slurred speech. LKWT 5/15/2021 at 0430. Patient reported going to bed around 2300 the night before and woke up at 0400 that morning with right sided weakness. Her daughter noticed slurred speech and right sided facial droop. Denied chest pain, HA, dizziness, no vision changes and no history of CVA. Stroke protocol was called. Teleneuro consulted and recommended a MRI. CT head was unremarkable. She takes ASA at home and received Plavix per neuro recommendations. Of note, patient tested positive for COVID but denied any respiratory symptoms and she has received her first COVID vaccination. Patient was admitted to the hospital for further treatment and evaluation for suspected CVA. Neurology consulted. Continued ASA, Plavix and Statin. Allowed for permissive HTN. Patient with history of Atrial fibrillation, currently normal sinus rhythm on telemetry. CHADS2VASC 3-would benefit from AC if no contraindication. Unsure why she has not been placed on AC and patient stated he only had one episode of Afib. Chest XR showed No acute cardiac pulmonary findings. Patient refused to have MRI brain due to anxiety. She stated that she attempted to have a MRI before and even with medication for anxiety she was not able to. Echo showed normal EF, mild MR, AR, TR, no PFO noted.CTA head and neck showed right vertebral artery ends in PICA, no acute abnormalities. Labs noted B12 4,268 cholesterol 231 total, HDL 52, LDL 152, TAG 134, HbA1c 6.2, TSH WNL. Patient was out of the window for tPA. She was given a large dose of IV Ativan for anxiety. She continued to have elevated blood pressures with nausea that required IV labetalol to maintain blood pressure. HTN could likely be due to her significant anxiety. Cardiology planned to follow patient after discharge to discuss AC medication. Patient initially tested positive for COVID on 2/2/2021 and was able to take patient out of isolation. Dx: CVA


VAERS ID: 1344167 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-13
Onset:2021-05-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blister
SMQs:, Severe cutaneous adverse reactions (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Elequis, Vit C, Metprolol, Diovan, Hytrin, Multivitamin
Current Illness:
Preexisting Conditions: A-Fib MS
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hands and feet broke out in blisters, blisters burst and now feet and hands raw.... no fever, chills..


VAERS ID: 1344237 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-03-03
Onset:2021-05-15
   Days after vaccination:73
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Bronchitis, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Colon resection with colostomy
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admitted to facility for bilateral pulmonary embolism after bronchitis for 3 weeks


VAERS ID: 1344329 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Fall, Loss of personal independence in daily activities, Mobility decreased
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flomax; Metformin; Testosterone; Wellbutrin; Atorvastatin; Vitamins?C,D3, B12,B complex
Current Illness: None
Preexisting Conditions: BPH; metabolic syndrome (pre-diabetes); depression All of these have stable and well controlled for a long time
Allergies: Erythromycin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The day following the vaccination, noted new onset dizziness and that continues. This is not triggered by position change but does worsen with change in head position. The severity varies. He fell once and he has had to change his activity level on two days. The other days have been milder but annoying. He is in the middle of a building project and is unable to climb ladders.


VAERS ID: 1344365 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (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: Patient took his daily Zyrtec for environmental allergies and that was 4 hours prior to vaccine. He started complaining at 12:22 am on May 15, 2021 (13 hours after vaccine of a slight headache. We did not have Tylenol so gave him 4 chewable
Current Illness: none
Preexisting Conditions: Tree nut allergies and environemntal. Autism spectrum
Allergies: Tree nut allergies and environmental
Diagnostic Lab Data: None. Did not go to doctor since patient responded very well to the Benadryl. The next morning he was completely fine. My other son, (age 15) took the vaccine at the same time and he has not issues. I''m convinced it was the aspirin.
CDC Split Type:

Write-up: Patient took his daily Zyrtec for environmental allergies and that was 4 hours prior to vaccine. He started complaining at 12:22 am on May 15, 2021 (13 hours after vaccine of a slight headache. We did not have Tylenol so gave him 4 chewable aspirins. Shortly after taking the aspirins, i.e. 20 minutes he started having involuntarily muscle tremors in his legs. I gave him 20 ml of Benadryl at 1:04 am and by 1:16 the tremors stopped and he told us that he felt completely fine. He slept soundly after the Benadryl. I think he is allergic to aspirin as he has never had it before.


VAERS ID: 1344379 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-13
Onset:2021-05-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Computerised tomogram thorax, Echocardiogram, Troponin increased
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: troponin, echo, CT
CDC Split Type:

Write-up: Chest pain, troponin elevation


VAERS ID: 1344640 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-13
Onset:2021-05-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Herpes zoster, Ophthalmological examination
SMQs:, Opportunistic infections (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: Vit D, vitamin C, turmeric, fish oil, iron, multivitamin
Current Illness: none
Preexisting Conditions: high cholesterol
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shingles; did not have ocular involvement on ophtho exam but was in correct distribution for this


VAERS ID: 1345277 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-13
Onset:2021-05-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 AR / -

Administered by: Private       Purchased by: ?
Symptoms: Blood creatine increased, Blood urea increased, Brain natriuretic peptide increased, C-reactive protein increased, Chest discomfort, Peripheral swelling, Protein urine present, Red blood cell sedimentation rate increased, Troponin, Urine analysis
SMQs:, Acute renal failure (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Proteinuria (narrow), Tubulointerstitial diseases (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None reported
Current Illness: One episode of non-bloody diarrhea
Preexisting Conditions: None
Allergies: No known allergies
Diagnostic Lab Data: Performed 5/24/21: Troponin 0.15 BNP 4093 BUN 60 Creatinine 2.34 UA: $g300 - protein, large - blood ESR 28 CRP 1.11
CDC Split Type:

Write-up: Received second dose of vaccine 5/13/21. Reportedly noticed bilateral lower extremity swelling Saturday 5/15/21, and mild to moderate chest pressure 5/17/21. Noticed swelling of the extremities worsening 5/22/21. Came to the emergency room for evaluation 5/24/21.


VAERS ID: 1345381 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-04-22
Onset:2021-05-15
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anticoagulant therapy, Computerised tomogram thorax abnormal, Dyspnoea, Dyspnoea exertional, Fibrin D dimer increased, Palpitations, Pulmonary thrombosis, Scan with contrast abnormal, Tachycardia
SMQs:, Anaphylactic reaction (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: birth control pill
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: d-dimer of 3.16 Chest CT with contrast Blood thinners started
CDC Split Type:

Write-up: Developed multiple blood clots in both lungs became extremely short of breath with any activity, heart palpitation, tachycardic


VAERS ID: 1345679 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Alabama  
Vaccinated:0000-00-00
Onset:2021-05-15
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Fatigue, Lethargy, Limb mass, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: The patient had no known allergies.
Allergies:
Diagnostic Lab Data: Test Date: 20210515; Test Name: Body temperature; Result Unstructured Data: Low grade
CDC Split Type: USJNJFOC20210531328

Write-up: PAINFUL LUMP IN THE RIGHT ARM; LETHARGIC; LOW GRADE FEVER; TIRED; This spontaneous report received from a patient concerned a 32 year old male. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included no known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 204A21A, and batch number: 204A21A expiry: UNKNOWN) dose was not reported, administered on 14-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 15-MAY-2021, the patient experienced painful lump in the right arm. On 15-MAY-2021, the patient experienced lethargic. On 15-MAY-2021, the patient experienced low grade fever. On 15-MAY-2021, the patient experienced tired. Laboratory data included: Body temperature (NR: not provided) Low grade. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from low grade fever on MAY-2021, was recovering from lethargic, and tired, and had not recovered from painful lump in the right arm. This report was non-serious.


VAERS ID: 1345761 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-05-15
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Headache
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210541227

Write-up: HEADACHE; This spontaneous report received from a patient concerned a patient of unspecified age and sex. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 205A21A expiry: UNKNOWN) dose was not reported, administered on 15-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 15-MAY-2021, the subject experienced headache. Treatment medications (dates unspecified) included: ibuprofen. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from headache. This report was non-serious.


VAERS ID: 1345777 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-05-15
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Headache, Nausea, Pain, Swelling, Vision blurred
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Blood pressure high; Fibromyalgia; Obesity; Osteoarthritis; Rheumatoid arthritis; Type II diabetes mellitus
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210542113

Write-up: chronic pain; nauseous; headache; dizzy; everything was foggy; swelling; This spontaneous report received from a patient concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. The patient''s concurrent conditions included fibromyalgia, osteoarthritis, rheumatoid arthritis, obese, high blood pressure, diabetes type 2, and co-morbidities. The patient received covid-19 vaccine (suspension for injection, route of admin, and batch number were not reported) dose was not reported, administered on 15-MAY-2021 for prophylactic vaccination. . The batch number was not reported and has been requested. No concomitant medications were reported. On 15-MAY-2021, the subject experienced dizzy. On 15-MAY-2021, the subject experienced everything was foggy. On 15-MAY-2021, the subject experienced swelling. On 15-MAY-2021, the subject experienced nauseous. On 15-MAY-2021, the subject experienced headache. On an unspecified date, the subject experienced chronic pain. The action taken with covid-19 vaccine was not applicable. The patient had not recovered from headache, and swelling, and the outcome of dizzy, nauseous, everything was foggy and chronic pain was not reported. This report was non-serious. This report was non-serious. This case, involving the same patient is linked to 20190513035 and 20191219543.


VAERS ID: 1345793 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Kansas  
Vaccinated:0000-00-00
Onset:2021-05-15
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Body temperature decreased, Disturbance in attention, Dizziness, Headache, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (broad), Vestibular 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:
Current Illness:
Preexisting Conditions: Comments: Patient had no known allergies.
Allergies:
Diagnostic Lab Data: Test Date: 20210515; Test Name: Body temperature decreased; Result Unstructured Data: 38 and 37.8 Degree Celsius; Test Date: 20210515; Test Name: Body temperature; Result Unstructured Data: 38.5 Degree Celsius
CDC Split Type: USJNJFOC20210544800

Write-up: HARD TO READ/CONCENTRATE; HEADACHE; DISCOMFORT WITH DIZZINESS; FEVER; This spontaneous report received from a patient concerned a 22 year old male. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included patient had no known allergies. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 203A21A, and expiry: UNKNOWN) dose was not reported, administered on 14-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 15-MAY-2021, the subject experienced fever. Laboratory data included: Body temperature (NR: not provided) 38.5 Degree Celsius, and Body temperature decreased (NR: not provided) 38 and 37.8 Degree Celsius. On 16-MAY-2021, the subject experienced discomfort with dizziness. On 16-MAY-2021, the subject experienced headache. On an unspecified date, the subject experienced hard to read/concentrate. Treatment medications (dates unspecified) included: paracetamol. The action taken with covid-19 vaccine was not applicable. The patient recovered from fever on 16-MAY-2021, was recovering from headache, and discomfort with dizziness, and the outcome of hard to read/concentrate was not reported. This report was non-serious.


VAERS ID: 1346007 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-03-16
Onset:2021-05-15
   Days after vaccination:60
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Maxine, omepresole,zita
Current Illness: None
Preexisting Conditions: Hypertension/high blood pressure GARD HIGH CHOLESTEROL
Allergies: Cosine, sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Complete numbing of the left upper biceps and shoulder with tingling of the left hand and fingers. Soreness in left shoulder. Has lasted since doses were given.


VAERS ID: 1346396 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia
SMQs:, Arthritis (broad)

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

Write-up: Error: Shoulder Joint Injury (prolonged pain, tingling, etc.)


VAERS ID: 1346417 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Injection site erythema, Injection site pain, Injection site swelling, Lethargy, Pain, Rash
SMQs:, Anaphylactic reaction (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Systemic: Allergic: Rash Generalized-Medium, Systemic: Body Aches Generalized-Medium, Systemic: Exhaustion / Lethargy-Medium


VAERS ID: 1346436 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Headache-Mild


VAERS ID: 1346449 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-05-01
Onset:2021-05-15
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21 / 5 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

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

Write-up: Some of the vaccine leaked after injection. I called moderna, and their protocol was not to reinject if half of the dose was received. Based on my clinical observation and knowledge the patient received at least half the dose.


VAERS ID: 1346634 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dermatitis acneiform, Dyspnoea, Feeling abnormal, Induration, Injection site reaction, Pyrexia, Rash, Rash erythematous, Swelling, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ibuprofen as needed after fever started, daily i take sertraline, lorazepam but was unable to bc i was throwing up non stop for days
Current Illness:
Preexisting Conditions:
Allergies: augmentin, lamictal
Diagnostic Lab Data:
CDC Split Type:

Write-up: HIGH FEVER OVER 102, ENTIRE FACE COVERED IN RED SWOLLEN RASH WITH RED HARD PIMPLE LIKE LOOKING DOTS THROUGH OUT IT EXTEND ACROSS MY FACE AND DOWN MY NECK DIRECTLY TO THE PLACE WHERE THE INJECTION SITE WAS. I ENDED UP REALLY OUT OF IT DUE TO THE HIGH FEVER AND COUDLN''T KEEP FLUID DOWN AND KEPT VOMITING FOR THE NEXT FOUR DAYS. THEN THE RASH STARTED TO HEAL AND MY TEMPERATURE DROPPED AND I SLOWLY FELT MORE NORMAL. IT''S NOW BEEN A WEEK AND A HALF SINCE THE VACCINATION AND I STILL GET VERY EASILY WINDED JUST BY WALKING AND FEEL REALLY WEAK ALL THE TIME.


VAERS ID: 1346688 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-25
Onset:2021-05-15
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Menstrual disorder
SMQs:

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

Write-up: Menstrual cycle normally 28/29 days, after 1st dose period started on cycle day 24 instead of the normal length.


VAERS ID: 1346911 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW1086 / 1 RA / ID

Administered by: Private       Purchased by: ?
Symptoms: Aphthous ulcer, Chills, Oropharyngeal pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: Enbrel, amitryptilline, Mobic, Prevacid, Zyrtec
Current Illness: none
Preexisting Conditions: history of psoriasis and Juvenile Idiopathic Arthritis, GERD and irritable bowel syndrome
Allergies: None known
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient started with chills, fevers to 100.5 , sore throat, oral mucosal aphthous ulcers within 24 hrs of receiving vaccine. Patient continues with these symptoms


VAERS ID: 1346951 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-13
Onset:2021-05-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / UNK LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Hypertonia, Myalgia, Neck pain, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Dose 1 of Pfizer - sore arm 1-2 day duration
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1.5 wk duration of pain and hypertonicity of left cervical muscles with tingling of left side of face down to left elbow. Unrelieved with conservative care and OTC NSAIDs.


VAERS ID: 1347230 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Loss of personal independence in daily activities, Mobility decreased, Pain in extremity, Sleep disorder
SMQs:, Dementia (broad), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Three days after I started having side effects I took paracetamol.
Current Illness:
Preexisting Conditions:
Allergies: Amoxicillin and bananas
Diagnostic Lab Data:
CDC Split Type:

Write-up: After the vaccine I started having arm aches. They progressively got worse to the point I could not move my arm and do simple things such as combing my hair. I only started taking paracetamol on the third day. The arm ache lasted four days. I was then able to do normal activities without feeling any pain, such as driving or exercising. Four more days passed and the arm ache returned. Strong enough to wake me up at night but not so painful I cannot do normal movements (aside from exercising). The pain is located right where I got the vaccine. It has been lasting for three days and I am not taking any paracetamol as I do not want to mask it and understand how long it will last.


VAERS ID: 1347287 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Lethargy, Pyrexia, SARS-CoV-2 test negative
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Montelukast Certrizine Citalopram Quetiapine Hydroxine
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID test-negative
CDC Split Type:

Write-up: lethargy, fever, chills, headache, fatigue up to 6 days post vaccination.


VAERS ID: 1347414 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chest pain, Electrocardiogram, Rectal haemorrhage, Urine analysis, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amitriptyline Aspirin Atorvastatin Baclofen Buspirone Carvedilol Vitamin D Famotadine Glyburide Lisinopril Melatonin Nifedipine Oxycodone/acetaminophin
Current Illness:
Preexisting Conditions: Type 2 diabetes Asthma CAD Hypertension
Allergies: Ampicillin Amoxicillin Penicilin Sulfa drugs Latex
Diagnostic Lab Data: Blood work Urinalysis EKG
CDC Split Type:

Write-up: Severe vomiUrinalysn and bleeding from rectum diarrhoea, follwed by chest pai


VAERS ID: 1347606 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-05-04
Onset:2021-05-15
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Rash erythematous, Rash pruritic, Swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None before. After vaccination I broke out with a rash/hives that really itch. Redness with a bump and a dot right in the middle. Had to go to doctor. They have me on meds.
Preexisting Conditions: Migraines
Allergies: Aspirin Augmentin Talwin Tesalon Pearls Sulfur
Diagnostic Lab Data: It started on May 15th. Went to clinic on May 19th. Said they don?t know what it is. Treating with oral meds. Loratadine, Famotidine and Prednisone.
CDC Split Type:

Write-up: Broke out with a rash/hives. Redness, itchy. Broke our on arms, legs and face.


VAERS ID: 1347627 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-01
Onset:2021-05-15
   Days after vaccination:44
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SYR

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

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

Write-up: I got shingles a little over a month after receiving my final covid vaccine


VAERS ID: 1347706 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Condition aggravated, Herpes simplex
SMQs:, Opportunistic infections (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: Fluoxetine 40mg
Current Illness: None
Preexisting Conditions: HSV-II, Anxiety, Depression, PCOS, endometriosis
Allergies: None
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: triggered HSV-II outbreak. Normally is suppressed, caused significant outbreak similar to initial outbreak.


VAERS ID: 1347848 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Unknown  
Location: California  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 2 LA / IM

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

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

Write-up: The patient''s first dose was Pfizer, Staff member administered the wrong second dose vaccine to patient.


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