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

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



Case Details (Reverse Sorted by Onset Date)

This is page 158 out of 6,867

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VAERS ID: 1548990 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Headache, Oropharyngeal pain, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Had COVID-19 in late October of 2020.
Preexisting Conditions: None.
Allergies: None.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe headaches, runny nose, constant dry cough, sore throat.


VAERS ID: 1549016 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Diarrhoea, Lymphadenopathy, Oropharyngeal pain, Pain
SMQs:, Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Jardiance 10mg (once daily) Magnesium Vitamin C Multi Vitamin Iron C2
Current Illness: Diabetes Fibro Myalgia
Preexisting Conditions: Diabetes Fibro Myalgia
Allergies: Latex Statin Eggs
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Lymph node on left side, pain under armpits, body ache, sore throat and dairrhea


VAERS ID: 1549035 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

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

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

Write-up: There was an administration error today (8/11) . Individual is under 18 years old.


VAERS ID: 1549047 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-08-10
Onset:2021-08-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Computerised tomogram, Dizziness, Electrocardiogram, Magnetic resonance imaging, Malaise, Seizure, Thirst, Urine analysis, X-ray
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Quillachew Montelukast
Current Illness: None
Preexisting Conditions: None
Allergies: Amoxicillin
Diagnostic Lab Data: EKG, MRI, X-ray, CT, blood panel, urine sample (8/11/2021)
CDC Split Type:

Write-up: The following morning around 7:30am, the patient had a seizure after indicating he was light headed, thirsty, and sick. He was transported via ambulance to the hospital for further testing. He arrived at the hospital just before 9am. The patient will be following up with neurology at a local university.


VAERS ID: 1549049 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

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

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

Write-up: After the vaccine, he had hives noted on inner sides of upper arms down to his antecubital areas and on his anterior and medial proximal thighs. Administered 10mg of cetirizine, which lessened the hives. Advised cetirizine qhs for a few days to a few weeks until the rash resolves, hydrocortisone cream 2.5% if the rash reoccurs.


VAERS ID: 1549051 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040CZIA / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Hypoaesthesia oral, Sensation of foreign body, Swelling face
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (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: Vitamin C Vitamin D
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 7min after shot Swelling of face, numbness in lips, difficulty breathing, felt lump in throat, and faint feeling


VAERS ID: 1549062 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-01-29
Onset:2021-08-11
   Days after vaccination:194
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 2 LA / IM

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

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

Write-up: PT RECIEVED PFIZER PRIME DOSE 01-08-2021 AND BOOSTER DOSE 01-29-2021. PCR/ANTIGEN AND IgG POSITIVE FOR COVID 19 DISEASE 08-11-2021


VAERS ID: 1549076 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-06
Onset:2021-08-11
   Days after vaccination:97
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asymptomatic COVID-19, Delivery, Exposure during pregnancy, SARS-CoV-2 test positive
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Normal pregnancy conditions and outcomes (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Positive SARS-CoV-2 by PCR 8/11/2021
CDC Split Type:

Write-up: Admitted to L&D, delivered baby 8/11/2021. Asymptomatic for COVID SxS


VAERS ID: 1549085 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injected limb mobility decreased, Injection site swelling, Injection site warmth, Pain, Pain in extremity, Paraesthesia, Sleep disorder
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 08/11/2021
CDC Split Type:

Write-up: Intensive pain & tingling in vaccinated arm. 8 hours later, can not move left arm without severe pain. Swelling & heat at injection site. Pain kept me awake most of the night.


VAERS ID: 1549089 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019B21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Fatigue, Immediate post-injection reaction, Seizure like phenomena, Somnolence, Tonic clonic movements
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: amlodipine 2.5mg; aspirin 81 mg; enalapril 10 mg; Xopenex; rosuvastatin 5 mg; vitamin D
Current Illness:
Preexisting Conditions: asthma; hypertension; hypercholesterolemia
Allergies: clonidine; codeine; demerol; erythromycin; heparin; lidocaine; morphine; novocain; robinul; statins; valium; zetia
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt experienced seizure-like activity with clonic tonic movements of all extremities directly following the administration. Pt did not lose consciousness and was not incontinent during the event. Pt complained of felling fatigue - challenge to keep her eyes open. EMS arrived in 4 minutes and took patient to ER


VAERS ID: 1549102 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 00001A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Immediate post-injection reaction, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: EMT reports that patient received the 1st dose of Pfizer 08/11/2021, Pt. fainted immediately after resulting transport for observation. Cognitive test preformed and showed normal cognitive ability. Pt. currently has recovered and discharged.


VAERS ID: 1549104 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-01-11
Onset:2021-08-11
   Days after vaccination:212
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Exposure to SARS-CoV-2, Malaise, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: hypertension
Allergies: Sulfa allergy
Diagnostic Lab Data: Sars-CoV-2 nasopharyngeal swab
CDC Split Type:

Write-up: Positive COVID-19 on 8/11/21 in fully vaccinated individual. Developed symptoms of fever, malaise, and congestion on day of test, approximately 5 days after exposure to an unvaccinated individual in her household who had tested positive for the virus.


VAERS ID: 1549109 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Circumstance or information capable of leading to medication error, Extra dose administered
SMQs:, Medication errors (narrow)

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

Write-up: The client came to the clinic and requested her "first" Pfizer vaccine and stated she did not have a vaccine card. Her electronic record was looked up, but none was found. Her last name was entered incorrectly at check-in. The client added an "e" in the spelling of her last name. This was corroborated by 2 people at check-in. Upon entry into Immunization Registry, it was found that she was already fully vaccinated with Pfizer.


VAERS ID: 1549112 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Vestibular disorders (broad), Dehydration (broad)

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

Write-up: Patient received their vaccine around 10 am on 8/11/21, and they reported they went to lunch and felt fine, then a few hours later they got back to work and their heart rate was elevated and they felt dizzy. Upon a follow-up call, they reported their heart rate was still 120-130bpm despite resting and relaxing and taking Benadryl.


VAERS ID: 1549115 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Discoloured vomit, Discomfort, Hyperhidrosis, Malaise, Nausea, Pallor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient reported he has history of fainting after getting a ceftriaxone injection years ago. We talked through the possible scenarios and proceed with the vaccine with his partner next to him for support. Patient sat down after vaccine for 5 minutes and his partner came up to notify me that patient was not feeling well. I went to check on him and saw that he was still alert, conscious and able to have a conversation. However, he appeared pale, uncomfortable and sweating. I went to get him some paper towel and went I came back he said he felt nauseous and wanted to head toward the restroom. I urged him to stay seated and I went to get him a plastic bag. By the time I came back, he already started vomiting tan fluid on the floor. Patient vomit for lest than one minute and felt better. He stayed for observation for another 20 minutes and felt well and left.


VAERS ID: 1549122 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: This client came to the clinic, denied having a vaccine card and stated she presented for her first Pfizer vaccine. She was looked up in the and the staff missed looking at the record correctly and that she was already fully immunized with 2 doses of Moderna. This error was caught while the client was still at the facility in observation. When asked if her record was correct in her already receiving 2 doses of Moderna, she said yes. She stated that she takes immunosuppressive medication and her immunologist told her to get another vaccine any way she could so she was protected against Covid.


VAERS ID: 1549124 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Fatigue, Feeling hot, Headache, Hyperhidrosis, Hypotension, Pallor, Paraesthesia, Tachypnoea
SMQs:, Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: syncope/vasovagal reactions
Other Medications: hyoscyamine prn - taken about 2x/week on average ; zyrtec prn;
Current Illness: none
Preexisting Conditions: Irritable Bowel Syndrome, seasonal allergies
Allergies: lidocaine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt presented to facility to get a Janssen COVID vaccine. Pt reports history of vasovagal reactions to flu vaccines in the past. Patient began feeling hot and became diaphoretic within 5 minutes of receiving the vaccine. Nurse noted pallor, tachypnea, and hypotension. Patient c/o tingling extremities, headache, and fatigue. Patient remained alert and oriented. He began to improve without further intervention within 10 minutes of injection, and fully recovered "feeling better" within 30 minutes of injection. Patient reported fatigue, but otherwise feeling well two hours later by phone on follow-up.


VAERS ID: 1549132 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Cough, Throat irritation
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

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

Write-up: Itchy throat, cough, tightness in chest


VAERS ID: 1549144 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / IM

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

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

Write-up: Second shot administered Inadvertently before 21 days. Patient walked into to get second dose of Pfizer covid-19 vaccine in the Second shot vaccine clinic at high school clinic event. Upon screening patient said she have received the first dose of Pfizer covid-19 vaccine during the first clinic we did 3 weeks ago on 07/20/21 at the school. Patient said she doesn?t have a record card from first dose. She has been administered the second dose of Pfizer covid-19 vaccine. While writing record card for second dose, she produced the card from first dose. According to that, she has been administered first dose of Pfizer covid-19 vaccine on 08/05/2021 by other vaccine administrator at the school. We have checked immtrac2 registry of state for first dose record but did not find any record of first dose of Pfizer covid-19 vaccine till 08/12/2021. Patient was under observation for 30 minutes and did well during that period. We informed patient and guardian(mother) to watch for any side effects she may experience and contact her physician if symptoms persist. Patient and mother both were informed not to get third dose of Pfizer covid-19 vaccine, as her 2 dose series is completed as per CDC guidelines.


VAERS ID: 1549160 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-09
Onset:2021-08-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site induration, Injection site pain, Injection site rash, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)

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

Write-up: Patient called on 8/12/21 saying she had a reaction to her 2nd COVID19 Pfizer vaccine given on 8/9/21. She said she started to notice yesterday (8/11/21) a rash like spot under the injection site. She described it as red, hard, sore, and hot to touch. It is still there today (8/12/21) and she called to tell us.


VAERS ID: 1549173 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-03-28
Onset:2021-08-11
   Days after vaccination:136
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

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

Write-up: PT VERBALLY STATES HE RECEIVED PRIME AND BOOSTER DOSE OF MODERNA COVID 19 IN DALLAS WITH LAST DOSE ADMINSITERED ON OR ABOUT 03-28-2021. PT TESTED POSITIVE FOR COVID 19 DISEASE 08-11-2021 PCR AND IgG POSITIVE.


VAERS ID: 1549180 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspnoea, Heart rate irregular, Muscle spasms, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Cardiac arrhythmia terms, nonspecific (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: Sulfa meds
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cramping on left side of chest, irregular, rapid heart beat. Muscle soreness, fever, shortness of breath. No treatment


VAERS ID: 1549181 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Circumstance or information capable of leading to medication error, Insomnia
SMQs:, Medication errors (narrow)

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

Write-up: My son and I received his vaccination card and when we got home (after the pharmacy was closed for the night) we realized that the pharmacy had marked his card as receiving the Janssen COVID Vaccine and not the Pfizer as scheduled and confirmed upon arrival. Needless to say, we both barely slept all night not knowing what shot my son had actually received. I went first thing this morning to the pharmacy and spoke with the pharmacist on duty (not the same pharmacist that administered the shot the night prior) and she was very appologetic and corrected the situation and corrected my son''s vaccination card. This never should have happened and I would like a governmental explanation as to how they are SO sure that my son ACTUALLY received the right injection. Thank you very much.


VAERS ID: 1549187 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Paraesthesia oral
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)

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

Write-up: Patient complained of tingling of lips, RN walked patient over to urgent care for further evaluation.


VAERS ID: 1549191 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-08-06
Onset:2021-08-11
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Fatigue, Immediate post-injection reaction, Musculoskeletal stiffness, Nodule, Pain in extremity, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Immediately following treatment, I suffered severe intense arm pain which after 4 hours, my entire arm was stiff and a large egg sized know appeared. On day six, the know turned red and became itchy with a rash. The following day, the size of the rash is very large and has spread over night and the knot is still present. For the first three days following the vaccine, I suffered severe exhaustion but other than these issues, no other side effects occurred.


VAERS ID: 1549195 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-29
Onset:2021-08-11
   Days after vaccination:104
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Dyspnoea, Interstitial lung disease, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: SARS-CoV-2 (COVID-19) by NAA, Micro detected on 8/11/21 CXR shows IMPRESSION: Interstitial airspace disease likely infectious in etiology
CDC Split Type:

Write-up: patient presented with shortness of breath, and tested positive for COVID-19


VAERS ID: 1549198 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK LA / -

Administered by: Public       Purchased by: ?
Symptoms: Amnesia, Confusional state, Dizziness, Hyperhidrosis, Hypotension, Loss of consciousness, Oxygen saturation decreased, Pallor
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Patient given Janssen vaccine at 12:05pm. At 12:10, patient became diaphoretic, lightheaded, and lost all color in face. We lowered patient to ground slowly, laid him flat on the carpet, and elevated feet on chair. Patient passed out. Checked vitals at 12:10pm. BP 110/72, O2 96, Pulse 62, RR 16. Patient regained consciousness and was confused/had no recollection about what had occurred. Assumed blood sugar was also low in combination with the low blood pressure, so I administered two glucose tablets and had the patient drink some apple juice. Checked vitals again at 12:20pm. BP 115/90, O2 92, Pulse 62, RR 14. BP increased and patient expressed that he was no longer lightheaded and felt much better. Checked vitals again at 12:30pm. BP 120/87, O2 96, Pulse 70, RR 14. Since the patient''s BP and O2 levels increased to normal, I had him call someone to pick him up so he wouldn''t have to drive home. I slowly assisted the patient to get up from the floor. Made sure he was stable enough to walk, was no longer lightheaded or symptomatic and that his color had returned in his face. I assisted him to the car and explained to his roommate what had occurred and the interventions we had done, including administering two glucose tablets and apple juice. Told patient to take it easy for the day and get some rest. Documented in the patient''s chart the adverse reaction to the Janssen vaccine. Also documented on Emergency flow sheet. VAERS report completed.


VAERS ID: 1549203 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 1 RA / IM

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

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

Write-up: Moderna vaccine given to patient under 18 years of age


VAERS ID: 1549204 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None was written on the consent form filled out by the patient
Current Illness: None was written on the consent form filled out by the patient
Preexisting Conditions: none was written on the consent form filled out by the patient
Allergies: None was written on the consent form filled out by the patient
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: On 08/11/21 patient came to the pharmacy with his 3 other family members (total of 4 people) for COVID vaccine. Rph administered Pfizer Covid Vaccine (dose 1) to the patient in a stand-up position and soon after patient fainted on the ground. He re-gained his conciousness right away. Rph called the store director. Rph asked patient to be sitting down on the ground and measured his bloodpressure - it was read 107/68. When Rph asked patient what his normal BP was, patient or the family members did not know. No history of hypertension was listed on the consent form. Rph monitored patient for 30 minutes and instructed him to seek medical care if necessary.


VAERS ID: 1549205 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-04
Onset:2021-08-11
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Injection site pruritus, Injection site rash
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atenolol, Zoloft, Synthroid
Current Illness: None
Preexisting Conditions: None
Allergies: Amoxicillin, Sulfa, Cleocin, pitted fruit
Diagnostic Lab Data: None
CDC Split Type:

Write-up: About 7 days after vaccination the injection site became itchy, red, burning and a rash approximately 10x6 cm erupted. The site hurt the day after the vaccine then was fine until the symptoms started on 8/11.


VAERS ID: 1549206 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-27
Onset:2021-08-11
   Days after vaccination:196
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Malaise, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes Mellitus Type 2 Hyperglycemia Atherosclerotic Heart Disease Of Native Coronary Artery Without Angina PeDiabetes Mellitus Type 2 Hyperglycemia Atherosclerotic Heart Disease Of Native Coronary Artery Without Angina Pectoris Personal History Of Malignant Neoplasm Of Prostate Hypothyroidism Acquired Aneurysm Iliac Artery Advanced Care Planning Loss Weight Repeated Falls Depressed Mood Tremor Postural Abscess Prostate Malnutrition Severe Protein-Calorie Aneurysm Abdominal Aortic Without Rupture Nephrolithiasis Osteomyelitis Percutaneous Transarterial Coronary Angioplasty Status Post Hyperlipidemia On Treatment Hypertensive Chronic Kidney Disease (CKD) Stage 3b Glomerular Filtration Rate (GFR) 30 To 44 Abdominal Aortic Aneurysm Repair Status Post Block Atrioventricular First Degree Loss Hearing Sensorineural Bilateral Cataract Senile Nuclear Sclerosis Right Major Neurocognitive Disorder Due To Alzheimer''s Without Behavior Disturbance Anemia
Allergies:
Diagnostic Lab Data: Coronavirus 2 PCR Detect, V symptomatic POSITIVE
CDC Split Type:

Write-up: SNF called to report patient developed a cough, fever 100.8, and malaise today. This despite ceftriaxone and vancomyicn antibiotic therapy for his prostate abscess. He needs timely eval to include blood tests, nasal PCR, CXR, etc. Consider drug fever if no source found.


VAERS ID: 1549212 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-08-10
Onset:2021-08-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049EZ1A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

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

Write-up: Blurred vision


VAERS ID: 1549214 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 1 RA / IM

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

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

Write-up: None


VAERS ID: 1549246 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-14
Onset:2021-08-11
   Days after vaccination:119
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / UNK LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031A21A / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthma, Condition aggravated, Injection site pain, Mobility decreased, Psoriatic arthropathy
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Asthma attack 1st shot 5min after, age 52, datev3/16/21,intramuscular, Moderna, COVID arm/ PsA flare up , age 52, 4/12/21,intram
Other Medications: Levothyroxine, singular, Paxil
Current Illness: None
Preexisting Conditions: PsA, psoriasis, low thyroid, asthma, anaphylactic food allergies.
Allergies: Iodine, latex, avocados, cantaloupe, corn, peanuts
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain at injection site, in able to touch muscle without pain. PsA flare up since 3weeks after 2nd shot. Flare up has been non stop. Unable to use hands on regular basis due to PsA.


VAERS ID: 1549265 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-05
Onset:2021-08-11
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / N/A RA / IM

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

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

Write-up: Itchy red hive like rash on bilateral extremities. Treated and resolved with Benadryl.


VAERS ID: 1549270 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Limb injury, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately 5 minutes post vaccination, the patient displayed shaking features and called out for help. He continued to shake wildly for approximately 30 seconds to 1 minute. He asked for help throughout and was visibly very upset. Staff implemented an emergency response, contacted EMS who responded in approximately 5 minutes from the time of the initial reaction. Prior to EMS arriving the patient was slowly lowered the the floor while shaking and gradually calmed down. He said "I think I just had a seizure." He injured his leg during the episode by hitting it off of one of the shelves in the pharmacy waiting area. He did not hit his head or appear to lose consciousness during the episode. Patient was examined by EMS upon their arrival. Vital signs were examined and noted by EMS (I do not have those numbers). Patient was slowly moved to a seating position by EMS and monitored for approximately 10 more minutes upon which time the patient experienced a similar episode to the first. At this point the patient was transported by EMS to the Hospital Emergency Department. The patient contacted the pharmacy later in the afternoon indicating that he had been examined and discharged to home.


VAERS ID: 1549272 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-10
Onset:2021-08-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204 A 21 A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia, Diarrhoea haemorrhagic, Gastrointestinal pain, Headache, Heart rate increased, Hypoaesthesia, Hypoaesthesia oral, Nausea, Paraesthesia, Vertigo
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Vestibular disorders (narrow), Noninfectious diarrhoea (narrow), Dehydration (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: Gout, elevated blood lipids / pressure
Allergies: allergic to serum used to manufacture vaccines. Seasonal allergies (pollen, etc)
Diagnostic Lab Data: none at this time
CDC Split Type:

Write-up: day after shot, began experiencing, nausea (at times severe) and intermittent vertigo, elevated heart rate. later in the same evening, symptoms remained and developed headache, which became severe at approx. 1000 pm, and "numbness" in mouth (lack of taste, cotton like feeling). diarrhea and intestinal cramping throughout the evening hours, with tingling / numbness / "pins and needles" in both hands. symptoms continued through 12AUG2021. if symptoms persist, medical evaluation will be sought.


VAERS ID: 1549283 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-04
Onset:2021-08-11
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 05E21A / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Dehydration, Diarrhoea, Dyspnoea, Myalgia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Dehydration (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: azithromycin, 500 mg, PO, Daily dexamethasone, 4 mg, PO, Dail
Current Illness:
Preexisting Conditions: Ongoing Chronic hip pain after total replacement of right hip joint Historical Cellulitis of left leg Eschar of lo
Allergies: NKA
Diagnostic Lab Data: SARS COV2 COVID19 PCR 08/11/2021
CDC Split Type:

Write-up: Date of Admission 08/11/2021 Chief Complaint Patient reports SOB, chest pain/ muscle pain, diarrhea, feeling dehydrated, and loss of History of Present Illness Patient is 66-year-old female with history bilateral hip replacements presented Still admitted on day from submitted


VAERS ID: 1549290 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 325 MG tablet Take 325-650 mg by mouth every 6 (six) hours as needed. albuterol (PROVENTIL HFA;VENTOLIN HFA;PROAIR HFA) inhaler Inhale 2 puffs into the lungs Every 6 (Six) Hours As Needed Pharmacy to dispense brand
Current Illness: None
Preexisting Conditions: GERD (gastroesophageal reflux disease) (*) PSA (psoriatic arthritis) (*) Attention deficit hyperactivity disorder (ADHD) (*) Depression (*) Allergic rhinitis Generalized hyperhidrosis Tobacco use disorder Family history of colon cancer Family history of heart disease Abnormal Pap smear of cervix Mark as Reviewed Reviewed by RN on 8/11/2021
Allergies: SulfasalazineAnaphylaxis, Swelling AmoxicillinOther (See Comments) IbuprofenNausea And Vomiting NaproxenNausea And Vomiting
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Employee states that within 6-hours of injection began to spike fever, headache, and body aches. States that temperature topped out at 101''F during the night but is getting lower today.


VAERS ID: 1549301 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-23
Onset:2021-08-11
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EL3248 / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EN5318 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Condition aggravated, Gait inability, Genital discomfort, Hypertension, Incontinence, SARS-CoV-2 test positive, Skin irritation, Urine analysis, Urine leukocyte esterase positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow), Sexual dysfunction (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Keflex 500 mg oral capsule, 500 mg= 1 CAP, PO, Q12H (Every 12
Current Illness:
Preexisting Conditions: Bladder Cancer, Diabetes, Heart Attach, Hypertension
Allergies: Reglan Statins codeine
Diagnostic Lab Data: SARS COV2 COVID 19 PCR 08/11/2021
CDC Split Type:

Write-up: Date of Admission 08/11/2021 Chief Complaint Weakness yesterday. Came to ED with his wife but there was a long wait in the lobby so he went home. Today weakness has subsided. Generalized irritation to groin and pubic area due incontinence. History of Present Illness The patient is a 84-year-old male with a past medical history significant for bladder cancer with prior cystectomy, hypertension, hyperlipidemia, type 2 diabetes, morbid obesity with a BMI of 43, who was brought the ER today due to generalized weakness and inability to walk. He is not a great historian. He states he was recently discharged from a rehab facility within the past week, and has been weak and unable to walk since leaving the facility. His wife is been unable to care for him. In the ER he did test positive for COVID-19. States that he received both of his Pfizer vaccines in February. He denies any cough or shortness of breath. He is saturating well on room air. He states that his wife at home has been coughing and short of breath. Vital signs in the ER show the patient to be quite hypertensive with systolic over to 17. Urinalysis with 2+ leukocyte esterase. Patient still admitted on day form submitted


VAERS ID: 1549307 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-12
Onset:2021-08-11
   Days after vaccination:211
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

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

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

Write-up: PATIENT WAS TESTED ON 8/11/21 AND TESTED POSITIVE TO COVID


VAERS ID: 1549318 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-08-09
Onset:2021-08-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN FA7484 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

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

Write-up: Patient complaining of heart racing post day 1 and after vaccine administration. Pulse at pharmacy on 8/12/2021 1:45 pm was 94 bpm. Advised patient to report to urgent care evaluation.


VAERS ID: 1549319 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

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

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

Write-up: On Wednesday, 8/11/21, client received his dose of Janssen Covid-19 vaccine (LOT #: 201A21A, exp: 9/21/21) at 3:20pm on his left deltoid. During assessment questions, client denied any underlying medical conditions or allergic reactions and was to be a 15 minute observation. At 3:24 pm, while waiting in Observation Area, client stated to RN, he is feeling "shaky and dizzy." At 3:25 pm, client was seated in anti-gravity chair and vitals were started and taken every 5 minutes. Client was also given a bottle of water and a granola bar that the patient drank and ate. Client stated he did eat lunch earlier. Vitals at 3:30 pm: BP: 130/80, HR: 82, O2 sat: 98%, RR: 20. Client was alert and oriented to person, place, time and orientation. At 3:35 pm, BP: 135/85, HR: 88, O2 sat: 97%, RR: 20. Client AOx4, skin dry and pink. At this time, client stated to RNs he felt no dizzyness or shakiness and denied nausea/vomiting. No further interventions needed. Client was educated by RNs on signs and symptoms of adverse reactions and when to go to the ED/call MD. Client was also encouraged to sign-up on v-safe. Client left vaccination site with a steady gait and driven home by his wife at approximately 4:00pm.


VAERS ID: 1549327 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Flushing, Hyperhidrosis, Skin discolouration, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Chills-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: AFTER 4 TO 5 MINUTES SKIN COLOR CHANGED-Severe, Systemic: Flushed / Sweating-Severe, Systemic: Shakiness-Medium


VAERS ID: 1549334 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 1 LA / UN

Administered by: Military       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Dysgeusia, Electrocardiogram normal, Hypoaesthesia oral, Nausea, Paraesthesia oral, Pharyngeal hypoaesthesia, Pharyngeal paraesthesia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid
Current Illness: None.
Preexisting Conditions: Hashimoto''s hypothyroid, vitiligo
Allergies: None.
Diagnostic Lab Data: EKG, blood pressure, pulse, and oxygen levels all normal within hours of vaccination.
CDC Split Type:

Write-up: Within 20 minutes of receiving the vaccination, I started getting dizzy, mouth, tongue and throat started tingling and becoming numb, nausea, tightness in chest, metallic taste in mouth. Was seen and monitored in the ER, released a couple of hours later. Tingling and numbness in mouth, tongue and throat and dizziness still persist over 24 hours later (at time of this report).


VAERS ID: 1549337 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-03
Onset:2021-08-11
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood lactic acid, Blood sodium decreased, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Computerised tomogram thorax normal, Cough, Dyspnoea, Exposure to SARS-CoV-2, Hypoxia, Lung consolidation, Lung opacity, Malaise, Oxygen saturation decreased, SARS-CoV-2 test positive, Sick relative
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Respiratory failure (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: alendronate oral tablet,
Current Illness:
Preexisting Conditions: Hyperlipidemia Hypertension Osteoporosis Tachycardia
Allergies: NKA
Diagnostic Lab Data: SARS COV2 COVID 19 PCR 08/11/2021
CDC Split Type:

Write-up: The patient presents with Shortness of breath. Pt reports to have taken her oxygen saturation at home and was noted to be hypoxic. Pt is currently COVID-19 positive, states she tested positive yesterday. Pt is not anticoagulated. PMHx significant for HTN, PE. Pt denies chest pain, cough, nausea, vomiting, fevers, chills, and all other acute systemic symptoms. The onset was Few days ago. Patient is a 75-year-old female with history of hypertension, hyperlipidemia, prior stroke and borderline diabetes presents the ED with worsening COVID-19 symptoms. Patient states she has been feeling ill for the past week. She tested positive for COVID infection yesterday. She reports a mild cough but significant shortness of breath. She denies any fevers or chills. She denies any nausea, vomiting or diarrhea. Husband is also sick with COVID infection. She had 1 Pfizer COVID vaccination last week. Patient was monitoring her O2 sats and says they were dropping into the 70s at home. She was initially on 10 L nasal cannula has since been transition to 60 liters/minute high-flow oxygen in the ED. Laboratory studies are generally unremarkable other than sodium of 133, and a lactic acid of 2.2. Her chest x-ray shows multifocal ground-glass infiltrates consistent with COVID pneumonia. CT of the chest is negative for pulmonary embolus. She does have moderate to severe bilateral ground-glass opacification and developing consolidation consistent with her known COVID pneumonia.


VAERS ID: 1549369 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-19
Onset:2021-08-11
   Days after vaccination:204
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EL3302 / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EN5318 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood sodium decreased, COVID-19, Chest X-ray abnormal, Dementia, Dyspnoea, Haemoglobin decreased, SARS-CoV-2 test positive, Troponin increased
SMQs:, Anaphylactic reaction (broad), Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Myocardial infarction (narrow), Dementia (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin, 81 mg, Chewed, Daily Breo Ellipta 100 mcg-25 mcg/inh
Current Illness:
Preexisting Conditions: Cardiovascular: hypertension, hyperlipidemia. Respiratory: COVID-19. Endocrine: no diabetes, no hypothyroid, no hype
Allergies: NKA
Diagnostic Lab Data: SARS COV2 COVID 19 PCR 08/11/2021
CDC Split Type:

Write-up: The patient presents with Couple of days hx of shortness of breath. Pt is currently COVID-19 positive, tested positive today. PMHx significant HTN, HLD. Pt denies nausea, vomiting, diarrhea, fevers, chills, and all other acute sysmetic symptoms. The onset was Couple of days ago. The course/duration of symptoms is constant. The Relieving factors is none. Risk factors consist of hypertension. Associated symptoms: denies chest pain, denies fever, denies chills, denies cough, denies nausea, denies vomiting, denies abdominal pain, denies back pain, denies weight gain and denies hemoptysis. She is largely asymptomatic. She denies any cough, shortness of breath, fevers, vomiting or diarrhea. He seems to some degree of dementia but is very pleasant and attempts to answer questions. She thinks that she received both COVID vaccinations several months ago. We were able to obtain her medication list from her daughter and appears that she has a history of Congestive heart failure, hypertension and Chronic obstructive pulmonary disease based on her medications. Patient has been stable on room air. Laboratory studies are significant for hemoglobin of 10.5, sodium of 130 in mildly elevated troponins of 21 and 15. Her chest x-ray shows findings consistent with Chronic obstructive pulmonary disease but no acute infiltrates. ALF facility is declined to accept her back to her COVID positive status and therefore admission is requested.


VAERS ID: 1549386 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-29
Onset:2021-08-11
   Days after vaccination:135
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA ER2613 / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EW0158 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, Exposure to SARS-CoV-2, Pyrexia, SARS-CoV-2 test positive, Sick relative
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acyclovir 800 mg oral tablet, 800 mg, PO, AM (Every morning) Ambien 5 mg oral tablet, 5 mg= 1 TAB, PO, QHS (At bedtime), PRN atorvastatin 20 mg oral tablet, 20 mg= 1 TAB, PO, Daily isosorbide mononitrate 30 mg oral tablet, extended relea
Current Illness:
Preexisting Conditions: HTN, HLD, CAD, peripheral neuropathy
Allergies: Bactrim
Diagnostic Lab Data: SARS COV2 COVID 19 PCR 08/07/2021
CDC Split Type:

Write-up: The patient presents with 44 year old female with a medical Hx of DM, HTN and CAD presents with a covid positive test on 8/7/21. Patient reports of worsening cough, shortness of breath and fever. Pt does note of receiving both of her covid Pfizer vaccinations. Patient was seen here x5 days ago in the ED after being exposed to son who is covid positive but has worsened since. Pt denies any chest pain, abdominal pain, urinary complications, diarrhea or vomiting. The onset was 5 days ago.


VAERS ID: 1549390 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Condition aggravated, Myalgia, Oropharyngeal pain, Pain in extremity, Pyrexia, Restlessness
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tramadol, Baclofen, Terazosin, Magnesium Oxide, Vit D3, Vit C, Spiriva inhalor, Montelukast
Current Illness: none
Preexisting Conditions: COPD, Thoracic Aortic Aneurysm, Chronic right hip pain (Hip replacement done May 6th 2019)
Allergies: none
Diagnostic Lab Data: none so far
CDC Split Type:

Write-up: My artificial Right hip has always given me pain, but this increased exponentially. I had extreme pain, in my hip, which continued to develop so that the pain by bedtime was debilitating, all the way down my right leg. I began to run a mild fever, I got no rest until morning, but at that point every joint, both shoulders, both hips, both elbows, both knees were painful to move. The muscles in my thighs were sore like someone had beaten me, and at first I thought I was developing a sore throat or swollen lymph nodes in my neck, but I''ve now determined this is the same as the pain in my thighs,


VAERS ID: 1549393 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-30
Onset:2021-08-11
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EW0185 / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, Anion gap, Bilevel positive airway pressure, Blood glucose increased, Blood lactic acid decreased, Blood sodium, COVID-19, COVID-19 pneumonia, Carbon dioxide abnormal, Chest X-ray abnormal, Chest pain, Chills, Computerised tomogram thorax abnormal, Cough, Diabetic ketoacidosis, Dyspnoea, Hypoxia, Lung infiltration, Lung opacity, Malaise, Oxygen saturation decreased, SARS-CoV-2 test, Tachycardia, Tachypnoea, White blood cell count normal
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (narrow), 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), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), 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: No active home medications
Current Illness:
Preexisting Conditions: Diabetes
Allergies: NKA
Diagnostic Lab Data: SARS COV2 COVID 19 PCR 08/11/2021
CDC Split Type:

Write-up: The patient presents with 4 day hx of shortness of breath with cough, chest pain upon coughing, and chills. EMS services were called and pt was noted to be hypoxic on 54% RA, pt was immediately placed on a nonrebreather. Pt denies recent sick contacts. Pt has been adminsitering with OTC medication with cough without relief. Pt denies fevers, headache, nausea, vomiting, diarrhea, and all other symptoms. The onset was 4 days ago.. The course/duration of symptoms is worsening. Patient is a 55-year-old language-speaking male with a history of untreated diabetes mellitus who presents to the ED with acute respiratory distress. Patient says he has been sick for the past week. He has had significant shortness of breath, Patient is a 55-year-old language-speaking male with a history of untreated diabetes mellitus who presents to the ED with acute respiratory distress. Patient says he has been sick for the past week. He has had significant shortness of breath, exacerbated by coughing. He denies any fevers, chills, nausea, vomiting or diarrhea. Patient''s wife called EMS and on their arrival sats were noted to be in the mid 50s. He was placed on a non-rebreather. On arrival to the ED patient was placed on heated high-flow oxygen 40 liters/minute. COVID-19 is positive in the ED. Patient is diabetic and says he has not been on any medication, only taking vitamins. He did get both COVID vaccinations with the first being on 06/26/2021 and the second vaccination 2 weeks ago. After arrival to the medical floor the patient has been increased to high-flow 60 liters/minute with sats 80-90%. He does desat to 80% with any movement or talking. Patient was tachycardic and tachypneic on arrival. He had ABG showed a PO2 of 59 on high-flow 40 liters/minute. Patient also has a white blood cell count of 23. He is in diabetic ketoacidosis with a blood glucose of 529, CO2 of 14, anion gap of 24 and a serum sodium of 127. His initial lactic acid was 5.3 which is come down to 3.4. His chest x-ray shows multifocal ground-glass infiltrates consistent with COVID pneumonia. CT the chest is negative for pulmonary embolus but does demonstrate diffuse bilateral mixed pulmonary infiltrates. Given patient''s continue desaturations into the high 70s to low 80s, after discussing with RT we have now transitioned him to BiPAP and placed him in a semi prone position. O2 sats are now in the low 90s


VAERS ID: 1549415 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-09
Onset:2021-08-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Eye disorder, Head discomfort, Presyncope, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Corneal disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Sudden onset vision changes - felt like my eyes were looking in different directions; vision skewed; felt pressure in my head, dizziness and felt like I was going to pass out. I thought I was having a stroke. The feeling passed after about 5 minutes. Did not seek treatment.


VAERS ID: 1549426 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-08-10
Onset:2021-08-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

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

Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA: Dose #1 - My son first started feeling hot or slightly feverish late morning followed by a headache. We checked his temperature a few different times throughout the day and it never got above 99F which was a good sign. However, the headache continued to worsen as the day went on (we gave him plenty of water to drink) and it got to the point where he was laying down crying while gripping his head. Since he was experiencing a severe headache and asking for some type of relief due to the intensity of the pain, we decided to give him some ibuprofen (one 200mg tablet). My son has never had to take any pain medication for a headache in the past so this was unusual and we believed that this headache was most likely caused by the vaccine. The ibuprofen subsided the pain and he was feeling better by the evening of that same day.


VAERS ID: 1549430 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Immediate post-injection reaction
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zinc, VitD, Lozartan
Current Illness: none
Preexisting Conditions: Blood pressure
Allergies: Cigarette smoke, unknown anaphylaxis in 2020
Diagnostic Lab Data:
CDC Split Type:

Write-up: Immediate adverse allergic reaction, struggled to breathe,


VAERS ID: 1549444 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / -

Administered by: Pharmacy       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: Multivitamin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Moderate arm pain on the same arm as the injection. Going on for 24 straight hours now post vaccination.


VAERS ID: 1549467 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002A21A / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Discomfort, Dizziness, Electrocardiogram, Erythema, Feeling abnormal, Feeling hot, Gait disturbance, Hyperhidrosis, Palpitations
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: no
Preexisting Conditions: Diagnosed anxiety in 2019; no meds taken for it
Allergies: none
Diagnostic Lab Data: EKG done on 8/11/21 in ER
CDC Split Type:

Write-up: At 1005 went to the ER with heart palpitations, felt lightheaded like she was going to faint, foggy head/mind, sweaty palms, body felt hot all over - ears were real red. Body felt real heavy and slow to walk - like she was drunk. In the ER she was treated for an adverse allergic rxn to vaccine and was given IV steroids and antihistamine by mouth; EKG was done, B/P was 180/68 and pulse was 130. She was told to follow up with doctor.


VAERS ID: 1549470 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-09
Onset:2021-08-11
   Days after vaccination:155
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Cough, Dyspnoea, Fatigue, Myalgia, Oropharyngeal pain, Rhinorrhoea, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Having muscle aches, runny nose, sore throat, extreme fatigue, cough, vomiting, SOB, chest pain in August


VAERS ID: 1549472 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eyelid function disorder, Pain in extremity
SMQs:, Periorbital and eyelid disorders (narrow), Ocular motility disorders (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Arm sore Left eye closed


VAERS ID: 1549482 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-10
Onset:2021-08-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA OO2F21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Postmenopausal haemorrhage
SMQs:, 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: Synthroid, Liothyronine, Furosemide, Xyzal, , Potassium, Vitamins: C, D, B Complex, Biotin, B 12
Current Illness: None, to my knowledge
Preexisting Conditions: Hypothyroidism, Hashimoto?s , Lymphedema
Allergies: All Sulfa based drugs
Diagnostic Lab Data: None as of yet
CDC Split Type:

Write-up: Post Menopausal breakthrough spotting


VAERS ID: 1549483 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Foaming at mouth, Throat irritation
SMQs:, Convulsions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Generalised convulsive seizures following immunisation (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: Denies
Current Illness:
Preexisting Conditions:
Allergies: Decongestants, antibiotics
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client received vaccine at 1:10 pm. Client complained of "foamy mouth and burning in throat" @1:30pm. Client has history of allergy to decongestants and antibiotics, reports hives and swelling of face with these medications. Client denies shortness of breath, difficulty breathing, or difficulty swallowing. RN offers client Benadryl for symptoms, client declines, states Benadryl makes her sleepy. Vitals signs are stable, client is able to drink water and reports this helps, foamy mouth has resolved. At 1:53 pm, client states she feels completely better, symptoms have resolved, vital signs remain stable. Client is able to leave observation area with family member, walking with steady gait @ 2:00pm. Client made aware to follow up with primary care physician and when to call 911.


VAERS ID: 1549486 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-12
Onset:2021-08-11
   Days after vaccination:91
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Asymptomatic, tested positive 8/11/21, case is in a facility .


VAERS ID: 1549526 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Diarrhoea, Dysgeusia, Headache, Injection site pain, Nausea, Pain, Vomiting
SMQs:, Acute pancreatitis (broad), Taste and smell disorders (narrow), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

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

Write-up: Metallic taste in mouth, nausea, vomiting, diarrhea, bodyaches ,headache injection site soreness


VAERS ID: 1549559 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-10
Onset:2021-08-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Diarrhoea, Ear pain, Headache, Injection site pain, Lymphadenopathy, Pain, Pain in extremity, Pyrexia, Skin warm, Tenderness
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: moderna covid vaccine 1st does
Other Medications: phentermine 37.5 mg 1/2 pill daily, topiramate 25mg 1 pill daily, zafirlukast 20mg 2x daily, spiriva 2.5 2puffs once a day, vitamin d3 2000 iu once a day
Current Illness: a cold, covid test was negative about 4wks prior
Preexisting Conditions: asthma alpha1 antitrypsin deficiency obesity
Allergies: percocet, montelukast, codeine, inhalation corticosteroids, steri strips
Diagnostic Lab Data: after the first does i had the swollen lymph nodes. i had and ultra sound and chest ct with contrast. they did find 3 swollen lymph nodes but the did not appear concerning.
CDC Split Type:

Write-up: arm tenderness, pain and warmth. swollen lymph nodes on left side of the neck along with tenderness in that area. pain in shoulder and scapula area on left side{side where injection was}. all over body aches, headache, ear ache, chills, fever and diarrhea. the very first symptoms were injection site pain and the swollen lymph nodes with in an hour of injection. headache and ear ache come on about 6hrs after followed shortly by diarrhea. the following day began chill and all over body ache along with previous symptoms. diarrhea had subsided by then. fever did not spike until nearly 24hrs later but only lasted a few hours. by the 48hr mark. symptoms have lessened but not completely gone. arm, neck shoulder pain remains the same as well as the swollen lymph nodes.


VAERS ID: 1549561 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Injection site pain, Interchange of vaccine products
SMQs:, Extravasation events (injections, infusions and implants) (broad), 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient was listed on clinical service appointment for a Pfizer vaccine at 9:40 am . In the computer the prescription was listed on prescription 7003537 as a Pfizer vaccine. After I administered the vaccine to the patient she showed me a plastic card that she had bought to put the vaccine in - i explained to her that she could also retrieve another online - that is when she informed me that her first vaccine was Moderna . I called patient later that day to see how she was feeling but she had gone out . I talked to her at 6:30 pm that day and she stated that she was fine except had a headache and some pain at the injection site . I told her that those symptoms can occur and to put ice on site.


VAERS ID: 1549563 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-08-10
Onset:2021-08-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Feeling cold, Headache, Influenza like illness, Nausea, Pain
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: Melatonin, Prozac, singulair
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Felt like I had the flu all day long. Woke up at 5 am with chills, aches, headache, dizziness, and nausea. These symptoms lasted all day until I went to bed at 9:45 pm.


VAERS ID: 1549565 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 3 LA / IM

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

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

Write-up: Second dose was overlooked and patient received a third dose. The nurse was told it was his first dose. Nurse was notified after administration by nurse working at facility that is was his third dose.


VAERS ID: 1549577 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044B21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Interchange of vaccine products, No adverse event
SMQs:, Medication errors (broad)

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

Write-up: verbally verified and signed written attestation that he had not gotten any Covid vaccine before the Moderna shot he got, but it was later found in our charts that he had gotten a dose of the Janssen J&J Covid vaccine on 3/15/21. did not have any reaction or complications during his observation period or any time after, that we are aware of.


VAERS ID: 1549581 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-29
Onset:2021-08-11
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angiogram, Asthenia, Chest X-ray, Chest discomfort, Cough, Dizziness, Dyspnoea, Electrocardiogram, Fibrin D dimer, Full blood count, SARS-CoV-2 test, Troponin
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: After the vaccine I had some sinus/cold symptoms too. Not sure if vaccine related or secondary cold
Preexisting Conditions: Kidney stones
Allergies: None
Diagnostic Lab Data: D-dimer, CT angio, CBC, Troponin, 12 lead ECG, chest X-ray, two COVID tests, ER visit 8/6, urgent care visit on 8/4
CDC Split Type:

Write-up: Shortness of breath, chest tightness, cough, dizziness, weakness


VAERS ID: 1549585 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: asthma
Allergies: NKDA
Diagnostic Lab Data: not necessary
CDC Split Type:

Write-up: When patient came in for her vaccine appointment, I asked her if this would be her first or second dose. She replied that this would be her first dose. I next asked her, if she ever received a dose from another manufacturer or any other dose from anywhere ever. She replied that she did not and that this would be her first dose. When I went to go enter her info into the system, I noticed that she did in fact receive 2 doses of Moderna from Health Department. Next, I tried to call her to discuss this with her and the number she gave me did not work.


VAERS ID: 1549591 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 02F21A / 1 RA / IM

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

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

Write-up: Pt has history of feeling faint/ dizzy with needles. She felt fine before and during immunization. She went to sit on bench while husband receiving his vaccine. She then felt nausea/dizziness. She laid down on bench, used cold compress, husband held her hand for 5 minutes or so, then she felt better. She stated she thinks it was just a delayed anxiety reaction. She was concerned about getting vaccine, then once all was finished symptoms presented. She felt better shortly after.


VAERS ID: 1549604 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-08-05
Onset:2021-08-11
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Injection site erythema, Injection site pruritus, Injection site reaction, Injection site swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (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: Dexmethylphenidate Omalizumab (Last injection 6/30/21)
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Too many to list, none severe.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Raised, red welt at injection site - extremely itchy. Smaller hives at various other parts of the body. Also felt lightheaded for approx. 15-20min. Started approx. 5min after injection


VAERS ID: 1549622 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-02
Onset:2021-08-11
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: External ear cellulitis
SMQs:

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

Write-up: Cellulitis bilateral ear auricle, left more affected than right ear.


VAERS ID: 1549630 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Crying, Headache, Hypoaesthesia, Injection site pain, Neck pain, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Depression (excl suicide and self injury) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MULTI-VITAMINS;VITAMIN D, VITAMIN C, ZINC, ELDERBERRY,
Current Illness: NONE
Preexisting Conditions: NONE THAT WE ARE AWARE OF
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: It started our with numbness on the left hand that eventually went away. Soreness on the arm and injection site. Headache within 30 minutes of the shot. Tylenol was given right away. left side of the neck hurt. And she began to cry uncontrollably especially if she was laughing all throughout the day and night. She took a 30 minute nap to see if the sore neck would go away.


VAERS ID: 1549659 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-09
Onset:2021-08-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Montelukast 10mg - 1 tablet daily Fenofibrate 160mg - 1 tablet daily Bupropion ER 150mg - 1 tablet twice daily Proventil inhaler - 2 puffs every 4 - 6 hours as needed
Current Illness: Asthma Depression hyperlipidemia
Preexisting Conditions: Asthma
Allergies: Sulfa medications
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient reported rash on back, chest and neck Advised to take Benadryl and go to ER if symptoms worsen


VAERS ID: 1549681 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 RA / IM

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

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

Write-up: itchy red rash on both arms


VAERS ID: 1549703 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-04
Onset:2021-08-11
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site swelling, Pain in extremity, Pruritus, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (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: ll Day Allergy Relief and Benadryl at night. Nothing else.
Current Illness: None noted.
Preexisting Conditions: N/A
Allergies: Shrimp, black mold and latex.
Diagnostic Lab Data: None, new symptoms.
CDC Split Type:

Write-up: Day # 7at appx 11PM, left arm started itching, swelling and sore. Woke up on the 12th to find a "goose egg" size area at injection site. It is now 8/12/21 at 5:27PM, site continues to itch with redness and swelling which has not resided.


VAERS ID: 1549712 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Abdominal pain upper, Dizziness, Fatigue, Headache, Hypoaesthesia, Immediate post-injection reaction, Malaise, Pain in extremity, Swelling face
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

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

Write-up: Persistent Numbness and swelling on right side of face several hours after injection. General dizziness, malaise, fatigue. Numbness in right arm at time of injection and subsequent pain later. Minor stomach pain. Mild headache. Symptoms persisting into the next day.


VAERS ID: 1549726 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

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

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

Write-up: Nurse administered too much vaccine. Checked on patient today. Headache and fatigue. Advised to monitor for worsening symptoms.


VAERS ID: 1549735 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Headache, Incorrect dose administered, Injection site pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Nurse administered too much vaccine. Checked on patient today. Sorness at injection site, headache and fever. Advised to monitor for worsening symptoms.


VAERS ID: 1549736 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-07-29
Onset:2021-08-11
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / SYR

Administered by: Public       Purchased by: ?
Symptoms: Injection site induration, Injection site rash, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)

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

Write-up: Rash at injection site 2 weeks following first dose. It is warm to the touch and hard in the center. It has been two days so far and has gone from the size of a quarter to a baseball.


VAERS ID: 1549749 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad), Medication errors (narrow)

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

Write-up: Nurse administered too much vaccine. Checked on patient today. Sore arm, no other symptoms. Advised to monitor for worsening symptoms.


VAERS ID: 1549752 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Chills, Dizziness, Flushing, Hyperhidrosis, Muscle tightness, Palpitations, Tremor
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levora
Current Illness: None reported
Preexisting Conditions: Raynaud''s disease Endometriosis
Allergies: Multiple allergies to food; patient listed mushrooms as one of those foods
Diagnostic Lab Data:
CDC Split Type:

Write-up: At approximately 1530, patient reported "my heart is racing", "shaking" of right arm, chills, diaphoresis, tightness in chest, tightness in neck, lightheadedness, and flushing of the face. Patient denied itchiness, rashes, difficulty swallowing, and difficulty breathing. Patient reported history of Raynaud''s disease, endometriosis, and allergies to sulfa drugs. At approximately 1531, EMT assessed patient vital signs: blood pressure 166/90 mmHg and pulse 112 beats/minute. Patient offered EMS. Patient agreed to EMS. At 1533, RN activated EMS. Patient offered intramuscular diphenhydramine. Patient agreed to intramuscular diphenhydramine. At 1536, RN administered 50 mg/1 ml intramuscular diphenhydramine. At 1540, EMT reassessed patient vitals signs: blood pressure 136/94 mmHg and pulse 80 beats/minute. At 1545, EMT reassessed patient vital signs: blood pressure 158/102 mmHg and pulse 84 beats/minute. At 1548, EMS arrived on scene and assumed care. RN educated patient on signs/symptoms of when to seek emergency care, to follow up with primary care provider and to sign up on v-safe. At approximately 1555, EMS transported patient to hospital for further care.


VAERS ID: 1549762 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Hypoaesthesia, Immediate post-injection reaction, Muscle twitching
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Dyskinesia (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Sexual dysfunction (broad)

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

Write-up: Right after the shot I experienced Facial numbness and twitches. I went to the emergency room and they couldn''t find an answer of why it was happening. Shortness of breath and chest tightness set in on 08/12/2021. I was told to go back to the ER.


VAERS ID: 1549772 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 1 LA / IM

Administered by: Private       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: Vyvanse 30MG
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: We transitioning from Pfizer to Moderna 08/11/2021 was the first day we were giving the Moderna vaccine. The parent came in demanding his son receive a COVID vaccine. The medical staff unintentionally gave the patient who is 14 years old the Moderna vaccine without remembering Moderna has only been approved for 18+.


VAERS ID: 1549774 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Nurse administered too much vaccine. Contacted. Only symptom was fever. Advised mother to notify clinic if any significantly worsening symptoms.


VAERS ID: 1549780 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

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

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

Write-up: Nurse administered too much vaccine. Contacted patient and told to notify clinic if any significantly worsening symptoms.


VAERS ID: 1549788 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

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

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

Write-up: Nurse administered too much vaccine. Attempted to reach patient unsuccessful. Will contact again tomorrow.


VAERS ID: 1549792 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-08-10
Onset:2021-08-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Asthenia, Autoscopy, Back pain, Bile output, Blood pressure increased, Feeling abnormal, Headache, Heart rate increased, Impaired work ability, Lethargy, Mobility decreased, Nausea, Palpitations, Rash, Somnolence, Tremor, Urticaria, Vomiting projectile
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Parkinson-like events (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), 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), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cort?f, florinef , propranolol , hctz
Current Illness: None
Preexisting Conditions: VHL , whipple surgery in past , adrenal insufficiency
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: One hour after vaccine received I developed severe abdominal pain and back pain . The next day around 10 I started to projectile vomit . Today , aug 12 I developed severe shakiness , hear racing , headache nausea and severe Lethargy . Difficult to ambulate due to weakness and almost an out of body experience . Got seen in clinic and my heart rate and blood pressure were elevated . I got sent home from work and almost fell asleep at wheel . When I got home I slept for hours and I was very nauseous . Now I keep throwing up bile and developed hives on my chest which the hives subsided . I have still a lot of lethargy and don?t feel right . Severe headache and back pain . When I went to clinic the nursing assistant said the nurse practitioner wants to see me because she thinks it is reaction to vaccine but unfortunately they were 2 hours behind . I called employee health , I work in hospital , and they immediately sent me home . I was never able to get evaluated by nurse or doctor . I?ve been trying to get hold of my pcp but there has been no call back at this time


VAERS ID: 1549793 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Alanine aminotransferase, Albumin globulin ratio, Anion gap decreased, Aspartate aminotransferase, Atrial fibrillation, Basophil count increased, Bilirubin conjugated, Blood albumin, Blood alkaline phosphatase, Blood bilirubin, Blood bilirubin unconjugated, Blood calcium normal, Blood chloride normal, Blood cholesterol, Blood creatine phosphokinase, Blood creatinine decreased, Blood glucose normal, Blood magnesium increased, Blood phosphorus normal, Blood potassium normal, Blood sodium normal, Blood thyroid stimulating hormone decreased, Blood triglycerides, Blood urea, Blood urea normal, Carbon dioxide normal, Chest discomfort, Chest pain, Dyspnoea, Echocardiogram abnormal, Ejection fraction normal, Eosinophil count decreased, Fibrin D dimer increased, Globulin, Glomerular filtration rate decreased, Glycosylated haemoglobin, Haematocrit normal, Haemoglobin normal, Heart rate increased, High density lipoprotein, Lipoprotein (a), Low density lipoprotein, Lymphocyte count normal, Mean cell haemoglobin concentration, Mean cell haemoglobin normal, Mean cell volume, Mitral valve calcification, Monocyte count increased, N-terminal prohormone brain natriuretic peptide increased, Neutrophil count normal, Non-high-density lipoprotein cholesterol, Platelet count normal, Protein total, Pulmonary arterial pressure normal, Red blood cell count normal, Red cell distribution width normal, SARS-CoV-2 test, Seizure, Tachycardia, Thyroxine free normal, Tri-iodothyronine free normal, Tricuspid valve incompetence, Troponin T normal, Ventricular hypertrophy, White blood cell count decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Haematopoietic leukopenia (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypothyroidism (broad), Hyperthyroidism (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Current outpatient prescriptions: 1) Amlodipine besylate 10 mg po tabs, 1 tablet daily 2) Aspirin 81 mg or tabs, 1 tablet daily 3) B complex-folic acid (b complex-vitamin b12 or), 1 tab daily 4) Calcium 500 mg or tabs, 2 tablets 3 tim
Current Illness: 1) Acromegaly - IGF-1 nl. Follow only 2) Hypoadrenal - Continue 25 mg daily and extra for stress. Long discussion about coronavirus vaccination. She is reluctant because of bad outcome from hip surgery and anger at medical practitoners, as well as thinking that replacement dose of hydrocortisone makes her immunocompromised. I told her it does not and urged her to get vaccinated soon. 3) Hypothyroid - T4 nl, so cont T4 rx 112 mcg a day.
Preexisting Conditions: Patient Active Problem List Diagnosis Date Noted ? Lumbar radiculopathy 05/05/2020 ? Leg length discrepancy 03/28/2017 ? Right hip pain s/p 12/2015 THA, subsidence of femoral stem 03/01/2017 ? ?osteoporosis 04/13/2012 Dx with osteoporosis and took fosamax for 2 years, developed severe heartburn that persists today. ? Ectopic atrial beats 04/04/2012 ? Atrial tachycardia 04/04/2012 ? TIA (transient ischemic attack) 04/04/2012 ? Sinoatrial node dysfunction 03/01/2012 ? Unspecified hypertensive heart disease without heart failure 03/01/2012 ? Syncope and collapse 03/01/2012 ? Cardiovascular disease 02/22/2012 1. Echo -- Date of last: 2/8/2012, LV function 65 % CONCLUSIONS 1. After infor med consent obtained, patient received 6mgs Versed. Topical lidocaine was applied in the orophar ynx. The probe was passed atraumatically. There were no complications. 2. Normal left ventr icular size and normal left ventr icular function. The ejection fraction is estimated to be 65%. 3. Normal right ventr icular size and normal right ventr icular function. 4. Left and right atria are both normal size. Note on left atrium: No evidence of interatr ial shunt with color flow doppler or agitated saline study. Left atrial appendage was visualized and appears normal. 5. Normal trileaflet aortic valve with no insufficiency and no stenosis. 6. Normal mitral valve with no stenosis and trace insufficiency. 7. The tr icuspid valve appears normal with no stenosis and trace regurgitation. 8. The pulmonic valve appears normal with no stenosis and no insufficiency. 9. The ascending aorta is dilated (4.3cm). 10. There is no pericardial effusion. 2. Stress test -- Date of last: 2/2/2012, LV function 70 % CONCLUSIONS 1. No ECG changes were observed dur ing phar macologic stress. The patient exper ienced headache. 75 mg. of Aminophylline was administered. 2. Normal myocardial perfusion. 3. Left ventr icular wall motion was normal. The LV ejection fraction was 70%. The end diastolic volume was 70 ml. 3. Cath -- Date of last: 4. Stent -- Date of last: ? Hypertension 01/24/2012 ? Acromegaly 01/24/2012 ? Chronic renal insufficiency, stage II (mild) 01/24/2012 ? History of SIADH 01/24/2012 ? Seizure, associated with hyponatremia 01/24/2012 ? Shortness of breath 01/24/2012 ? Palpitations 01/24/2012 ? Chest pain 01/24/2012 ? FAMILY HISTORY COLON CANCER 01/22/2010 ? MENINGIOMA, RIGHT CAVERNOUS SINUS 01/22/2010 Discovered incidentally in 1998 during monitoring of somatotroph adenoma. Stable since then. ? HYPOPITUITARISM 01/20/2009 Had transspenoidal surgery in 1985 and proton beam rx in 1988 for acromegaly and a large somatotroph adenoma. Has been panhypopit for many years. ? HISTORY OF CVA 01/01/1987 Had small CVA during pregnancy in 1985. Has been taking ASA.
Allergies: Allergy List: 1) Codeine Sulfate - Anaphylaxis 2) Aspartame (Nutrasweet) [Aspartame] 3) Ceclor [Cefaclor] 4) Ciprocin-Fluocin-Procin [Fluocinolone Acetonide] 5) Darvon [Propoxyphene Napsylate] 6) Demerol 7) Dilantin 8) Entex La 9) Fentanyl 10) Fentanyl And Related - Blurry Vision - Stiff Neck, Lethargic 11) Floxin [Ofloxacin (Ophth)] 12) Gentamicin [Gentamicin Sulfate] 13) Hctz 14) Hypafix [Wound Dressings] - Blisters - Sun burn reaction 15) Morphine - Blurry Vision - Stiff neck, Lethargic 16) Quinolones 17) Toprol Xl [Metoprolol Succinate] 18) Tramadol 19) Vancomycin 20) Adhesive Tape [Tape] - Itching and Rash
Diagnostic Lab Data: She underwent an echo that notedmildly increased LV wall thickness with no segmental wall motion abnormalities. EF estimated at 60%. No obvious LV thrombus identified. Left Atrium moderately dilated. Mild mitral annular calcification with mild mitral regurgitation. Mild aortic valve thickening with no stenosis. PASP is normal. When compared to 6/2019 study there was a decreased in MR and TR. Component Latest Ref Rng & Units 8/11/2021 8/11/2021 1:12 PM 1:53 PM Glucose 70 - 99 mg/dL 133 (H) Urea Nitrogen 8 - 20 mg/dL 18 Creatinine 0.44 - 1.03 mg/dL 1.04 (H) eGFR, Non-AA $g=60 mL/min/1.73 m2 52 (L) eGFR, AA $g=60 mL/min/1.73 m2 $g60 BUN/Creatinine 6 - 22 (calc) Sodium 136 - 144 mmol/L 141 Potassium 3.6 - 5.1 mmol/L 4.2 Chloride 101 - 111 mmol/L 104 Carbon Dioxide 22 - 32 mmol/L 29 Calcium 8.9 - 10.3 mg/dL 9.6 Protein, Total 6.1 - 8.1 g/dL Albumin 3.6 - 5.1 g/dL GLOBULIN 1.9 - 3.7 g/dL (calc) A/G RATIO 1.0 - 2.5 (calc) Bilirubin, Total 0.2 - 1.2 mg/dL Alkaline Phosphatase 37 - 153 U/L AST 10 - 35 U/L ALT 6 - 29 U/L Bilirubin, Direct < OR = 0.2 mg/dL Bilirubin, Unconjugated 0.2 - 1.2 mg/dL (calc) % Neutrophils % 66.8 % Lymphocytes % 21.2 % Monocytes % 10.2 % EOSINOPHILS % 0.6 % Basophils % 1.2 # Neutrophils 1.80 - 7.50 THO/uL 3.00 # Lymphocytes 1.00 - 5.00 THO/uL 1.00 # Monocytes 0.10 - 1.00 THO/uL 0.50 # Basophils 0.00 - 0.20 THO/uL 0.10 # Eosinophils 0.00 - 0.40 THO/uL 0.00 ANION GAP 3 - 12 8 White Blood Cells 4.0 - 11.0 THO/uL 4.5 Red Blood Cells 3.80 - 5.30 MIL/uL 4.75 Hemoglobin 12.0 - 16.0 g/dL 14.5 Hematocrit 36 - 46 % 42 RDW 11.5 - 14.5 % 14.1 MCH 27 - 33 pg 30 MCHC 31 - 36 g/dL 35 MCV 80 - 100 fL 87 Platelets 150 - 400 THO/uL 226 Total Cholesterol 100 - 200 mg/dL Triglycerides 25 - 150 mg/dL HDL Cholesterol 40 - 59 mg/dL LDL Cholesterol 0 - 129 mg/dL Non-HDL Cholesterol 0 - 159 mg/dL SARS-CoV-2 SARS-CoV-2 Interpretation LIPOPROTEIN (a) <=29 mg/dL CREATINE KINASE 29 - 143 U/L Hemoglobin A1c <5.7 % of total Hgb NT proBNP 0 - 125 pg/mL 636 (H) MAGNESIUM 1.8 - 2.5 mg/dL 2.3 PHOSPHORUS 2.4 - 4.7 mg/dL 4.1 Troponin T 0.000 - 0.030 ng/mL <0.010 D-DIMER 0.00 - 0.50 ug/mL FEU 0.63 (H) TSH 0.45 - 5.33 uIU/mL 0.02 (L) FREE THYROXINE 0.61 - 1.30 ng/dL 1.26 FREE T3 2.50 - 3.90 pg/mL 2.42 (L)
CDC Split Type:

Write-up: 70 year old female with a past medical history that includes Hypertension, Hyperlipidemia, Adrenal insufficiency 2/2 pituitary tumor s/p resection, Hypothyroidism, previous TIA/CVA with known atrial ectopia that presented to the ED for evaluation of tachycardia with associated chest pain after receiving COVID vaccine #2. In discussion with the patient, she reported that she was in her usual state of health. She proceeded to get her 2nd COVID vaccine. About 10-15 minutes after receiving the vaccine, she developed fast heart rates (80s at that time from a baseline closer to 50 as per the patient). She noted that her heart rates continued to climb as high as the 150s on her pulse oximeter. She developed associated chest pain/tightness with mild shortness of breath approximately 3 hours after her vaccine was given. She presented to the ED at HUP for evaluation given the persistence of the symptoms. Notably, she reports similar fast heart rates after her first vaccine which improved on their own and were NOT at that time associated with chest pains. In the ED she was noted to be in Afib with a rapid ventricular rate in the 140-150s. She was afebrile and without leukocytosis or electrolyte abnormalities. Her TSH was low at 0.02 with free T3/T4 labs pending. She had one negative troponin and an age-adjusted normal D-Dimer. Her BNP was elevated to 636. She received one dose of IV diltiazem 10 mg with improvement in her heart rate and recovery to sinus rhythm with PACs. She was placed in the observation overnight for telemetry monitoring and echocardiogram. While in the ED observation unit she was resumed on her home medications. She was monitored on telemetry and remained in normal sinus rhythm with occasional PACs. She had no recurrence of chest pain.


VAERS ID: 1549796 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Decreased appetite, Headache, Incorrect dose administered, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Nurse administered too much vaccine. Per mother- states that he has fever, headache, soreness in arm, and no appetite. Informed mother that if symptoms become worse such as chest pain, SOB, high fever; they needed to present to the ER.


VAERS ID: 1549798 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-01-04
Onset:2021-08-11
   Days after vaccination:219
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
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: Positive Covid by PCR on 8/11/21
CDC Split Type:

Write-up: Covid like symptoms began 8/6/21


VAERS ID: 1549803 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Decreased appetite, Headache, Incorrect dose administered, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Nurse administered too much vaccine. Per mother- states that he has fever, headache, soreness in arm, and no appetite. Mother advised to return to clinic or emergency room if worsening in symptoms.


VAERS ID: 1549805 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, Influenza like illness, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Nurse administered too much vaccine. Patient notified. Experiencing fever and flu like symptoms. Advised to return to clinic or emergency room for worsening symptoms.


VAERS ID: 1549809 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / SYR

Administered by: School       Purchased by: ?
Symptoms: Asthenia, Headache, Paralysis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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:
Preexisting Conditions: None
Allergies: None.
Diagnostic Lab Data: This was a telemedicine appointment and our clinic does not have the rapid turnaround for labs nor does it have advanced imaging. Pt declined to go to the ED but agreed to call 911 if symptoms worsened. He has a TM follow-up with me tomorrow.
CDC Split Type:

Write-up: Pt called the clinic for a telemedicine appointment at 3 PM 8/12/2021. Pt reports he had paralysis in his right hand immediately after the shot. That has resolved. 8/12/2021 he developed a HA and was too weak to get out of bed. He reports he is now walking around and he is taking IBP "every hour" for his headache which is now 1/10 on the pain scale. Earlier it was 8/10. The patient was instructed to have someone drive him to the nearest ED for evaluation of his HA and weakness in light of having received the J & J vaccine.


VAERS ID: 1549811 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

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

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

Write-up: Nurse administered too much vaccine.


VAERS ID: 1549815 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Headache, Incorrect dose administered, Injection site pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Nurse administered too much vaccine. Patient notified. Having soreness at injection site, headache and fever. Advised to return to clinic or emergency room if symptoms worsen.


VAERS ID: 1549820 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Headache, Incorrect dose administered, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: Nurse administered too much vaccine. Per mother, patient has headache, nausea and vomiting. Advised to notify nurse tomorrow if symptoms not improving.


VAERS ID: 1549830 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysphagia, Ear pain, Injection site swelling, Mouth swelling, Pain in extremity, Pharyngeal swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (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: flu vaccine 1988
Other Medications: Duloxetine HCL QD Glucophage BID Chlorthalidone QD Diclofwnac Sodium BID
Current Illness: No illnesses
Preexisting Conditions: fibramyalgia autoimmune disorder high BP diabetes pulmonary hypertension
Allergies: Flu vaccine augmentin many, many BP meds Synthetic fibers eggs
Diagnostic Lab Data: I called and let my doctor know.
CDC Split Type:

Write-up: Approximately at 1700 I began feeling like I was having trouble swallowing on the right side, it progressed throughout the night that I actually got up at midnight and took Benadryl. No relief swelling on right side of throat inside mouth so I took Benadryl. By 1000 a.m. 8/12/2021 I could tell the swelling was improving. When I swallow my right ear hurts. My right arm is swollen pingpong ball size with a small pebble swelling at injection site. It almost feels like a zit. The arm is really really painful.


VAERS ID: 1549842 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-04
Onset:2021-08-11
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Injection site swelling, Muscle spasms, Musculoskeletal stiffness, Neck pain, Pain in extremity
SMQs:, Retroperitoneal fibrosis (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Patient reports visible arm swelling at site of injection and are soreness. Also reports soreness/stiffness throughout neck and back on the side of injection, as well as muscle spasms.


VAERS ID: 1549957 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: On 8/11/21, patient completed the 15-min observation period. She was on her way out of the warehouse when she experienced chest pain. She sat back down on the chair and paramedics was called. She was checked out ok but declined to go to the hospital. She stayed at the pharmacy for 20 minutes and left with her friend. She will get the second dose at the hospital where she can be closely monitored.


VAERS ID: 1549963 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-11
Onset:2021-08-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site pain, Myalgia, Nerve compression
SMQs:, Rhabdomyolysis/myopathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: wild caught salmon oil 2000 mg daily, cbd oil 20 mg after receiving the jab, turmeric
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: - mild muscle burning/pinching sensations in the left arm, left trapezius, and left shoulder blade - mild pain at the injection site(feels like bruising)


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