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

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



Case Details (Reverse Sorted by Onset Date)

This is page 159 out of 3,524

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VAERS ID: 1348039 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cataract, Headache, Heart rate increased, Hypoaesthesia, Vision blurred
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Lens disorders (narrow), Retinal disorders (broad), Hypoglycaemia (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: blurry eyes, fast heart rate, headCHE, FACE NUMBNESS,cataracts


VAERS ID: 1348836 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Muscle spasms, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient experienced fever, chills, and leg cramping on the first night after receiving the vaccination. Symptoms subsided by the next day and only soreness in the arm was experienced.


VAERS ID: 1348852 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-12
Onset:2021-05-15
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Tinnitus
SMQs:, Hearing impairment (narrow)

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

Write-up: Ringing in ears


VAERS ID: 1348861 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-06
Onset:2021-05-15
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

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

Write-up: Shingles flare up after second dose


VAERS ID: 1349009 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Florida  
Vaccinated:0000-00-00
Onset:2021-05-15
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1806025 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Burning sensation, Chest discomfort, Chest pain, Chills, Dizziness, Dyspnoea, Fatigue, Gait disturbance, Headache, Movement disorder, Pain, Pain in extremity, Sensory disturbance
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210534745

Write-up: CHEST PAIN; DIZZINESS; SHORTNESS OF BREATH; SHE WAS UNABLE TO MOVE FOR WHOLE DAY; CRAWL TO THE BATHROOM; CHILLS; HEADACHE; FATIGUE; BURNING ARM; BODY ACHE; CHEST TIGHTNESS; LEFT ARM PAIN; LEFT SIDE OF BODY OUT OF IT; This spontaneous report received from a patient concerned a 27 year old female. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 1806025, expiry: UNKNOWN) dose was not reported, administered on 15-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 15-MAY-2021, the subject experienced left side of body out of it. On 15-MAY-2021, the subject experienced chest tightness. On 15-MAY-2021, the subject experienced left arm pain. On 15-MAY-2021, the subject experienced burning arm. On 15-MAY-2021, the subject experienced body ache. On 16-MAY-2021, the subject experienced she was unable to move for whole day. On 16-MAY-2021, the subject experienced crawl to the bathroom. On 16-MAY-2021, the subject experienced chills. On 16-MAY-2021, the subject experienced headache. On 16-MAY-2021, the subject experienced fatigue. On 18-MAY-2021, the subject experienced chest pain. On 18-MAY-2021, the subject experienced dizziness. On 18-MAY-2021, the subject experienced shortness of breath. Treatment medications (dates unspecified) included: paracetamol. The action taken with covid-19 vaccine was not applicable. The patient recovered from she was unable to move for whole day, was recovering from crawl to the bathroom, had not recovered from fatigue, burning arm, headache, dizziness, shortness of breath, chills, left arm pain, and chest pain, and the outcome of left side of body out of it, chest tightness and body ache was not reported. This report was non-serious.; Sender''s Comments: V0 Medical assessment comment not required as per standard procedure as the case was assessed as non-serious.


VAERS ID: 1349014 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Colorado  
Vaccinated:0000-00-00
Onset:2021-05-15
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Fatigue, Feeling cold, Injection site pain, Poor quality sleep, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 20210515; Test Name: Body temperature; Result Unstructured Data: 99.4 (unit unspecified); Test Date: 20210516; Test Name: Body temperature; Result Unstructured Data: normal
CDC Split Type: USJNJFOC20210537455

Write-up: RESTLESS SLEEP; FELT COLD; INJECTION SITE SORENESS; TIRED; LOW GRADE FEVER; This spontaneous report received from a patient concerned a 47 year old male. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 203A21A, and batch number: 203A21A expiry: 23-JUN-2021) dose was not reported, administered on 15-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 15-MAY-2021, the subject experienced restless sleep. On 15-MAY-2021, the subject experienced felt cold. On 15-MAY-2021, the subject experienced injection site soreness. On 15-MAY-2021, the subject experienced tired. On 15-MAY-2021, the subject experienced low grade fever. Laboratory data included: Body temperature (NR: not provided) 99.4 (unit unspecified). On 16-MAY-2021, Laboratory data included: Body temperature (NR: not provided) normal. The action taken with covid-19 vaccine was not applicable. The patient recovered from restless sleep, felt cold, and low grade fever on 16-MAY-2021, injection site soreness on 19-MAY-2021, and tired on 17-MAY-2021. This report was non-serious.


VAERS ID: 1349029 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-05-15
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Colonoscopy, Headache, Hemiparesis, Hypoaesthesia, Limb discomfort, Musculoskeletal stiffness, Myalgia, Pain, Pain assessment
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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: Abstains from alcohol; Blood pressure high; Non-smoker
Preexisting Conditions: Medical History/Concurrent Conditions: General body pain (Patient had history of pain on the right side of the body but not similar as she was experiencing now.); Comments: Patient had No known allergies. Patient had no drug abuse or illicit drug usage.
Allergies:
Diagnostic Lab Data: Test Date: 202105; Test Name: Pain scale; Result Unstructured Data: the pain scale varies from 6-10/10; Test Date: 20210501; Test Name: Colonoscopy; Result Unstructured Data: Unknown
CDC Split Type: USJNJFOC20210544454

Write-up: WEAKNESS OF THE RIGHT SIDE OF THE BODY; NUMBNESS ON RIGHT SIDE OF THE BODY; PAIN ON THE RIGHT SIDE OF THE BODY; STIFFNESS OF BODY; FEELING OF HEAVINESS IN BODY; HEADACHE; MUSCLE PAIN THAT EXTENDS TO THE BONES; This spontaneous report received from a consumer concerned a 59 year old not Hispanic or Latino, Asian female. The patient''s weight was 130 pounds, and height was 162 centimeters. The patient''s past medical history included pain on the right side of the body but not similar to what she was experiencing now, and concurrent conditions included high blood pressure, no alcohol use, and non smoker, and other pre-existing medical conditions included patient had no known allergies and patient had no drug abuse or illicit drug usage. The patient was not pregnant at the time of report. The patient received covid-19 vaccine (suspension for injection, intramuscular, batch number: 1805029, expiry: unknown) frequency 1 total, dose was not reported, administered on 13-MAR-2021 at deltoid in left arm for prophylactic vaccination. No concomitant medications were reported. The reporter stated that on the 15-MAY-2021, his mother started to develop side effects of the vaccine such as headache, pain and numbness on her right side of the body which started from her head to her feet and weakness of the right side of the body. According to the reporter the pain scale varied from 6-10/10, she described the pain like a feeling of heaviness, stiffness and muscle pain that extends to her bones. The patient consulted her health care professional and Chiropractor 2 days before the date of report and they did not prescribe anything but recommended to do MRI which she will do moving forward. Patient was taking over the counter pain medication and had massage on the painful area but it only helped for a short period of time and according to her son it was really affecting her activity of daily living (subsumed under event weakness of the right side of the body) as the symptoms were getting worse. On an unspecified date in MAY-2021, Laboratory data included: Pain scale (NR: not provided) the pain scale varies from 6-10/10. On 01-MAY-2021, Laboratory data included: Colonoscopy (NR: not provided) Unknown. The action taken with covid-19 vaccine was not applicable. The patient had not recovered from numbness on right side of the body, pain on the right side of the body, weakness of the right side of the body, headache, feeling of heaviness in body, stiffness of body, and muscle pain that extends to the bones. This report was serious (Other Medically Important Condition). covid-19 vaccine weakness of the right side of the body. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).


VAERS ID: 1349667 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature, 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210515; Test Name: Body temperature; Result Unstructured Data: Test Result:102.6; Comments: fever of 102.6
CDC Split Type: USPFIZER INC2021548220

Write-up: Headache; fever of 102.6; This is a spontaneous report from a contactable consumer (patient). A 13-year-old female (no pregnant) patient received the first dose of BNT162B2 via an unspecified route of administration on left arm on 14May2021 at 17:30 as single dose for COVID-19 immunization. Medical history was not reported. The patient not receive any other vaccines within 4 weeks prior to the COVID vaccine and not received the list of other medications within 2 weeks of vaccination. Prior to vaccination, the patient was not diagnosed with COVID-19 and hadn''t been tested for COVID-19 since the vaccination. Concomitant medication was not reported. The patient experienced headache and fever of 102.6 on 15May2021. The outcome of events was unknown. No follow-up attempts are possible; information about lot/batch number cannot be obtained.


VAERS ID: 1349671 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Pain, Vaccination site pain
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ALLEGRA; LOPERAMIDE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Irritable bowel syndrome (IBS); Migraine (migraines); Penicillin allergy (known_allergies: Penicillin)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021550075

Write-up: Pain in arm of injection; all over body soreness; headache; This is a spontaneous report from a non-contactable consumer (patient). A 25-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE; Lot number and expiry date not reported), via an unspecified route of administration, in the right arm on 14May2021 (at the age of 25-years-old) as 2nd dose, single for COVID-19 immunization. Medical history included irritable bowel syndrome, migraines and allergy to penicillin. Concomitant medications included fexofenadine hydrochloride (ALLEGRA), loperamide, probiotics and multivitamins. The vaccine was administered at Pharmacy/Drug Store. The patient did not receive any other vaccine within 4 weeks of vaccination. The patient was not pregnant. Prior to vaccination, the patient was not diagnosed with COVID-19 and since the vaccination has not been tested for COVID-19. Historical vaccine included BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE; Lot number and expiry date not reported), via an unspecified route of administration, in the left arm on an unspecified date (at the age of 25-years-old) as first dose, single for COVID-19 immunization. The patient experienced pain in arm of injection, all over body soreness and headache on 15May2021. The events were reported as non-serious. The patient did not receive any treatment for the events. The outcome of the events was recovering. No follow-up attempts are possible; information about lot/batch number cannot be obtained.


VAERS ID: 1350291 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-04-20
Onset:2021-05-15
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Pain, Rash, Rash macular, Skin irritation, Skin odour abnormal, Taste disorder
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Trulicity, Humalog, Lantus, Metformin, Sertraline, Amlodipine, Clonazepam, Risperidone, Losartan, Rosuvastatin
Current Illness: None
Preexisting Conditions: Diabetes, Melanoma, Heart Disease, PTSD, Sleep Apnea
Allergies: Codeine, Vicodin, several other pain killers
Diagnostic Lab Data: No medical tests performed.
CDC Split Type:

Write-up: A rash dominant on both arms and other locations on body that makes skin feel like alligator skin having bumps and red spots. Body aches that can inhibit activity. Periods of really bad body odor. Foods normally favorites that normally taste good, taste awful. Treatment so far has been the application of Triamcinolone Acetonide Ointment 0.1% on rash areas twice a day.


VAERS ID: 1350337 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-11
Onset:2021-05-15
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

Write-up: A non-pruritic macropapular rash appeared on the front of both thighs and back of arms. It then progressed to the rest of the legs and arms. It resolved a week after it started on it''s own.


VAERS ID: 1350530 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-09
Onset:2021-05-15
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Cholecystectomy, Cholecystitis acute, Laparoscopic surgery, Magnetic resonance imaging abdominal
SMQs:, Infectious biliary disorders (narrow), Gallbladder related disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol, allopurinol, insulin, Zetia, aspirin, gabapentin, metoprolol, vitamin D, zinc, Jardiance, Lasix
Current Illness:
Preexisting Conditions: Heart disease (heart failure and coronary artery disease with hx of CABG), T2DM on insulin
Allergies: Ciprofloxacin
Diagnostic Lab Data: Abdominal MRI, laparoscopic cholecystectomy
CDC Split Type:

Write-up: Acute cholecystitis requiring lap chole


VAERS ID: 1350550 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 1 LA / IM

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

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

Write-up: Patient year verified, Month and day not verified. No adverse reactions noted


VAERS ID: 1350611 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: North Dakota  
Vaccinated:2021-04-06
Onset:2021-05-15
   Days after vaccination:39
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKN OWN / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Disseminated varicella zoster virus infection, Respiratory failure, Toxic encephalopathy, Varicella virus test positive
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Hypokalaemia (broad), Sepsis (broad), Opportunistic infections (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine, carvedilol, Mucinex, losartan, metformin, Crestor
Current Illness: None reported.
Preexisting Conditions: hypertension, morbid obesity
Allergies: No known allergies.
Diagnostic Lab Data: PCR was positive and confirmed for VZV along with VZV IGG and IGM also being positive.
CDC Split Type:

Write-up: Patient admitted to hospital 5/15/2021 with acute toxic encephalopathy due to disseminated varicella zoster virus and acute hypercapneic respiratory failure. Patient remains hospitalized as of date of this report. Encephalopathy is resolving and patient has been extubated but remains on 4 liters of oxygen via nasal canula.


VAERS ID: 1350616 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Decreased appetite, Headache, Nausea, Pyrexia, Substance use
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug abuse and dependence (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Night of and next morning of vaccine: fever of 103.8 F recorded, and associated shivering From 2nd day after shot: claims of: pounding headache, no appetite, nausea and eating caused more nausea Claimed that marijuana usage alleviated some of the nausea and appetite issues


VAERS ID: 1350618 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Injection site rash, Rash, Varicella virus test positive, Varicella zoster virus infection
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

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

Write-up: Rash on arm starting from injection site, progressing over the following days.


VAERS ID: 1350741 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER D43A21A / 1 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Anger, Electrocardiogram, Hyperacusis, Impaired work ability, Laboratory test, Magnetic resonance imaging, Nausea, Pain, Vertigo
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (narrow), Hearing impairment (narrow), Vestibular disorders (narrow)

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

Write-up: vertigo and extreme nausea 05/20/2021 since , can''t work, can''t get out of bed, i can hear my eyes move body aches, can''t care for sick family. extreme anger!!! need to go back to the doctor or hospital! no one seems to be able to help, medicine prescribed make me sleep which stops the vertigo and my life


VAERS ID: 1351020 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-24
Onset:2021-05-15
   Days after vaccination:52
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Aphasia, Computerised tomogram thorax abnormal, Deep vein thrombosis, Hypoxia, Pulmonary embolism, Right ventricular dysfunction, Unresponsive to stimuli
SMQs:, Cardiac failure (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Spironolactone, baclofen, omeprazole, potassium chloride, pregabalin, nystatin powder, mupirocin, morphine, mesalamine, meclizine, gabapentin, ibuprofen, fludrocortisone, eszopiclone, duloxetine, diazepam, cyclobenzaprine, Vitamin D, aspiri
Current Illness: Quadrapelegic, urinary tract infections history. CVA
Preexisting Conditions: Quadrapelegic, urogenic bladder, CVA, gastric bypasxs
Allergies: Adhesive tapes
Diagnostic Lab Data:
CDC Split Type:

Write-up: Unresponsive and unable to speak at home. Hypoxic, CT showed large bilateral pulmonary embolism with heart strain, as well as bilateral femoral DVT.


VAERS ID: 1351077 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein increased, Chills, Computerised tomogram thorax abnormal, Cough, Dyspnoea, Fibrin D dimer increased, Malaise, Neutrophil count decreased, Neutrophil percentage increased, Pain, Pneumonia, Procalcitonin, Pyrexia, SARS-CoV-2 test negative, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Haematopoietic leukopenia (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (narrow), 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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Metformin, Lisinopril
Current Illness: Uncertain as to one month prior if pt. had any illnesses, but at day of Covid vaccine on 05/14/2021 assumed pt. denied any s/s of illness if pt. was screened. Pt. received vaccination.
Preexisting Conditions: HTN, Diabetes Type 2, History of Diverticulitis, Gout, Bronchitis, Former smoker - pt. cont. to chew
Allergies: NKA
Diagnostic Lab Data: Pt. has elevated WBC of 13.7, Neutrophil % of 75.5%, CRP of 5.60, Procal of 0.05. CT scan oif chest shown right upper and middle lobe pneumonia. Pt. had elevated d-dimer 3100. Pt. Covid PCR test on 5/18/2021 was negative.
CDC Split Type:

Write-up: Pt. received 2nd Covid vaccine on 05/14/2021. On 05/15/2021 pt. reports not feeling well with s/s of body aches and chills. Pt. reports that on 5/16/21 that he noticed fever, cough and increased SOB. Pt. presents with c/o increase SOB on 05/18/2021. Pt. was admitted with diagnosis of right upper and middle lobe pneumonia on 05/18/2021. Pt. required 2-3 L of O2 per nasal cannula. Pt. was also on antibiotics on Rocephin 1 gm IV every 24 hours. Pt. received a one time dose of Azithromycin 500 mg in ED.


VAERS ID: 1351370 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Breo Ellipta inhaler, metoprolol, lisinopril, ascorbic acid, cholecalciferol, multivitamin, fish oil, selenium, teriflunomide
Current Illness: None
Preexisting Conditions: HTN, MS
Allergies: hydrocodone/acetaminophen, oxycodone/acetaminophen
Diagnostic Lab Data: None
CDC Split Type:

Write-up: This isn''t an ADR, it''s an administration timing error. The patient came in at the 21-day mark, as recorded on vaccine card, which states Pfizer vaccine given for first dose. Patient insists that she received Moderna. Looking at card, lot number corresponds to Moderna. Second dose was given as Moderna, but then it was realized that the dose was given 7 days too early. Therefore, this is a timing error, where second dose of Moderna vaccine was given at 21 day interval instead of 28 days.


VAERS ID: 1351380 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Malaise, Serum sickness-like reaction
SMQs:, Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: age 20 to rabies vaccine
Other Medications: No
Current Illness: No
Preexisting Conditions: No
Allergies: Had a similar reaction to rabies vaccine 20 years ago
Diagnostic Lab Data: None
CDC Split Type:

Write-up: serum like sickness with polyarthralgias, malaise and fatigue Treatment with NSAIDS, rest


VAERS ID: 1351403 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-13
Onset:2021-05-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest X-ray normal, Chest pain, Computerised tomogram normal, Dyspnoea, Fatigue, Fibrin D dimer, Pericarditis, Red blood cell sedimentation rate, Troponin, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: nausea and vomiting 1 week prior
Preexisting Conditions: History of acid reflux
Allergies: Grass pollen, tree and shrub pollen and dust
Diagnostic Lab Data: WBC 11.6 Trop 0.05 D-dimer 0.57 Sed Rate 17
CDC Split Type:

Write-up: Patient developed chest pain, shortness of breath and fatigue. Chest pain was worse with laying down. Went to Urgent Care and EKG revealed abnormal changes and was sent to ER for evaluation. Found to have minimally elevated troponin, WBC, Sed Rate, CRP and D-dimer. CXR and CT scan were normal with only small L axillary lymph node identified. Diagnosed with pericarditis and discharged home with Ketorolac for 5 days. Symptoms resolved.


VAERS ID: 1351490 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: NECK, BACK, CHEST AND NECK HIVES + ITCHING WITHIN FEW HOURS OF RECEIVIING PFIZER COVID-19 VACCINE. SYMPTOMS PERSIST AS OF 5/26/21 WITH MINIMAL IMPROVEMENT. PREDNISONE TREATMENT STARTED 5/26/21.


VAERS ID: 1351493 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-03-01
Onset:2021-05-15
   Days after vaccination:75
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Amnesia, Blood glucose increased, Confusional state, Immediate post-injection reaction, Laboratory test, Magnetic resonance imaging head normal
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, Levothroxine, Allopurinol, Pravastatin, low dose asprin
Current Illness: None
Preexisting Conditions: Diabetes 2,
Allergies: Cholesterol medication lipitor unsure of name
Diagnostic Lab Data: MRI. And Lab tests
CDC Split Type:

Write-up: Immediate memory loss. MRI has been taken with no abnormalities noted. Sugar count went from 116, 120 to 299 and continued through April and May with memory loss that he cannot remember anything within 2 minutes. He has been very confused and repeats the same questions over and over. His blood sugar has been the same for years until the vaccine


VAERS ID: 1351557 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-08
Onset:2021-05-15
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C211A / 1 AR / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary mass, Erythema, Peripheral swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Red and swollen arm a week after injection. The redness spread to the whole top part of the arm. The swollenness was so severe that it looked like muscle. Nodule formed under skin in the arm pit.


VAERS ID: 1351569 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anaphylactic reaction, Chest discomfort, Throat irritation
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: fluoxetine, albuterol, flonase,
Current Illness: adjustment disorder
Preexisting Conditions:
Allergies: bee stings- anaphylaxis
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 5/15/2021 1120: EW0182 1st dose QMC -BVC Pt c/o itching to throat, chest tightness immediately. Mother gave benadryl at 1207. Epi pen at 1235. Pt taken to ED by mother. Pt rec''d prednisone, famotidine after observation and dx of anaphylaxis to Pfizer Covid 19 vaccine.


VAERS ID: 1351588 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Electrocardiogram, Hypotension, Skin warm, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Prior to arrival, the patient received her first COVID vaccine at the clinic, after which she suddenly felt dizzy, described as lightheadedness, and felt warm. She was noted to be hypotensive with SBP at 67. She subsequently drank water with some improvement. No syncope, severe headache, numbness, tingling sensations, or focal weakness. Mother was concerned and brought the child to the ED for further evaluation. Currently the patient feels better. No similar symptoms in the past. The patient denies any chest pain or pressure, shortness of breath, or abdominal pain. No recent fever or cough.She is otherwise healthy and has a normal cardiopulmonary exam and reassuring EKG. The description of her symptoms and the environment which happened is very consistent with vasovagal syncope and she does not have any stigmata, and acute neurologic or cardiac emergency. I believe she is safe and stable for discharge home and she was discharged with return precautions and follow-up instructions.


VAERS ID: 1351641 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-08
Onset:2021-05-15
   Days after vaccination:68
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 2 - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cerebrovascular accident, SARS-CoV-2 test positive
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: No record in chart.
Current Illness:
Preexisting Conditions: Arthritis, CHF, CKD, chronic pain, diabetes, hypertension, sleep apnea, trouble walking
Allergies:
Diagnostic Lab Data: SARS-COV-2 (COVID-19) by NAA, Micro: SARS CoV2 Detected (5/16/2021)
CDC Split Type:

Write-up: 57-year-old female who lives in an assisted living/skilled nursing facility, from where she was transferred to the hospital because of suspected stroke. Subsequently, the patient was undergoing workup and result for COVID-19 test came back positive. The patient denies cough, fever, chills. Denied any history of cough, fever, chills, or shortness of breath. She is a known diabetic and kidney failure. The patient suffers from morbid obesity also, and has gait and mobility disorder. The patient has a history of acute onset dysphagia and mental status changes. Tested positive for COVID on 5/16/2021.


VAERS ID: 1351713 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-11
Onset:2021-05-15
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Anion gap normal, Basophil count decreased, Blood chloride normal, Blood creatinine normal, Blood potassium normal, Blood sodium normal, Blood thyroid stimulating hormone normal, Carbon dioxide normal, Eosinophil count decreased, Fatigue, Glomerular filtration rate, Haematocrit normal, Haemoglobin normal, Headache, Immature granulocyte count, Lymphocyte count decreased, Mean cell haemoglobin concentration normal, Mean cell haemoglobin normal, Mean cell volume increased, Monocyte count decreased, Neutrophil count decreased, Pain, Paraesthesia, Platelet disorder, Red blood cell count normal, Red cell distribution width normal, White blood cell count normal
SMQs:, Agranulocytosis (broad), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (broad), Peripheral neuropathy (broad), Systemic lupus erythematosus (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Advair HFA, Singulair, Nexplanon
Current Illness: None
Preexisting Conditions: Asthma, Allergies, Sun Allergy
Allergies: Mannose
Diagnostic Lab Data: 5/20/21 - Urgent Care Visit, Creatinine Whole Blood Your value 0.5 mg/dL GFR, Estimated Your value $g60 mL/min/1.73m2 Sodium, WB Your value 138 mmol/L Standard range 136 - 145 mmol/L Potassium, Whole Blood Your value 4.1 mmol/L Standard range 3.5 - 5.1 mmol/L Chloride, Whole Blood Your value 104 mmol/L Standard range 95 - 106 mmol/L Carbon Dioxide Whole Blood Your value 25 mmol/L Standard range 22 - 31 mmol/L Anion Gap Your value 9 mmol/L Standard range 7 - 16 mmol/L TSH, Reflex Your value 1.65 uIU/mL Standard range 0.30 - 4.50 uIU/mL WBC Your value 9.4 x10(9)/L Standard range 3.5 - 10.5 x10(9)/L RBC Your value 4.26 x10(12)/L Standard range 3.90 - 5.03 x10(12)/L Hemoglobin Your value 13.1 g/dL Standard range 12.0 - 15.5 g/dL HCT Your value 41.5 % Standard range 34.9 - 44.5 % MCV Your value 97.4 fL Standard range 80.0 - 100.0 fL MCH Your value 30.8 pg Standard range 27.6 - 33.3 pg MCHC Your value 31.6 g/dL Standard range 31.5 - 35.2 g/dL RDW Your value 13.9 % Standard range 11.9 - 15.5 % Platelets Your value 277 x10(9)/L Standard range 150 - 450 x10(9)/L Automated NRBC Your value 0 /100 WBC Standard range <=0 /100 WBC Neutrophil Absolute Your value 6.4 10(9)/L Standard range 1.7 - 7.0 10(9)/L Lymphocyte Absolute Your value 2.0 10(9)/L Standard range 1.0 - 4.8 10(9)/L Monocytes Absolute Your value 0.6 10(9)/L Standard range 0.2 - 0.9 10(9)/L Eosinophil Absolute Your value 0.3 10(9)/L Standard range 0.0 - 0.5 10(9)/L Basophil Absolute Your value 0.1 10(9)/L Standard range 0.0 - 0.3 10(9)/L Immature Gran % Your value 0.4 % Standard range 0.0 - 0.5 %
CDC Split Type:

Write-up: Parathesia (on/off tingly in checks, arms, legs) Tired, Body Aches, Headache


VAERS ID: 1351873 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-05-01
Onset:2021-05-15
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 & EW0172 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Intensive care
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Metoprolol 200mg, Triamterene-HCTZ, Klor-Con M20, Furosemide 20mg, Warfarin 5mg, Digoxin 0.125
Current Illness: None
Preexisting Conditions: Sleep Apnea AFIB
Allergies:
Diagnostic Lab Data: Rushed to ICU
CDC Split Type:

Write-up: Complete cardiac arrest 2 weeks after shots


VAERS ID: 1351906 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Eye pain
SMQs:, Glaucoma (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: patient has glaucoma
Allergies: Ace Inhibitors Aspirin Sulfonamides
Diagnostic Lab Data: Patient is seeing her eye dr
CDC Split Type:

Write-up: Patient received 2nd Moderna shot on 05/15/2021 and started feeling eye pain and believes her glaucoma to be worse now.


VAERS ID: 1352388 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-08
Onset:2021-05-15
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 80777-0273-10 / 1 LA / SYR

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: Armour thyroid, Fish oil, V K2, V B12, V D3, Niacin, Alendronate, Tamsulosin
Current Illness:
Preexisting Conditions: Enlarged prostrate, Swollen Retina
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pain in left arm between elbow and shoulder. Painful in the morning, then subsides. One week after injection pain was severe for three days. Now not severe but still painful in morning and evening. Usually pain-free during the day.


VAERS ID: 1352399 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / UNK LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Intermenstrual bleeding
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: Taken morning of; around 8:30/9:00am Vegan digestive enzymes (Veganzyme). Water with Vitamin C powder (1000mg)
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: PCN and Ceclor
Diagnostic Lab Data:
CDC Split Type:

Write-up: Spotting has occured daily since the day after vaccine was administered on 5/14/21. Menstrual cycle typically regular and was expected to begin on 5/29/21.


VAERS ID: 1352529 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-03
Onset:2021-05-15
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: lisinopril, clopidogrel
Current Illness: N/A
Preexisting Conditions: Chronic Heart Failure
Allergies: Sulfa
Diagnostic Lab Data: Went to dr on May 24th and was prescribed prednisone 20mg 2 daily for 5 days
CDC Split Type:

Write-up: Patient states that about 1.5 to 2 weeks after receiving the vaccine she broke out in itchy hives over body. Most severe upper thighs and back,


VAERS ID: 1353598 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SEROQUEL
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021567727

Write-up: This is a spontaneous report from a contactable consumer (patient). A 55-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE; lot number: EW0182), via an unspecified route of administration in the left arm on 14May2021 at 12:00 (at the age of 55-years-old), 1st dose, single, for COVID-19 immunization. The patient had no medical history. Concomitant medication included quetiapine fumarate (SEROQUEL). The patient previously took zithromax z-pack and experienced drug hypersensitivity. Prior to vaccination, the patient was not diagnosed with COVID-19, did not receive other vaccines four weeks prior. The patient was not pregnant at the time of vaccination. On 15May2021 at 07:00, the patient started experiencing severe back pain and on 18May2021 she developed a weltish rash all over her lower back. As of the day of report, the patient was still experiencing back pain. The events were reported as non-serious and resulted in doctor or other healthcare professional office/clinic visit. The patient had three visits to chiropractor to relieve back pain. The patient had not been tested for COVID-19 since vaccination. The outcome of the event severe back pain was not recovered and that of another event was unknown.


VAERS ID: 1353600 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-05-13
Onset:2021-05-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 RA / -

Administered by: Private       Purchased by: ?
Symptoms: Diarrhoea, Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ZOLOFT; ADDERALL; BACTRIM; IBUPROFEN
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Bipolar II disorder; Cardiovascular disorder NOS; Colonic polyp; Disturbance in attention
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021567870

Write-up: Vaginally bleeding x4 days; diarrhea x 2 mornings; This is a spontaneous report from a contactable consumer (patient). A 46-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE; lot number: EW0179 and expiration date was not reported), via an unspecified route of administration in right arm, on 13May2021 at 10:30 (at the age of 46 years old) as 1st dose, single for COVID-19 immunization in a hospital. Medical history included colon polyps, bipolar II disorder, inattentive add and early cardio disease. Concomitant medications included sertraline hydrochloride (ZOLOFT); amfetamine aspartate, amfetamine sulfate, dexamfetamine saccharate, dexamfetamine sulfate (ADDERALL); sulfamethoxazole (+) trimethoprim (BACTRIM) and ibuprofen. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. It was unknown if the patient was pregnant at the time of vaccination. Prior to vaccination, the patient was not diagnosed with COVID-19 and since the vaccination, the patient was never tested for COVID-19. The patient experienced vaginal bleeding for 4 days and diarrhea for 2 mornings on 15May2021 at 10:00. The events were assessed as non-serious by the reporter. No treatment was received by the patient regarding these events. The outcome of these events was recovering at the time of report.


VAERS ID: 1353636 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Fibromyalgia, Illness, Influenza like illness, Myalgia, Pain, Somnolence
SMQs:, Rhabdomyolysis/myopathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lyrica
Current Illness: None
Preexisting Conditions: Fibromyalgia, Chronic Fatigue Syndrome
Allergies: None
Diagnostic Lab Data: None yet. I don?t know who to go to for help.
CDC Split Type:

Write-up: I was sick with moderate flu-like symptoms for two days, then recovered from those. However, I am continuing to experience a major increase in my fibromyalgia/Chronic Fatigue Syndrome symptoms (excessive daytime drowsiness where I need at least a 4-hour nap each day with 7 hours sleep/night, and also full body muscle and joint pain that is not getting better with usual treatments of Lyrica, hot baths or heat pad, light activity, rest, or ibuprofen). My symptoms were being managed daily by those treatments to get down to a ?3 or 4-out-of-10 scale? level. Since my second Pfizer vaccine I am averaging about ?7-out-of-10 scale? pain, and unmanageable fatigue. I have never had any reactions to vaccines before and am fully vaccinated.


VAERS ID: 1354125 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-28
Onset:2021-05-15
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is having no adverse symptoms, but the two doses were administered only 17 days apart which is outside of the standard dosing interval.


VAERS ID: 1354189 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cardiac flutter, Electrocardiogram ambulatory, Electrocardiogram normal, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: simvestatin, COQ10, flonaise, multi vitamin, vitamin D, probiotic
Current Illness: none. covid positive 3/23/21
Preexisting Conditions: N/A
Allergies: penicillin, erythromycin, sulfa
Diagnostic Lab Data: Had EKG, Eccocardiogram, holter monitor done in April with normal results. had EKG reading for 5 hrs in ER, EKG in dr. office - normal after shot. wore another monitor for 2 days that I just turned back in today.
CDC Split Type:

Write-up: no symptoms till 26 hrs after 2nd shot. severe heart palpitations - felt like heart was going to explode. went to ER, normal EKGs and nothing found in ER. since episode - have had mild heart flutters for 10 days now. during covid illness - had 1 hard palpitation - and some mild flutters. nothing nearly as severe as after the shot.


VAERS ID: 1354283 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Vermont  
Vaccinated:2021-03-22
Onset:2021-05-15
   Days after vaccination:54
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Peripheral swelling, Thrombosis
SMQs:, Cardiac failure (broad), Angioedema (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin, baclofen, fexophenadine, hydrochlorathiazide, fluticazone propionate, omeprazole, tamsulosin, multi-vit & b-12.
Current Illness: none
Preexisting Conditions: asthma, high blood pressure
Allergies: shellfish, crustacean
Diagnostic Lab Data: Visit to PCP, seen by PA 5/17/21.
CDC Split Type:

Write-up: Blood clot in right foot. Swelling. I didn''t immediately consider the possible connection to the Pfizer vac. Sorry for the delay.


VAERS ID: 1354438 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Injection site pain, Myalgia
SMQs:, Rhabdomyolysis/myopathy (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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: IT''S BEEN THIRTEEN DAYS SINCE MY SECOND VACCINE SHOT AND MY LEFT ARM IS STILL SORE AT THE INJECTION SITE AND SURROUNDING MUSCLES.


VAERS ID: 1354526 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: I had one slight reaction to a flu shot that was given to me when I was newly pregnant. However, other than that one time that I had slight tightness in my throat, I have not experienced any adverse side effects to the flu shot.
Diagnostic Lab Data: none
CDC Split Type:

Write-up: My right arm broke out in hives slightly less than 24 hours after receiving the vaccination. It started as slightly itchy spots, then progressed into hives over all of my forearm. I also have an intermittent fever of up to 103 F over the 28 hour period following my shot and was incredibly fatigued.


VAERS ID: 1354531 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary mass, Axillary pain, Injection site mass, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Severe swollen underarm with under arm pain lasted a week. Swelling on the side of the neck started a few days later and is still there. Swelling in arm pit is down but can still feel lumps in my arm pit and new lumps on my bicep all on the injection side of the body.


VAERS ID: 1354534 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Body temperature increased, Condition aggravated, Depression, Emotional distress, Headache, Insomnia, Migraine
SMQs:, Neuroleptic malignant syndrome (broad), Depression (excl suicide and self injury) (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: Escitalopram, Bupropion
Current Illness: Depression/anxiety, infertility, anemia
Preexisting Conditions: Depression/anxiety, infertility, anemia
Allergies: Sulfa medications
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe migraine overnight, difficulty sleeping. Slight headache for several days after. Slightly elevated temperature overnight. Inconsolable crying and sadness overnight. Depression symptoms worsening and continuing to be worse than before vaccination.


VAERS ID: 1354572 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: 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? 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: 0950: received 1st dose of Pfizer vaccine EN6207 in right deltoid 0955: developed itchy red hive like rash in 3 areas of right arm, denied sob. 0957: received 25mg po Benadryl Instructed patient to stay 30 minutes to be monitored. No further issues and left after 30 minutes


VAERS ID: 1354666 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-13
Onset:2021-05-15
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Computerised tomogram head, Electrocardiogram, Electroencephalogram, Laboratory test, Magnetic resonance imaging head, Movement disorder, Muscular weakness, Seizure like phenomena, Tic
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Convulsions (narrow), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (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? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Fluoxetine 20 mg Loestrin Fe1/20
Current Illness:
Preexisting Conditions: depression, ADHD, hip dysplasia
Allergies: eggs, wheat
Diagnostic Lab Data: May 15: EKG, labs May 16: CT head, MRI brain, labs May 17: EEG, labs
CDC Split Type:

Write-up: Patient started having seizure like activity and weakness in her arms and legs; the patient was brought by EMS to the ER and admitted for testing. She had tics that were occurring of her head and neck area. After she was released with no abnormalities noted to be causing her symptoms, she was referred to a Functional Movement Disorder specialist at a clinic, who diagnosed her with Functional Movement Disorder. Her symptoms resolved completely about a week after her hospitalization.


VAERS ID: 1354729 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-13
Onset:2021-05-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Muscle twitching, Tinnitus
SMQs:, Dyskinesia (broad), Dystonia (broad), Hearing impairment (narrow)

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

Write-up: twitching nerves (including but not limited to left arm) tinnitus


VAERS ID: 1354853 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Hypertension, Injection site pain, Malaise, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypertension (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: metformin, tradjenta, glipizide, lisinopril, atorvastatin, multivitamin, vitamin B, calcium
Current Illness:
Preexisting Conditions: diabetes type 2, high blood pressure
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: flulike symptoms: general malaise, body aches, low grade fever, pain at site of injection symptoms began appx. 12 hours after injection and continued for the next 24 hours


VAERS ID: 1354867 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Tinnitus
SMQs:, Hearing impairment (narrow)

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

Write-up: I have had constant tinnitus for almost two weeks which started very soon after my second Moderna shot. It varies in severity but never goes away completely.


VAERS ID: 1354880 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-30
Onset:2021-05-15
   Days after vaccination:46
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Vaccination complication
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fusillade, Crimidine, Metoprolol, Levothyroxine, Humira, Aspirin, Loratadine OTC, Citrucel
Current Illness: No
Preexisting Conditions: Mitro valve replacement and CAD
Allergies: Sulfa drugs
Diagnostic Lab Data: No
CDC Split Type:

Write-up: About a month and a half after getting 2nd dose of Modera 3/30, I had covid arm, it came out of no where and about 3-4 days ago another bump has come up but it''s not big as the first one.


VAERS ID: 1354900 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-05-13
Onset:2021-05-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 with hx of epilepsy controlled, no seizures since 2018 on Depakote and lamictal, after second dose of Moderna vaccine two days later has had 7 seizures in one week. No other obvious seizure trigger.


VAERS ID: 1354944 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-06
Onset:2021-05-15
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Alanine aminotransferase increased, Anaemia, Aspartate aminotransferase increased, Blood alkaline phosphatase increased, C-reactive protein increased, Cellulitis, Chills, Computerised tomogram abnormal, Computerised tomogram thorax, Erythema, Haemoglobin decreased, Inflammatory marker increased, Leukocytosis, Liver function test increased, Lymphadenopathy, Malaise, Neutrophil percentage increased, Platelet count decreased, Pyrexia, Red blood cell sedimentation rate increased, Skin warm, Thrombocytopenia
SMQs:, Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Haematopoietic erythropenia (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Biliary system related investigations, signs and symptoms (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Omeprazole, atorvastatin, aspirin
Current Illness: None
Preexisting Conditions: Hypertension, GERD
Allergies: None
Diagnostic Lab Data: LFT elevation peaking at ALT 140 / AST 157 / AlkP 264. Mild leukocytosis to 11.55 (86% neutrophils), mild anemia (nadir Hgb 10.8), and mild thrombocytopenia (platelet nadir 116). Elevated inflammatory markers - ESR 41, CRP peaked at 262. All lab abnormalities have improved. Imaging notable for CT chest with soft tissue stranding over the left chest wall and enlarged left axillary node to 13mm on short axis.
CDC Split Type:

Write-up: Approximately 9 days after the vaccination, tender left axillary lymphadenopathy, malaise, chills, and high fever (to 104F) developed; followed several days later by development of marked erythema and warmth over the left chest wall, left axillary region, and onto left back. This presentation required brief hospitalization for treatment of a presumed cellulitis and further diagnostic workup of fevers and lymphadenopathy. The patient was treated with antibiotics for cellulitis and empirically for possible tick-borne illness (early Lyme, glandular tularemia) with notable improvement in the skin erythema and fevers.


VAERS ID: 1355001 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 1 RA / IM

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

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

Write-up: The client was inadvertently given the Moderna COVID vaccine when he should have received Pfizer. The Moderna vaccine has not yet been authorized for the clients age group. The client was advised to wait 30 minutes for observation after receiving the vaccination in which time he showed no adverse reactions. The clients mother was told she would be contacted with instructions for the clients second dose after CDC guidelines could be consulted regarding which vaccine he should receive next.


VAERS ID: 1355057 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-24
Onset:2021-05-15
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Deafness unilateral, Tinnitus
SMQs:, Hearing impairment (narrow)

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

Write-up: Loud ringing in ears, lose of some hearing in left ear.


VAERS ID: 1355058 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-02
Onset:2021-05-15
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037A2113 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Hypoaesthesia, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Crestor, Citalopram 10mg/day (1/2 pill), vitamin D, Valtrex 500 mg twice/day
Current Illness: herpes, asthma
Preexisting Conditions: asthma
Allergies: none
Diagnostic Lab Data: None; Doctor''s appointment to be made for numbness in toes
CDC Split Type:

Write-up: Debilitating fatigue and muscle soreness for 2 days from 1''st shot; Debilitating fatigue and muscle soreness for 3 days from 2nd shot; also developed numbness in 3 toes on right foot after 2nd shot


VAERS ID: 1355332 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Dizziness, Oxygen therapy
SMQs:, Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Respiratory failure (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: duloxetine, benzapril, carvedilol, plavix, doxazosin, baby aspirin, restasis, lyrica, d3, probiotic, calcium, magnesium, curaminbcm95, mo7, afrin, opc3, melatonin, garlic, tylenol, rephresh, eye ointment, vitamin c, breath x, red wine, puri
Current Illness: allergies
Preexisting Conditions: arnold, quiari, aortic anurysem, ibs, hernia, disease of spine, sleepapnea, central apnea, confusion,
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: woozy, weak,used oxygen,


VAERS ID: 1355347 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

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

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

Write-up: The event is strictly related to administering COVID-19 vaccine to a patient that was not 12 year of age at the time of the vaccination. There have not been any adverse events reported. We have introduced countermeasures to prevent future events.


VAERS ID: 1356523 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C2A1 / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Erythema, Feeling hot, Hypoaesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Around 25 minutes after my vaccine my face got red, hot, and half of the right side of my face went almost numb. It lasted for a few hours. I went home and put ice on it. I did not get a hold of a doctor or the person that vaccinated me. I do have pictures of my face when I got hot. You can see it was red. I?m not sure if I should get the second one. It was pretty scary.


VAERS ID: 1356910 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-07
Onset:2021-05-15
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Blood test, Breast tenderness, Chills, Culture, Dizziness, Electrocardiogram, Mastitis, Migraine, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Functional lactation disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Pre natal vitamin- currently breastfeeding
Current Illness: None
Preexisting Conditions: Asthma and migraines
Allergies: Pollen and cats
Diagnostic Lab Data: Breast culture- still waiting for results 5/27/21 Bloodwork and ekg -5/20/21
CDC Split Type:

Write-up: Started to get a migraine with dizziness (atypical of when I usually get migraines) which then went Into mastitis, chronic dizziness and a second bout of mastisis, I?ve breastfed two other children and never had mastitis,. There have been many reports in my moms groups of women getting mastitis after receiving the vaccine. Currently still ill with fever body aches chills dizziness and breast tenderness


VAERS ID: 1357074 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:0000-00-00
Onset:2021-05-15
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Fatigue
Preexisting Conditions: Comments: The patient was taking 4 prescription medications.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210551403

Write-up: FEELING VERY FATIGUED; This spontaneous report received from a patient concerned a 78 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included fatigue, and other pre-existing medical conditions included the patient was taking 4 prescription medications. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 203A21A, and expiry: UNKNOWN) dose was not reported, administered on 14-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 15-MAY-2021, the subject experienced feeling very fatigued. The action taken with covid-19 vaccine was not applicable. The patient had not recovered from feeling very fatigued. This report was non-serious.


VAERS ID: 1357637 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-27
Onset:2021-05-15
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Acoustic stimulation tests normal, Tinnitus
SMQs:, Hearing impairment (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Saw ENT. Hearing test came back fine. Physical exam came back fine.
CDC Split Type:

Write-up: Ringing in left ear.


VAERS ID: 1357659 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

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

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

Write-up: Pt attended a health fair and was given Janssen vaccine. He does not meet the 18+ age requirement for this particular vaccine. No adverse reaction noted. Mother aware immediately following administration.


VAERS ID: 1357771 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Wrong product 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: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)


VAERS ID: 1357868 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-25
Onset:2021-05-15
   Days after vaccination:51
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Balance disorder, Computerised tomogram, Dizziness, Loss of control of legs, Lumbar puncture, Magnetic resonance imaging
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 5/17/21-CAT scan, MRI. 5/18/21-Lumbar puncture
CDC Split Type:

Write-up: 5/15/21-7am: Loss of balance and dizziness 5/17/21-8am: complete loss of control of right leg. 9am: admitted to ER as signs of stroke. 5/18/21-started IV steroids for inflammation.


VAERS ID: 1357908 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: atorvastatin calcium 10mg, hydrochlorothiazide 25mg,vitamin d3 supplement, Tylenol
Current Illness: No
Preexisting Conditions: Obesity, high blood pressure, high cholesterol
Allergies: Lactose intolerance
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fever, cold, sweats, headache, tired, body ache


VAERS ID: 1357987 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-05
Onset:2021-05-15
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Tinnitus
SMQs:, Hearing impairment (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: Levothyroxine 75mg
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tinnitus in both ears


VAERS ID: 1358032 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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 rash on both arms. Started after vaccination and has not yet resolved. Itching relieved from oral benadryl.


VAERS ID: 1358093 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-10
Onset:2021-05-15
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Military       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: tested positive for COVID-19 5/15/2021 via nasal swab
CDC Split Type:

Write-up: Patient received 2nd dose of COVID-19 Moderna vaccine on 10April2021 and tested positive for COVID-19 5/15/2021 via nasal swab .


VAERS ID: 1358103 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cellulitis, Rash, Rash pruritic, Wound
SMQs:, Anaphylactic reaction (broad), Accidents and injuries (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin for men.
Current Illness: none
Preexisting Conditions: 1. autism 2. psoriasis
Allergies: No known allergies.
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Received Moderna vaccine on 5/14/21. The morning of 5/15/21 the patient awoke with a pruritic rash on the trunk, which spread to the upper and lower extremities, and face. Patient went to emergency room and was given oral Benadryl x1, oral Prednisone 40mg x1, and sent home the same day with a topical steroid cream. Seen again at my office on 5/28/21. Rash had mostly resolved, but pruritic rash still present on lower back and buttocks. Rash has resulted in small open wounds due to scratching, with surrounding cellulitis. Currently treating with 7-day course of Bactrim for cellulitis. No evidence of anaphylaxis.


VAERS ID: 1358131 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 0205A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Muscle spasms, Pain in extremity
SMQs:, Retroperitoneal fibrosis (broad), Dystonia (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: Allergy shots, Vitamin D supplement
Current Illness: none. In great health
Preexisting Conditions: environmental and other allergies
Allergies: Allergic to latex, gluten, penecillin, erythromycin, all NSAIDS
Diagnostic Lab Data: Medical doctor visit, @25 co-pay. PT to assist in relieving the back pain, $25 co-pay per visit. 2x/week for not sure how long.
CDC Split Type:

Write-up: Within 24 hours I was feeling a leg cramping in my lower left calf, similar to when you have sat on an airplane too long. By the early hours of Sunday morning, it had "spread" in my legs to upper legs and both legs. The pain increased to excruciating, and continued overnight through Monday. During that overnight, I was caring for my elderly mother. I assisted her to the bathroom per usual for the past 2 years. After the 3rd and final assist for the night, I felt lower back pain. That also increased and continues to be causing significant pain. The pain in my legs is gone.


VAERS ID: 1358254 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-15
Onset:2021-05-15
   Days after vaccination:61
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Insomnia, Respiratory tract congestion
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Itires by Pekana, Ricura by Pekana Gamma O3 by Biopure Thuja by Pekana Virus Nosode by PF Ion Gut Health Supren by Pekana Pectaclear by Eco Eugenics Heart/Fatigue Thyrotain NAC by Pure Encapsulations apo-STRUM by Pekana Itires Ointment 35g
Current Illness: NO
Preexisting Conditions: NO
Allergies: Phenegran
Diagnostic Lab Data:
CDC Split Type:

Write-up: chest congestion. sneezing, mucus symptoms, insomnia , exhausted


VAERS ID: 1358389 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-13
Onset:2021-05-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none but I did have COVID-19 (positive test) 11/11/2020.
Preexisting Conditions: none
Allergies: penicillin, amoxicillin, ceclor, suprax, cephalosporins
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 1. Big red splotch 2-3 inches in diameter at vaccination site 2. full body hives (not super itchy); size of a pen dot, slightly puss-filled. Started on abdomen and moved throughout to extremities over 7 days. Treatment: Benadryl Outcome: hives spread throughout the body to extremities over the course of a week and then disappeared.


VAERS ID: 1358548 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 2 LA / IM

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

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

Write-up: NO ADVERSE EVENT REPORTED. PATIENT WAS 17 YEARS OLD AT TIME OF 1ST VACCINE. PATIENT RECEIVED DOSE AS PART OF A LARGE, MULTI-LANGUAGE VACCINE CLINIC. AFTER THE VACCINE WAS ADMINISTERED AND PATIENT LEFT, HER REPORTED AGE WAS NOTED AND THE QUESTION AROSE OF CORRECTNESS OF THE REPORT. ATTEMPTS WERE MADE TO CONTACT THE PATIENT TO CONFIRM HER DOB WITHOUT RESOLUTION. A NOTE WAS LEFT WITH HER CONSENT FORM FOR HER SCHEDULED SECOND DOSE. DUE TO MISCOMMUNICATION, I DID NOT SPEAK WITH HER PRIOR TO HER RECEIVING HER SECOND DOSE.


VAERS ID: 1358567 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aphonia, Asthma, Condition aggravated, Dyspnoea, Fatigue, Oropharyngeal pain, Pain in extremity, Productive cough, Pyrexia, Respiratory tract congestion, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Dulera inhaled steroid for asthma, albuterol inhaler as needed for asthma, daily vitamin, Flonase, Claritin, allergy shots (immunotherapy) 2 full days prior to vaccine,
Current Illness:
Preexisting Conditions: Asthma, environmental allergies
Allergies: Almond allergy, Diflucan and Tetracycline allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Days 1-3 post vaccine: extremely sore arm, low grade fever, general fatigue Days 4-5: higher temperature (100+) sore throat, chest congestion, productive cough, loss of voice Days 6-10: temperature & congestion subsided, asthmatic wheezing, cough, shortness and sudden loss of breath during normal activities Day 10: visited asthma specialists and was prescribed prednisone, nebulizer with albuterol and budesonide inhalants as a breathing aid, Days 11- present: still managing asthmatic symptoms, slightly improved with meds but not able to resume normal activities


VAERS ID: 1358602 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 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? 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: Parent wrote the wrong date of birth on the consent form. Year was modified to make the child 12 years old. Age was not verified and child received the vaccine at age 11. Parents were notified and told they cannot get child their second dose until they are 12 years old.


VAERS ID: 1358608 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Parent wrote the wrong age on the consent form. The correct date of birth is written on the form but the parent wrote that the child was 12 instead of 11. Age was not verified and child received the vaccine at age 11. Parents were notified and told they cannot get child their second dose until they are 12 years old.


VAERS ID: 1358667 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206HZIA / 1 LA / IM

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

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

Write-up: About 1 hour after the vaccine I had tingling and numbness in the left side of my face. It lasted about 30 minutes and came back intermittently for several days. The morning after I received the vaccine I had a noticeable ringing in my ears when I woke. It lessened and went away after several hours but has been present most mornings since and has lessened and then stopped as the day progressed. Today (5/28) was not present when I woke but suddenly started again about 5:00 pm.


VAERS ID: 1358683 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 3 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: 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: NOT REPORTED
Current Illness: NOT REPORTED
Preexisting Conditions: NOT REPORTED
Allergies: NKA
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: PATIENT RECEIVED THREE DOSE OF PIZER VACCINE.


VAERS ID: 1358839 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abortion spontaneous, Back pain, Exposure during pregnancy, Fatigue, Foetal heart rate normal, Nausea, Night sweats, Pain, Ultrasound scan vagina, Vaginal haemorrhage, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow), Normal pregnancy conditions and outcomes (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: prenatal medicines
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: 5/17, 5/25 & 5/26 vaginal ultrasounds
CDC Split Type:

Write-up: Received second shot at 10 weeks pregnant (due 12/6/21). The night of 5/14 - started having night sweats, extreme lower back pain, nausea, and spotting from the vagina. All of these symptoms were new and none were experienced during pregnancy otherwise. (After the first shot at 7 weeks pregnant, only had a sore arm at injection site) On 5/15 - multiple episodes of vomiting, excessive exhaustion, and bleeding continued. 5/16-5/25 - bleeding increased Went to OBGYN 5/17 & 5/25 to get checked and both times they were able to locate a heartbeat, but were unsure why bleeding continued to occur. 5/25 11:30pm woke up in excessive pain and bleeding, resulting in a miscarriage. 5/26 2:00am ER confirmed miscarriage.


VAERS ID: 1358850 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Decreased appetite, Disturbance in attention, Fatigue, Headache, Night sweats, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (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: Valsartan 160 mg, Vitamin D, Zyrtec
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe headache for 48 hours Mild headache for one week Severe fatigue for 48 hours Fatigue for one week Loss of appetite for 24 hours Night sweats and low grade fever for 72 hours Loss of concentration for one week


VAERS ID: 1359005 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Headache, Nausea, Pain, Pain in extremity
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: Sore arm, aches, tired, headache for about 48 hours Nausea for 2 hours


VAERS ID: 1359014 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Abdominal discomfort, Dermatitis allergic, Fatigue, Rash, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Multi-Vitamin
Current Illness: no
Preexisting Conditions: asthma; celiac disease
Allergies: Peanut allergies; celiac disease - no gluten
Diagnostic Lab Data: no
CDC Split Type: vsafe

Write-up: She had an upset stomach and was feeling really tired. Then the next morning, she had a rash - itchy and bumpy - torso, back arms and face. Went to the Doctor and she said it looked like an allergic rash. She told us that based on my daughter''s genetics and her asthma - (I (her mother) had an anaphylaxis with my second Moderna shot - my entire body was giant hives.)- That he did not recommend her to have the 2nd shot. My daughter still has some of the rash - a little on her left cheek, stomach and back still. The itching is gone. She did take Benadryl for it.


VAERS ID: 1359305 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: NO ADVERSE EVENT REPORTED - PATIENT WAS NOT CORRECT AGE AT TIME OF VACCINATION


VAERS ID: 1359850 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Lymphadenopathy, Malaise, Mobility decreased, Pain in extremity
SMQs:, Parkinson-like events (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No prescriptions. Only muti-vitamin supplements.
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin, myocin drugs.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received the first and second doses at Pharmacy. Second vaccine shot was on Friday, May 14, 2021, in the left arm. On Saturday, May 15, 2021, I wasn''t feeling well. Then later in the evening I developed a bulge under the left arm. The lympth node increased in size; my left arm would ache, especially if I would stretch to reach for something. I have been applying cold packs. This situation has now continued for two weeks.


VAERS ID: 1359954 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-05-15
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Discomfort, Fatigue, Headache, Limb discomfort, Neck pain, Pain in extremity, Paraesthesia, Somnolence
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210552171

Write-up: DISCOMFORT IN LEGS AND ARMS GOES UPTO ELBOW AND ARMPIT/IN THIGH OF THE LEFT LEG; TINGLING/ NUMBNESS IN LEG/ARM/IN THE FINGERS; PAIN IN NECK; WHOLE WEEK SLEEPINESS; PAIN IN LEFT ARM; DISCOMFORT IN ARMS; TIREDNESS; PAIN IN HEAD; This spontaneous report received from a patient concerned a female of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported.The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: UNKNOWN) dose was not reported, administered on 15-MAY-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 15-MAY-2021, the subject experienced discomfort in legs and arms goes upto elbow and armpit/in thigh of the left leg. On 15-MAY-2021, the subject experienced tingling/ numbness in leg/arm/in the fingers. On 15-MAY-2021, the subject experienced pain in neck. On 15-MAY-2021, the subject experienced whole week sleepiness. On 15-MAY-2021, the subject experienced pain in left arm. On 15-MAY-2021, the subject experienced discomfort in arms. On 15-MAY-2021, the subject experienced tiredness. On 15-MAY-2021, the subject experienced pain in head. Treatment medications (dates unspecified) included: ibuprofen. The action taken with covid-19 vaccine was not applicable. The patient recovered from pain in neck, pain in left arm, and pain in head on MAY-2021, and the outcome of discomfort in legs and arms goes upto elbow and armpit/in thigh of the left leg, tiredness, whole week sleepiness, tingling/ numbness in leg/arm/in the fingers and discomfort in arms was not reported. This report was non-serious.


VAERS ID: 1360493 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Depression, Hallucination, Intentional self-injury, Mood altered
SMQs:, Suicide/self-injury (narrow), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (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: Medical History/Concurrent Conditions: Ear pain (other_medical_history: Chronic ear pain); Food allergy (Gorgonzola cheese)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021548191

Write-up: Hallucinations; Urge to self harm; Severe mood swings; Depressive state; This is a spontaneous report from a contactable consumer. A 23-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 2 via an unspecified route of administration, administered in Arm Left on 15May2021 08:30 (Batch/Lot Number: EW0185), at the age of 23-years-old as 2nd dose, single for COVID-19 immunization. Historical vaccine included first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) on 24Apr2021 08:30 (lot number: EW0151) at the age of 23-years-old in the left arm. Medical history included Chronic ear pain and allergies with Gorgonzola cheese. The patient''s concomitant medications were not reported. Most recent COVID-19 vaccine was administered at the Pharmacy or Drug Store. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. No other medications were received within 2 weeks of vaccination. The patient experienced severe mood swings and depressive state, urge to self-harm (medically significant) and hallucinations (medically significant) on 15May2021 11:45. No treatment was given. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient has not been tested for COVID-19. The outcome of the events was not recovered. Information on Lot/Batch number was available. Additional information has been requested.


VAERS ID: 1360495 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Dyspnoea, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Shellfish allergy (Known allergies: Seafood Shell Fish)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021548277

Write-up: chills; shortness breath; hives on face; dizziness; This is a spontaneous report from a contactable consumer (patient). A 53-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/Lot Number: EW0177), via an unspecified route of administration, administered in arm left on 15May2021 at 11:15 (at the age of 53-years-old) as 1st dose, single dose for COVID-19 immunisation. Medical history included known allergies: seafood shellfish from an unknown date and unknown if ongoing. The patient''s concomitant medications were not reported. The patient had the 1st dose of the Pfizer vaccine, was fine for 8 hours, then had chills, shortness breath, hives on face and dizziness on 15May2021 at 20:00. The patient had shellfish seafood allergies. Last time he had one, that also happened after 8 hours. Therapeutic measures were taken as a result of all events [50mg diphenhydramine (BENADRYL)]. The outcome of the events was recovering.


VAERS ID: 1360522 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Cough, Dry mouth, Headache, Pain in extremity, Sleep disorder, Thinking abnormal
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Tendinopathies and ligament disorders (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021549922

Write-up: I only slept 1 hour; My arm, head and back hurt.; My arm, head and back hurt.; My arm, head and back hurt.; Dry mouth; coughing; random thoughts; This is a spontaneous report from a contactable consumer (patient). A 46-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE lot/batch number and expiration date not reported) via an unspecified route of administration, administered on the left arm on 15May2021 12:00 as 1st dose, single for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. On 15May2021 12:15, the patient only slept 1 hour, his arm, head and back hurt. Dry mouth, coughing, random thoughts. He felt like he was dying over here. Events were considered serious, disability. No treatment was received for the events. The facility where the vaccine was administered was in a hospital. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. There were no other medications the patient received within 2 weeks of vaccination. Since the vaccination, the patient has not been tested for COVID-19. Prior to vaccination, the patient was not diagnosed with COVID-19. Outcome of the events was not recovered. No follow-up attempts are possible; information about lot/batch number cannot be obtained.


VAERS ID: 1360549 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: she is little dizzy; This is a spontaneous report from a contactable consumer (parent). This consumer reported for a 13-year-old female patient (reporter''s daughter). A 13-year-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE; lot number: EW0185; expiration date not provided), via an unspecified route of administration on 15May2021 17:00 as single dose for covid-19 immunisation. Patient''s medical history and concomitant medications were not reported. The patient experienced ''she is little dizzy'' on 15Ma2021. Patient''s clinical course is as follows: It was reported that the patient was 13-years-old and got Pfizer shot this afternoon about 5 o''clock. Now patient stated ''she is little dizzy''. Reporter stated ''And I don''t know is it related to that or not I just wanted to ask''. Reported also mentioned that ''Yes. In certain places you get that at 13''. When concern was paraphrased the reporter stated ''Yes''. When information about department was given, reporter stated, "Are they are there now?". Reporter was informed about Pfizer drug safety role and asked for permission to probe further questions, reporter stated, "Honestly I would like to go to site cause it''s 12 o''clock midnight here, it''s little late". When probed for lot and expiration, reporter stated, "It''s not on the card. Oh 1st dose Pfizer, EW0185". Outcome of the event was unknown.


VAERS ID: 1360552 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: California  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021556755

Write-up: body ache; bad headache; dizziness; This is a spontaneous report from a contactable consumer (patient''s father). A 12-year-old female patient received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number and expiration date: Not reported), via an unspecified route of administration on 14May2021 around 17:00 as a single dose for covid-19 immunization. The patient''s medical history and concomitant medications were not reported. The patient received her first dose of the Pfizer BioNTech Covid 19 vaccine on 14May2021 around 5pm and she has got some really bad symptoms right now and don''t know what to do. On 15May2021, the following morning she had a bad headache and some dizziness. On an unspecified date, the patient had body ache. The patient received treatment for event bad headache and dizziness with little naproxen. Outcome of the event was unknown. Information about lot/batch number cannot be obtained. Additional information has been requested.


VAERS ID: 1360598 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Kansas  
Vaccinated:0000-00-00
Onset:2021-05-15
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Fever (mother also experienced fever); Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021571303

Write-up: stabbing headache on the upper left side that was like a migraine; Chills; Fever; Coughing straining or bending; This is a spontaneous report from a contactable consumer (patient himself). A 30-year-old male patient received second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for injection, Lot number: EW0173), via an unspecified route of administration in left arm on an unspecified date at 11:15 (at the age 30-year-old) as a single dose to prevent COVID/ COVID-19 immunization. The patient''s medical history and concomitant medications were none. Family history included mother also experienced fever. The patient previously received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for injection, Lot number: EW0171), via an unspecified route of administration in left arm on 23Apr2021 (at the age of 30-year-old) as a single dose for COVID-19 immunization. History of all previous immunization with the Pfizer vaccine considered as suspect (or patient age at first and subsequent immunizations if dates of birth or immunizations are not available) was none. Additional vaccines administered on same date of the Pfizer suspect was none. It was reported that, caller was reporting additional adverse events after getting the second dose of the COVID-19 vaccine on Friday. He had chills the following day on 15May2021. He had to wait 15 minutes after getting the vaccine. He had fever on 15May2021. He took one dose of 500mg Tylenol and felt ok. He had a stabbing headache on the upper left side that was like a migraine on 16May2021. It worsened with coughing straining or bending on an unspecified date in 2021. He was fine when he was relaxed. The headache was still ongoing. The headache started on Sunday. Should he be worried or not. Was there anything additional that he could take or not. Questioned he received the second dose of the vaccine on Friday or not. Was it worth it to call the state health department or not. He had a fever the same date as chills. The fever was a slower onset. No investigation assessment. No relevant tests. The adverse events did not require a visit to emergency room and physician office. The patient was treated with Tylenol 500mg for the events fever and chills. The outcome of the event headache was not recovered, recovered on an unspecified date in 2021 for the event cough and recovered on 15May2021 for the other events. Description of product complaint: He had a stabbing headache on the upper left side that was like a migraine. He took one dose of 500mg Tylenol and felt ok. It worsened with coughing straining or bending. He was fine when he was relaxed. The headache was still ongoing. Product strength and count size dispensed: Tylenol 500mg. Follow-up attempts are needed. Further information is expected.


VAERS ID: 1360657 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Eye irritation, Feeling hot, Headache, Injection site pain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Corneal disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever 101.7F, severe weakness, headache, body aches, chills, heat waves, burning eyes, painful (not sore) L arm at the injection site


VAERS ID: 1360806 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-05-13
Onset:2021-05-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Oedema peripheral, Pain
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I took a dissolvable B-12, One a Day Women Vitamins, Hair/Nails/Skin Vitamin, Vitamin D and Vitamin C.
Current Illness: No
Preexisting Conditions: I was diagnosed with High Blood Pressure and Fiber Muscular Dysplasia.
Allergies: I am allergic to Sulphur and several food allergies identify by tests (bananas, pineapple, eggs, onion, walnuts, peanuts, almonds, pecans, navy beans, crab and oysters). I also have environmental allergies as well (dust, mold, grass, insects).
Diagnostic Lab Data: I did not have any medical tests or laboratory results at this time.
CDC Split Type: vsafe

Write-up: I took a shower Saturday morning and noticed that there was swelling under my right armpit. It was painful to use that arm to brush my teeth. I called the Nursing Line and they explained that it is common to noticed swelling and pain in the armpit area after receiving the Vaccine and it the pain or selling became worst to make an appointment to see a Doctor.


VAERS ID: 1361060 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Chest discomfort, Chest pain, Dizziness, Dyspnoea, Headache, Heart rate increased, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Arthritis (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: QVar, Albuterol, orthocyclen
Current Illness: Anxiety and depression
Preexisting Conditions: Tear of right labrum s/p surgical correction
Allergies: None
Diagnostic Lab Data: Vitals at time of visit: BP 122/52, Pulse 65, Resp: 20, SpO2: 99%, wt: 135.
CDC Split Type:

Write-up: Patient reports immediately after receiving the vaccine she developed chest tightness and pain that has continued to wax and wane the past two weeks. Has some intermittent difficulty breathing and fast heart rate that each last about 20- 30 minutes. Also accompanied by dizziness or lightheadedness. Reports her whole right leg feels tingly and her joints hurt, but denies weakness, redness or swelling of the joints or right foot. Also has a continuous headache that started within an hour of receiving the vaccine and worsened over the next few days. This too has waxed and waned.


VAERS ID: 1361146 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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
CDC Split Type:

Write-up: My arm was bruised badly (size of half dollar), hot and the area was sore just at the site of injection. It also became very itchy. This side effect lasted 7-8 days.


VAERS ID: 1361271 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 1 RA / IM

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

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

Write-up: Redness, swelling, warm-to-touch, nodule/hardness (under the skin) localized to around the injection site starting 1-2 days after the vaccine and still present 14 days post-vaccination TREATMENT: ibuprofen OTC to help with swelling


VAERS ID: 1361316 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-03
Onset:2021-05-15
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Intermenstrual bleeding, Menstrual disorder
SMQs:, Haemorrhage terms (excl laboratory terms) (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: Effexor Synthroid
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Menstruated in the middle of ordinary cycle (two weeks after regular period)


VAERS ID: 1361411 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Fatigue, Headache, Malaise, Pain, Pain in extremity, Paraesthesia oral, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: The first dose I was sick for 4 days. I immediately felt dizzy, tingly lips and lightheaded. I began to run a fever that day and had a headache for a week after. My 2nd dose was 45 days after the first. I experienced tingly lips, some arm pain. Later the Sam?s day I began to feel extremely tired. The next day I woke up feeling sore all over and a few hours later had a fever and horrible headache. My headache has not subsided, although it?s not as painful I still feel sore and achy on the right back lower part of my head. Today, 5/30/21 I have been experiencing pain along my shoulders, back of neck and the back of my head. It?s been 15 days since my 2nd vaccine.


VAERS ID: 1361495 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I take Topamax daily.
Current Illness: No
Preexisting Conditions: No
Allergies: I am allergic to Augmentin (break out in hives). I also allergic to daily, wheat, eggs, chocolate, corn, and shrimp.
Diagnostic Lab Data: I emailed my Doctor to inform her of the symptoms I was having. My Doctor did not think that my blood pressure was caused by the vaccine and told me to keep checking it.
CDC Split Type: vsafe

Write-up: I didn''t feel anything until after I woke up the next day was achy, nauseated, with my joints hurting.


VAERS ID: 1361608 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 705A27A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Probiotics, vitiams
Current Illness: None
Preexisting Conditions: None, well heart murmur. Bicuspid valve.
Allergies: N/A
Diagnostic Lab Data: I used Bengay.
CDC Split Type:

Write-up: Next day I had chills, but day 2, my arms and wrists hurt badly.


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