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

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

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 165 out of 10,493

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VAERS ID: 2000270 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33130BA / UNK LA / IM

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

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

Write-up: Patient experienced fatigue, sore arm, and a slight fever.


VAERS ID: 2000308 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-16
Onset:2021-12-23
   Days after vaccination:282
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / 1 - / OT

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

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

Write-up: Her lower eyelid and it was swollen; This spontaneous case was reported by a consumer and describes the occurrence of SWELLING OF EYELID (Her lower eyelid and it was swollen) in a 77-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 042B21A and 006B21A) for COVID-19 vaccination. Concurrent medical conditions included Sleep disorder NOS. Concomitant products included ALPRAZOLAM (XANAX) for Sleep disorder. On 16-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 15-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 23-Dec-2021, the patient experienced SWELLING OF EYELID (Her lower eyelid and it was swollen). On 28-Dec-2021, SWELLING OF EYELID (Her lower eyelid and it was swollen) had resolved. When patient woke up on 23-Dec-2021, she touched her lower eyelid, and it was swollen. She did not do anything besides soak it. The next day it was worse. she went to the doctor, but the doctor did not help much. she couldn''t see it anymore, so she didn''t think much of it. This case was linked to MOD-2021-435971 (Patient Link).


VAERS ID: 2000461 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067H21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: Patient came for appointment to get a booster of Moderna. Technician administered vaccine dose from a vial that was left over night at room temp. It was punctured on 12/22/21 at 9:33am therefore patient received dose from vial that was 25 hours after first punctured. Manufacture was contacted for further guidance. They responded that lot number was tested against covid activity for past time excursion and it still held protection activity for covid. pt was made aware and will not received additional dose.


VAERS ID: 2001110 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-24
Onset:2021-12-23
   Days after vaccination:274
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21A / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal distension, Acute respiratory failure, Alanine aminotransferase normal, Anion gap, Anticoagulant therapy, Aortic stenosis, Arthralgia, Arthritis, Aspartate aminotransferase normal, Asthenia, Atrial fibrillation, Back pain, Bacteraemia, Balance disorder, Blood albumin decreased, Blood alkaline phosphatase normal, Blood bicarbonate normal, Blood bilirubin increased, Blood calcium decreased, Blood calcium increased, Blood chloride normal, Blood creatine increased, Blood glucose normal, Blood potassium normal, Blood sodium normal, Blood urea increased, Breath sounds abnormal, C-reactive protein increased, COVID-19, COVID-19 pneumonia, Cardiomyopathy, Chest X-ray normal, Chronic kidney disease, Chronic obstructive pulmonary disease, Computerised tomogram thorax normal, Condition aggravated, Contusion, Cubital tunnel syndrome, Diabetic neuropathy, Diabetic vascular disorder, Dry age-related macular degeneration, Dyspnoea, Dyspnoea exertional, Dysstasia, Essential hypertension, Exposure to SARS-CoV-2, Fall, Fatigue, Fibrin D dimer normal, Gait disturbance, Gastrooesophageal reflux disease, Glaucoma, Glomerular filtration rate decreased, Haematocrit decreased, Haemoglobin decreased, Hyperlipidaemia, Hypertension, Hypogonadism male, Hypophagia, Hypothyroidism, Hypoxia, Insulin-requiring type 2 diabetes mellitus, International normalised ratio, Lumbar radiculopathy, Mean cell volume normal, Mechanical ventilation, Metabolic encephalopathy, Metabolic function test abnormal, Mitral valve stenosis, Muscular weakness, Musculoskeletal chest pain, Neutrophil count normal, Obesity, Oedema peripheral, Platelet count decreased, Polyneuropathy, Protein total decreased, Pulmonary mass, Pulmonary oedema, Rash, Red blood cell count decreased, Respiratory distress, SARS-CoV-2 test positive, Sleep apnoea syndrome, Spinal osteoarthritis, Streptococcal sepsis, Use of accessory respiratory muscles, Vertigo positional, Vitamin D deficiency, Walking aid user, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Dyslipidaemia (narrow), Haematopoietic erythropenia (narrow), Haematopoietic thrombocytopenia (narrow), Peripheral neuropathy (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (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), Parkinson-like events (broad), Acute central respiratory depression (narrow), Biliary system related investigations, signs and symptoms (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (narrow), Hypertension (narrow), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Retinal disorders (narrow), Hypothyroidism (narrow), Vestibular disorders (narrow), Lipodystrophy (broad), Fertility disorders (narrow), Chronic kidney disease (narrow), Hypersensitivity (narrow), Arthritis (narrow), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (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? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen 1,300 mg Oral 2 times daily, 1,300mg = 2 tablets Albuterol Sulfate 108 (90 Base) MCG/ACT 2 puffs Inhalation Every 4 hours PRN Amoxicillin 1,000 mg Oral 3 times daily Atorvastatin Calcium 10 mg Oral Every morning Cholestyramine
Current Illness: hospitalized 11/8-11/14/21 for sepsis/GBS bacteremia - returned to hospital after fall 11/15/21, then d/c''d to sub acture rehab
Preexisting Conditions: Pre-Existing Active Problems Diagnosis Date Noted POA ? Weakness 11/09/2021 ? Acute metabolic encephalopathy 11/09/2021 ? Platelets decreased 11/08/2021 ? Early dry stage nonexudative age-related macular degeneration of both eyes 05/24/2021 ? Rash 05/17/2021 ? Chronic obstructive pulmonary disease, unspecified 03/10/2021 ? Gait disturbance 02/13/2021 ? Essential hypertension 02/13/2021 ? Stage 3 chronic kidney disease 01/01/2021 ? Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene 01/01/2021 ? Chronic right-sided thoracic back pain 12/07/2020 ? Poor balance 12/07/2020 ? Multiple lung nodules 12/07/2020 ? Mitral stenosis 10/08/2020 ? Dyspnea on minimal exertion 09/23/2020 ? Cubital tunnel syndrome of both upper extremities 06/29/2020 ? At high risk for injury related to fall 06/15/2020 ? Polyneuropathy 06/02/2020 ? Aortic stenosis 06/25/2019 ? Chronic anticoagulation 06/07/2019 ? Chronic atrial fibrillation 04/19/2019 ? Morbid obesity 05/29/2017 ? Frequent falls 12/22/2016 ? Glaucoma 07/31/2016 ? Hypothyroidism, unspecified type 07/26/2016 ? Benign paroxysmal positional vertigo, unspecified laterality 05/13/2015 ? Osteoarthritis of spine with radiculopathy, lumbar region 05/13/2015 ? Cardiomyopathy, nonischemic 08/13/2014 ? Hypogonadism male 04/30/2013 ? OSA (obstructive sleep apnea) 06/21/2012 ? GERD (gastroesophageal reflux disease) 06/21/2012 ? Vitamin D deficiency 04/25/2012 ? Arthritis ? Hyperlipidemia ? Hypertension ? Type 2 diabetes mellitus with diabetic polyneuropathy, with long-term current use of insulin ? Atrial fibrillation 07/26/2011
Allergies: Allergen Reactions ? Simvastatin [Hmg-Coa-R Inhibitors] Myalgia zocor ? Ace Inhibitors Cough ? Amoxicillin Rash
Diagnostic Lab Data: Lab Results Component Value Date WBC 8.20 12/23/2021 RBC 4.30 (L) 12/23/2021 HGB 13.0 (L) 12/23/2021 HCT 39.4 (L) 12/23/2021 MCV 91.6 12/23/2021 PLATELET 140 12/23/2021 NEUTABSOLU 5.85 12/23/2021 Lab Results Component Value Date GLUCOSE 123 (H) 12/23/2021 SODIUM 140 12/23/2021 POTASSIUM 4.4 12/23/2021 CHLORIDE 103 12/23/2021 ANIONGAP 10 12/23/2021 BUN 16 12/23/2021 CREATININE 1.59 (H) 12/23/2021 CALCIUM 8.7 12/23/2021 TOTALPROTE 6.6 12/23/2021 ALBUMIN 2.9 (L) 12/23/2021 ALKALINEPH 81 12/23/2021 AST 16 12/23/2021 ALT 10 12/23/2021 BILIRUBINT 1.2 (H) 12/23/2021 EGFR 42 (L) 12/23/2021 Comprehensive Metabolic Panel (CMP) (Abnormal) Collected: 12/25/21 0609 Order Status: Completed Specimen: Blood, Venous Updated: 12/25/21 0656 Sodium Level 141 134 - 146 mmol/L Potassium Level 4.4 3.4 - 5.0 mmol/L Chloride 105 98 - 112 mmol/L HCO3 27 21 - 29 mmol/L Anion Gap 9 9 - 18 mmol/L Glucose Level 193 High 70 - 99 mg/dL Blood Urea Nitrogen 29 High 8 - 20 mg/dL Creatinine 1.46 High 0.60 - 1.30 mg/dL MDRD eGFR 46 Low $g=60 mL/min/1.73 m2 CG eCrCl 38 mL/min/1.73 m2 Calcium Level Total 8.9 8.6 - 10.4 mg/dL Protein Total 6.3 6.0 - 8.0 g/dL Albumin Level 2.8 Low 3.5 - 5.0 g/dL Bilirubin Total 1.1 High 0.2 - 1.0 mg/dL Alkaline Phosphatase 71 40 - 129 IU/L Alanine Aminotransferase 11 10 - 40 IU/L Aspartate Aminotransferase 20 10 - 40 IU/L C Reactive Protein (CRP), Blood Level (Abnormal) Collected: 12/25/21 0609 Order Status: Completed Specimen: Blood, Venous Updated: 12/25/21 0656 C-Reactive Protein 25.9 High <=5.0 mg/L D-Dimer (Normal) Collected: 12/25/21 0608 Order Status: Completed Specimen: Blood, Venous Updated: 12/25/21 0645 D-Dimer Quant 260 0 - 500 ng/mL FEU
CDC Split Type:

Write-up: Hospitalized (12.23.21 - 12.26.21); COVID-19 positive (12.23.21); Fully vaccinated -moderna x2 d/c summary: Discharge Summary MD (Physician) ? ? General Medicine BRIEF OVERVIEW: Discharge Provider: MD Primary Care Provider: DO Admission Date: 12/23/2021 Discharge Date: 12/26/2021 Active Hospital Problems Diagnosis Date Noted POA ? COVID 12/23/2021 Unknown Discharge Disposition: home health care svc Active Issues Requiring Follow-up: - Recommend follow-up your primary care physician to ensure continued clinical improvement. - Recommend continue working with home healthcare services to improve strengthening of the lower extremities. - Recommend continued use of as-needed oxygen at rest or with activity. Is recommended patient continue to isolate, wear masks for total of 10 days from symptom onset. Pending Labs Order Current Status Peripheral Blood Culture Preliminary result Peripheral Blood Culture Preliminary result DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypoxia [R09.02] Generalized weakness [R53.1] COVID-19 virus infection [U07.1] COVID [U07.1] HOSPITAL COURSE: 84-year-old man with history of chronic atrial fibrillation on Coumadin, nonischemic cardiomyopathy, chronic obstructive pulmonary disease, CKD who was recently admitted for GBS bacteremia and have completed antibiotics course in SAR. He has been home for 2 weeks. He has been weak since returning home. Patient did have a fall 2 weeks ago upon returning home, where he reports his legs gave out while walking with his walker and he landed on his buttock and right side. He has had pain in the right posterior ribs and right shoulder. He denies any head injury or loss of consciousness. At that time, he was able to stand with assistance after the fall. Patient had a repeat fall today walking with his walker. He states his legs again gave out and he landed on his buttock. He again denies any head injury or loss of consciousness. The patient is fully vaccinated with Moderna but overdue for booster. Patient''s son is COVID-19 positive, and is in quarantine in the front of the house. In the ED, he tested positive for COVID. Desats 87% with activity. CXR negative. He received Decadron and 1 L of Saline due to low po intake. Unfortunately his O2 needs increased to 6L upon arrival at BL While at Facility the patient continued to improve. Required no more than 4 L nasal cannula eventually requiring only 2 L at rest and with activity. Patient remained afebrile normotensive and continue to hemodynamically improved. Recommend patient follow up with his PCM within 3-5 days of discharge. CONSULTS / RECOMMENDATION: Consult Orders (From admission, onward) None INPATIENT PROCEDURES: Surgery and Procedures None Non-surgical Procedures (From admission, onward) None BP 139/72 | Pulse 97 | Temp 37 ?C (Oral) | Resp 18 | Ht 1.753 m | Wt 128 kg | SpO2 93% Comment: ambulating | BMI 41.67 kg/m? Physical Exam Vitals and nursing note reviewed. Constitutional: Appearance: He is well-developed. HENT: Head: Normocephalic and atraumatic. Eyes: Conjunctiva/sclera: Conjunctivae normal. Cardiovascular: Rate and Rhythm: Normal rate and regular rhythm. Heart sounds: No murmur heard. Pulmonary: Effort: Pulmonary effort is normal. No respiratory distress. Breath sounds: Normal breath sounds. No wheezing or rhonchi. Abdominal: Palpations: Abdomen is soft. Tenderness: There is no abdominal tenderness. Musculoskeletal: Cervical back: Neck supple. Skin: General: Skin is warm and dry. Neurological: Mental Status: He is alert. H&P: CHIEF COMPLAINT: COVID Assessment/Plan ASSESSMENT / PLAN: Acute respiratory failure with hypoxemia due to COVID Pneumonia Severe COVID Pneumonia Fully vaccinated with Moderna but have not received Booster yet Exposed to COVID Positive son Was on RA and only desats with Activity in the ED but Now on 6L of O2 S/p 1 L of IVF I suspect Pulmonary edema may play a role in his sudden increased in O2 needs Will repeat another CXR now Will give 40 of Lasix IV NOW Continue Decadron 6 mg daily Unclear how long he has been symptomatic and with is underlying CkD, will hold off Remdesivir Continue Aggressive pulmonary Hygiene, prone ventilation Isolation per protocol Recurrent Falls No syncope or head trauma CT Thorax without contrast no acute trauma in the chest Likely due to generalized weakness from COVID PT/OT Check Orthostat when able Recent admit for GBS bacteremia 11/15/2021 Completed Abx course at Rehab CKD 3a Cr close to baseline Will strive to avoid nephrotoxic agents and dose meds per GFR Chronic A fib on Coumadin Mitral and Aortic stenosis INR therapeutic Daily INR Continue home coumadin dosing DM II Will start lantus and sliding scale insulin On High dose Toujeo and sliding at home Monitor POC glc per protocol Update A 1c HLD Continue Statin NICM without angina Resume home Torsemide 20 mg bid Continue Lisinopril, statin OSA GERD PPI Hypothyroidism Synthroid HTN Continue Lisinopril Morbid Obesity Will encourage weight loss BMI of 39.56 DVT prophy on Coumadin FULL CODE HISTORY OF PRESENT ILLNESS: The patient is an 84-year-old man with history of chronic atrial fibrillation on Coumadin, nonischemic cardiomyopathy, chronic obstructive pulmonary disease, CKD who was recently admitted for GBS bacteremia and have completed antibiotics course in SAR. He has been home for 2 weeks. He has been weak since returning home. Patient did have a fall 2 weeks ago upon returning home, where he reports his legs gave out while walking with his walker and he landed on his buttock and right side. He has had pain in the right posterior ribs and right shoulder. He denies any head injury or loss of consciousness. At that time, he was able to stand with assistance after the fall. Patient had a repeat fall today walking with his walker. He states his legs again gave out and he landed on his buttock. He again denies any head injury or loss of consciousness. The patient is fully vaccinated with Moderna but overdue for booster. Patient''s son is COVID-19 positive, and is in quarantine in the front of the house. In the ED, he tested positive for COVID. Desats 87% with activity. CXR negative. He received Decadron and 1 L of Saline due to low po intake. Unfortunately his O2 needs increased to 6L upon arrival at BL. Patient Active Problem List Diagnosis ? Atrial fibrillation ? Arthritis ? Hyperlipidemia ? Hypertension ? Type 2 diabetes mellitus with diabetic polyneuropathy, with long-term current use of insulin ? Vitamin D deficiency ? OSA (obstructive sleep apnea) ? GERD (gastroesophageal reflux disease) ? Hypogonadism male ? Cardiomyopathy, nonischemic ? Benign paroxysmal positional vertigo, unspecified laterality ? Osteoarthritis of spine with radiculopathy, lumbar region ? Hypothyroidism, unspecified type ? Glaucoma ? Frequent falls ? Morbid obesity ? Chronic atrial fibrillation ? Chronic anticoagulation ? Aortic stenosis ? Polyneuropathy ? At high risk for injury related to fall ? Cubital tunnel syndrome of both upper extremities ? Dyspnea on minimal exertion ? Mitral stenosis ? Chronic right-sided thoracic back pain ? Poor balance ? Multiple lung nodules ? Gait disturbance ? Essential hypertension ? Chronic obstructive pulmonary disease, unspecified ? Stage 3 chronic kidney disease ? Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene ? Rash ? Early dry stage nonexudative age-related macular degeneration of both eyes ? Platelets decreased ? Weakness ? Acute metabolic encephalopathy ? COVID Review of Systems Constitutional: Positive for fatigue. Negative for chills and fever. HENT: Negative for sore throat. Eyes: Negative for visual disturbance. Respiratory: Positive for shortness of breath. Negative for cough, wheezing, chest tightness and sputum production. Cardiovascular: Negative for chest pain, palpitations, leg swelling and PND. Gastrointestinal: Negative for nausea, vomiting, abdominal pain, constipation and diarrhea. Genitourinary: Negative for dysuria, polyuria and urgency. Musculoskeletal: Negative for back pain. Neurological: Negative for headaches, dizziness, light-headedness, loss of consciousness, numbness/tingling and weakness. Endo/Heme/Allergy: Negative for adenopathy. Psychiatric/Behavioral: Negative for depression. Skin: Negative for rash. Objective OBJECTIVE: BP (!) 153/106 | Pulse 128 | Temp 36.8 ?C (Oral) | Resp 28 | Wt 121.5 kg Comment: Simultaneous filing. User may not have seen previous data. | SpO2 95% | BMI 39.56 kg/m? Physical Exam Vitals and nursing note reviewed. Constitutional: General: He is in acute distress. HENT: Head: Normocephalic and atraumatic. Mouth/Throat: Mouth: Mucous membranes are moist. Eyes: Conjunctiva/sclera: Conjunctivae normal. Neck: Vascular: No JVD. Cardiovascular: Rate and Rhythm: Normal rate and regular rhythm. Heart sounds: Normal heart sounds. No murmur heard. Comments: No peripheral edema and JVD Pulmonary: Effort: Respiratory distress present. Breath sounds: No wheezing or rales. Comments: Diminished BS with mild accessory muscle use Chest: Chest wall: No tenderness. Abdominal: General: Bowel sounds are normal. There is distension. Palpations: Abdomen is soft. Tenderness: There is no abdominal tenderness. There is no rebound. Musculoskeletal: General: No tenderness. Normal range of motion. Cervical back: Normal range of motion and neck supple. Right lower leg: Edema (1+) present. Left lower leg: Edema (1+) present. Comments: Bruises on the skin Skin: General: Skin is warm and dry. Neurological: Mental Status: He is alert and oriented to person, place, and time. Deep Tendon Reflexes: Reflexes normal. Comments: None focal Psychiatric: Mood and Affect: Mood normal.


VAERS ID: 2001277 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-14
Onset:2021-12-23
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 2 LA / IM

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

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

Write-up: Tested Positive for Covid


VAERS ID: 2001423 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-09
Onset:2021-12-23
   Days after vaccination:75
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 3 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Aspiration, C-reactive protein increased, COVID-19, Colon adenoma, Colonoscopy abnormal, Fibrin D dimer increased, Hyperchlorhydria, Hypoxia, Infection, Large intestine polyp, Pneumonia, Pneumonia aspiration, Pyrexia, SARS-CoV-2 test positive, Vomiting, White blood cell count increased
SMQs:, Acute pancreatitis (broad), Asthma/bronchospasm (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal premalignant disorders (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific inflammation (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (narrow), 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? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ARIPiprazole (ABILIFY) 5 MG tablet atorvastatin (LIPITOR) 40 MG tablet buPROPion (WELLBUTRIN XL) 150 MG 24 hr tablet buPROPion (WELLBUTRIN XL) 300 MG 24 hr tablet cholecalciferol (VITAMIN D3) 50 MCG (2000 UT) tablet escitalopram (LEXAPRO) 1
Current Illness: 12.23.21: Colonoscopy. 1 of the polyps was adenomatous. Recommend repeat colonoscopy in 5 years
Preexisting Conditions: NA
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized (12.23.21); COVID-19 positive (12.23.21); Fully vaccinated plus booster Admission Date: 12/23/2021 Discharge Date: 12/24/2021 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Aspiration pneumonia of both lungs due to gastric secretions, unspecified part of lung COVID-19 Aspiration pneumonia of left lower lobe due to vomit HOSPITAL COURSE: Patient is a 51 y.o. female who presents today with acute hypoxemia and aspiration pneumonia. Patient had elective colonoscopy done earlier today. Following the procedure she was acutely hypoxemic requiring 5 L of oxygen. She had been totally asymptomatic prior to this procedure in regards to any respiratory symptoms or COVID symptoms. COVID test was done after procedure and was noted to be positive. Patient is fully vaccinated and has had booster. In the emergency department it was noted that she had elevated dimer so CT angiogram was done which revealed evidence of left lower lobe pneumonia indicative of likely aspiration pneumonia. Decision was made to admit patient to inpatient this time. She is placed on IV Rocephin and oral doxycycline at this time. Continue supplemental oxygen. Placed on oral Decadron. She was not placed on remdesivir at this time. Overnight patient''s clinical condition improved. She was transitioned to room air as maintain adequate oxygen saturations on room air. Patient has mild increase in white blood cell count overnight but most likely secondary to receiving a dose of Decadron. Fevers have improved. Since infection is most likely secondary to aspiration patient will be discharged on a 5 day course of antibiotic. With elevated D-dimer and markedly elevated CRP patient will complete a full course of Decadron. Patient has been instructed to hold her estrogen replacement therapy in till follows up with primary care physician. She was also instructed to isolate for 10 days. Around other people patient should wear a mask. Patient also instructed if she has worsening shortness of breath especially with activity feels her clinical condition is deteriorating anyway she should return to the emergency department immediately for further evaluation.


VAERS ID: 2001475 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-12-17
Onset:2021-12-23
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Covid positive contact unknown


VAERS ID: 2001647 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 6188797 / 1 RA / SYR

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

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: n/a
Current Illness: n/a
Preexisting Conditions: Mixed Connective Tissue Disease
Allergies: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Can not hear out of the left ear and strong ringing sound


VAERS ID: 2001671 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-10
Onset:2021-12-23
   Days after vaccination:257
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Alanine aminotransferase normal, Albumin globulin ratio normal, Anion gap, Aspartate aminotransferase normal, Blood albumin decreased, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood calcium decreased, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood potassium normal, Blood sodium normal, Blood urea normal, Bronchoscopy abnormal, C-reactive protein increased, COVID-19, Carbon dioxide normal, Chest X-ray abnormal, Computerised tomogram thorax abnormal, Crystal urine present, Dyspnoea, Dysuria, Feeling cold, Globulin, Glomerular filtration rate normal, Haematocrit decreased, Haemoglobin decreased, Haemoptysis, Hot flush, Illness, Immunosuppression, Leukopenia, Lung infiltration, Mean cell volume increased, Menopausal symptoms, Neutrophil count, Platelet count normal, Pneumonia, Pneumonia bacterial, Protein total normal, Pyrexia, Red blood cell count decreased, SARS-CoV-2 test positive, Urine analysis, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (narrow), 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? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: azaTHIOprine (Imuran) 50 mg tablet ? b complex vitamins capsule Take 1 capsule by mouth once daily ? budesonide-formoteroL (Symbicort) 160-4.5 mcg/actuation inhaler Inhale 2 puffs into the lungs 2 (two) times daily 1 each 11 ? esomeprazo
Current Illness:
Preexisting Conditions: Diagnosis ? Medullary sponge kidney ? Abnormal Pap smear ? HPV (human papilloma virus) anogenital infection ? Anxiety ? Deviated nasal septum ? Bulging disc ? Left leg pain ? Sural neuritis ? Microscopic polyangiitis ? Vasculitis ? Rheumatoid factor positive ? ANCA-associated vasculitis ? Granulomatosis ? Neuropathic pain ? Tracheal stenosis ? Plantar fasciitis ? Pinched nerve ? Pain of right heel ? Pneumonia ? Pneumonitis
Allergies: methotrexate - pulmonary toxicity estradiol - soreness in the area of the patch muscle relaxants - nervous/anxious oxycodone-acetaminophen - itching
Diagnostic Lab Data: Lab Results Component Value Date WBC 5.26 12/23/2021 RBC 3.58 (L) 12/23/2021 HGB 10.9 (L) 12/23/2021 HCT 34.1 (L) 12/23/2021 MCV 95.3 12/23/2021 PLATELET 294 12/23/2021 NEUTABSOLU 4.91 12/23/2021 Lab Results Component Value Date GLUCOSE 111 (H) 12/23/2021 SODIUM 139 12/23/2021 POTASSIUM 4.8 12/23/2021 CHLORIDE 103 12/23/2021 TOTALCO2 24 07/07/2020 ANIONGAP 12 12/23/2021 BUN 11 12/23/2021 CREATININE 0.77 12/23/2021 CALCIUM 8.8 12/23/2021 TOTALPROTE 6.7 12/23/2021 ALBUMIN 3.1 (L) 12/23/2021 GLOBULIN 2.4 07/07/2020 AGRATIO 1.8 07/07/2020 ALKALINEPH 64 12/23/2021 AST 21 12/23/2021 ALT 19 12/23/2021 BILIRUBINT 0.3 12/23/2021 EGFR $g60 12/23/2021
CDC Split Type:

Write-up: Hospitalized (12.23.21 - 12.27.21); COVID-19 positive (12.23.21); Fully vaccinated - J&J x1 D/c summary: Discharge Summary MD (Physician) ? ? General Medicine BRIEF OVERVIEW: Discharge Provider: MD Primary Care Provider: NP Admission Date: 12/23/2021 Discharge Date: Dec 27, 2021 Active Hospital Problems Diagnosis Date Noted POA ? COVID-19 virus infection 12/25/2021 Yes ? Fever in adult 12/25/2021 Yes ? Pulmonary infiltrates 12/23/2021 Yes Resolved Hospital Problems No resolved problems to display. Pre-Existing Active Problems Diagnosis Date Noted POA ? Abnormal CT of the chest 10/14/2021 Unknown ? Granulomatosis with polyangiitis 03/09/2018 Unknown ? Microscopic polyangiitis 02/07/2018 Unknown ? Tracheal stenosis 02/07/2018 Unknown ? LPRD (laryngopharyngeal reflux disease) 11/29/2017 Unknown Discharge Disposition: home or self care DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pulmonary infiltrates [R91.8] Hemoptysis [R04.2] Immunosuppressed status [D84.9] Fever, unspecified fever cause [R50.9] COVID-19 virus infection [U07.1] HOSPITAL COURSE: Patient is a vaccinated (J&J 4/10/21, no booster) and immune suppressed 51 yo woman who was admitted to Hospital with fever and shortness of breath. She was sent to the hospital from her Rheumatologist''s office, Dr., during a visit for a second dose of rituximab; he and staff advised she present to the emergency department after report of ongoing fever at which point she was admitted. She carries dx of complex tracheal stenosis (hx dilation w/ mitomycin and Kenalog) and microscopic polyangiitis, ANCA-associated vasculitis, for which she has been working with Rheumatology, Dr., and taking Imuran, recent steroid, and recent first dose of Rituximab. She arrived taking oral estrogen for menopausal symptoms. Fever persisted for most of her stay, typically in the early morning hours around 4-6 AM with her last recorded fever at 12/26/21 AM, the day prior to discharge. Her shortness of breath was mild, O2 saturations remained at 90 and above, and supplemental oxygen was never used but her CXR w/ mild pulmonary infiltrates were noted a negative nasal swab source for Covid PCR, but was positive on BAL from bronchoscopy 12/23/21. No diffuse alveolar hemorrhage (DAH) was confirmed by bronch so infiltrates were though possibly due to Covid pneumonia. She was given prednisone 20 mg daily, an increase from recent start of 15 mg daily for her vasculitis. Symptom start of most current fever and sense of illness was 12/19/21 based on her calendar, and was distinct from prior once monthly fevers since summer 2021. Pulmonology recommended monoclonal antibody which was arranged 12/25/21. ID weighed in and did not express confidence infection was the reason for fevers over past 6 mos, that it is possible recent sx are from Covid infection. It was recommended: o she have COVID-19 antibody levels collected in approximately 3 months to determine if she developed nuclear capsid antibodies following this infection. o She should receive at least 1 booster vaccine, preferably mRNA vaccine either Pfizer or Moderna. She will need to wait at least 90 days after her monoclonal antibody infusion before booster vaccine can be given. o If she does not develop antibodies following her current infection, she may be a candidate for prophylactic monoclonal antibody administration. Her immunologist can contact the Infectious Disease office or the monoclonal antibody infusion clinic at that time to determine if there are any clinical trials that would be beneficial for this patient. These recommendations were provided in writing in her DC material for her reference. Dr., her Rheumatologist, then weighed in and recommended continued HOLD on Imuran at discharge and wanted her to be, 1) 2-3 weeks out from antibiotic treatment for possible bacterial pneumonia, and 2) feeling well. CRP was high on admission and it was not clear if this was a useful measure in the setting of chronic inflammation. Rocephin and azithro empiric for CAP to be completed orally if discharged CAP tx was completed in hospital but her probability of bacterial pneumonia was in question. Leukopenia resolved during her stay, with hold on Imuran, despite Covid infection, etc. Bactrim PJP ppx, Hydroxychloroquine, Valtrex, Lyrica and PPI continued Hot flashes from acute-onset menopause due to HOLD on oral estrogen in setting of Covid infection (indication to avoid adding to any hypercoagulable state from Covid infection). She was able to tell the difference between hot flashes and illness, especially fever given she got cold with fever, not hot. Dysuria had been intermittent per her report. UA 12/22/21 contained calcium oxalate crystals, and neither this nor a second collection 12/23/21 contained support for infection. Had there been infection, abx for CAP would likely have offered coverage. She discharged home 12/27/21 feeling well compared to prior (but we appreciate she had not suffered fever the morning of discharge) with plan to follow up with her Rheumatologist. A leukemia / lymphoma w/u was pending at discharge and will require follow-up Prednisone was to resume at dose prior to admission, 15 mg daily. She has had close follow-up since admission with her Rheumatologist, Dr. and plans to f/u after discharge CONSULTS: Pulmonology Infectious Disease Rheumatology by phone PROCEDURES: Bronchoscopy 12/23/21 BP 113/73 | Pulse 73 | Temp 36.6 ?C (Oral) | Resp 22 | Ht 1.651 m | Wt 80 kg | SpO2 97% Comment: back in bed | BMI 29.35 kg/m? Physical Exam Constitutional: General: She is not in acute distress. HENT: Nose: Nose normal. Eyes: Extraocular Movements: Extraocular movements intact. Pupils: Pupils are equal, round, and reactive to light. Cardiovascular: Rate and Rhythm: Normal rate and regular rhythm. Pulmonary: Effort: Pulmonary effort is normal. No respiratory distress. Breath sounds: Normal breath sounds. Abdominal: General: Bowel sounds are normal. There is no distension. Palpations: Abdomen is soft. Tenderness: There is no abdominal tenderness. Musculoskeletal: Right lower leg: No edema. Left lower leg: No edema. Skin: General: Skin is warm and dry. Neurological: General: No focal deficit present. Mental Status: She is alert. Mental status is at baseline. Cranial Nerves: No cranial nerve deficit. Psychiatric: Mood and Affect: Mood normal. Behavior: Behavior normal. Thought Content: Thought content normal. Judgment: Judgment normal.


VAERS ID: 2001702 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-12-22
Onset:2021-12-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 330288D / 3 AR / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Heart rate increased, Pyrexia, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D, Levothyroxine, Vascepa (fish oil), Vitamin B12, Calm Magnesium powder
Current Illness: None
Preexisting Conditions: Back and shoulder pain, fatigue
Allergies: Lactose intolerant
Diagnostic Lab Data: I went to urgent care and was given saline with anti inflammatory and anti nausea medication in it. My heart rate slowly went back to normal over the next 2 days.
CDC Split Type:

Write-up: I felt feverish and had a headache after my booster of Pfizer. The next day, I was napping a lot. I woke up from a nap and my fitness device said I had been exercising and reported high heart rate. My heart rate was high (around 135) for about 4 hours from 1PM ET to 5PM ET.


VAERS ID: 2001946 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-17
Onset:2021-12-23
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / N/A LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Acne, Dysmenorrhoea, Heavy menstrual bleeding, Menstruation delayed, Mood swings, Vaginal odour
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Dementia (broad), Depression (excl suicide and self injury) (broad), Fertility 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: Bupropion, venlafaxine
Current Illness: None
Preexisting Conditions: Mild Depression
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: First menstrual cycle post vaccination was late and then extremely heavy and long. Also noted change in menstrual cycle symptoms that previously were not experienced; cramping, acne and mood swings. Husband additionally noted and stated within days of dosing vaginal scent changed and had increased odor compared to previous.


VAERS ID: 2002008 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Alabama  
Vaccinated:0000-00-00
Onset:2021-12-23
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H21A / 3 LA / SC

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect route of product administration
SMQs:, Drug abuse and dependence (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: None at the time of vaccination and it has not been a month
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: None reported


VAERS ID: 2002026 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H21A / 3 LA / SC

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, No adverse event, Product storage error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: No illness reported at the time of vaccination and it has not been a month since event
Preexisting Conditions: Atrial fibrillation, Osteoarthritis, hyperlipidemia
Allergies: Metformin - GI intolerance
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Administered a covid vaccine past 24 hours past beyond use date. Patient received a covid vaccine that was stored at room temperature ~ 36 hours after first puncture, No adverse effect reported,


VAERS ID: 2002084 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS - / 1 RA / IM

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

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

Write-up: patient was 17 years 6 months old and was given Moderna vaccine instead of Pfizer Vaccine


VAERS ID: 2002715 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: California  
Vaccinated:2021-12-22
Onset:2021-12-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1622 / 3 - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Headache, Heart rate increased, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 2nd dose of pfizer vaccine- fever up to 102f, headache and chills for 1 day.
Other Medications: levothyroxin 25mcg
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: no
CDC Split Type:

Write-up: chills, fever up to 102, body ache started at 3.30 am. Heart rate increased to 124bpm in the morning at 7am. HR in relaxed state remained more than 100 throughout the day, in 80-90s the next day and below 70s on 3rd day. Fever lasted for a day. Headache and body ache for 2 days.


VAERS ID: 2005528 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-28
Onset:2021-12-23
   Days after vaccination:239
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Covid positive contact unknown


VAERS ID: 2005535 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211021A / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Headache, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Headache and nausea began within a few hours of vaccination and persisted for approximately 36 hours before resolving. The following day fatigue set in and this has persisted to this day, 2 weeks later. The fatigue is present despite sleeping at least 7 hours a night regularly and 10 hours a night for several nights in the past 2 weeks when able. Headaches have been occurring regularly with headaches on approximately 50% of days since vaccination which is abnormal for me,


VAERS ID: 2005551 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-03
Onset:2021-12-23
   Days after vaccination:323
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Covid positive


VAERS ID: 2005559 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Product storage error
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 RECEIVED AN EXPIRED DOSE OF THE PFIZER BOOSTER VACCINE.


VAERS ID: 2005568 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Product storage error
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 RECEIVED AN EXPIRED DOSE OF THE PFIZER BOOSTER VACCINE.


VAERS ID: 2005598 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-10
Onset:2021-12-23
   Days after vaccination:257
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, Alanine aminotransferase increased, Anion gap, Aspartate aminotransferase, Blood albumin decreased, Blood alkaline phosphatase normal, Blood bicarbonate, Blood bilirubin normal, Blood calcium decreased, Blood chloride decreased, Blood creatinine normal, Blood glucose normal, Blood potassium decreased, Blood sodium decreased, Blood urea increased, Blood urea normal, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Creatinine renal clearance decreased, Dehydration, Diarrhoea, Disorientation, Escherichia infection, Fatigue, Glomerular filtration rate normal, Hypoxia, Lethargy, Lung disorder, Lung opacity, Malaise, Protein total decreased, SARS-CoV-2 test positive, Tachypnoea, Urinary tract infection, Vomiting, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (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), Dementia (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (narrow), Hypokalaemia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin 81 MG EC tablet atorvastatin (LIPITOR) 40 MG tablet donepezil (ARICEPT) 10 MG tablet hydroCHLOROthiazide (HYDRODIURIL) 25 MG tablet losartan (COZAAR) 25 MG tablet metoprolol succinate-XL (TOPROL-XL) 50 MG 24 hr tablet multivitamin w
Current Illness:
Preexisting Conditions: Past Medical History: Diagnosis Date ? Benign tumor of blood vessel ? Chronic lymphocytic leukemia (HCC) 3/22/2020 ? Heart attack (HCC) ? Sarcoptosis CAD d/t lipid rich plaque HTN major neurocognitive disorder anxiety
Allergies: No known allergies
Diagnostic Lab Data: Comprehensive Metabolic Panel (CMP) [361369052] (Abnormal) Collected: 01/04/22 1327 Order Status: Completed Specimen: Blood, Venous Updated: 01/04/22 1413 Sodium Level 134 134 - 146 mmol/L Potassium Level 3.1 Low 3.4 - 5.0 mmol/L Chloride 97 Low 98 - 112 mmol/L HCO3 26 21 - 29 mmol/L Anion Gap 11 9 - 18 mmol/L Glucose Level 157 High 70 - 99 mg/dL Blood Urea Nitrogen 13 8 - 20 mg/dL Creatinine 0.63 0.50 - 1.10 mg/dL MDRD eGFR $g60 $g=60 mL/min/1.73 m2 CG eCrCl 62 mL/min/1.73 m2 Calcium Level Total 8.4 Low 8.6 - 10.4 mg/dL Protein Total 5.0 Low 6.0 - 8.0 g/dL Albumin Level 1.8 Low 3.5 - 5.0 g/dL Bilirubin Total 0.9 0.2 - 1.0 mg/dL Alkaline Phosphatase 52 35 - 104 IU/L Alanine Aminotransferase 44 High 10 - 40 IU/L Aspartate Aminotransferase 39 10 - 40 IU/L DR CHEST SINGLE VIEW [361369028] Resulted: 01/01/22 1436 Order Status: Completed Updated: 01/01/22 1438 Narrative: EXAMINATION: Single View Chest EXAM DATE: 1/1/2022 12:02 PM TECHNIQUE: Single view chest INDICATION: worsening tachypnea, covid COMPARISON: 12/22/2021 ENCOUNTER: Not applicable _________________________ FINDINGS: The cardiomediastinal silhouette is stable. Diffuse patchy bilateral airspace opacities have increased, particularly on the left. No definite pleural effusion or pneumothorax is visible. _________________________ Impression: Increased patchy bilateral airspace disease.
CDC Split Type:

Write-up: Hospitalized (12.23.21 - still admitted currently); COVID-19 positive (12.22.21); Fully vaccinated - pfizer x2 - ED at HCF 12/22 H&P: Attestation signed by MD at 12/23/2021 4:40 PM I have personally interviewed and examined the patient on 12/23/2021.I agree with the documented findings and plan of care in his/her note. Brief exam: Sleeping but arousable Answers yes/no questions appropriate No increased work of breathing Brief history and medical decision making: 80 y/o vaccinated female here with COVID pna, acute hypoxic RF. Worsening oxygen needs o/n, now on HFNC. Will add remdesivir after discussion with daughter, consider increasing to IV solumedrol if no improvement. Expand All Collapse All Hide copied text Hover for details HOSPITALIST Admission History and Physical CHIEF COMPLAINT lethargy Assessment/Plan ASSESSMENT Principal Problem: Pneumonia due to COVID-19 virus Active Problems: Essential hypertension Chronic lymphocytic leukemia (HCC) Major neurocognitive disorder (HCC) Anxiety PLAN Acute hypoxic respiratory failure 2/2 Covid pneumonia O2 sat 83% on room air at home for EMS Covid + in ED 12/22 On 4L NC in ED-- now requiring 6L Symptom onset: 12/18 Vaccinated (3/17, 4/10) CXR with bilateral patchy ill-defined airspace disease Decadron 6 mg IV Prone position as able/ IS Daily covid labs Consider remdesivir - will need to discuss with daughter Vomiting Diarrhea Likely 2/2 Covid Denies abdominal pain Received 1.5L of IVF in ED Anti-emetics prn Imodium prn CLL Follows with Dr. heme/oncology WBC 31, at her baseline Monitor AKI 2/2 dehydration Cr 1.11 (baseline ~ 0.8) Received 1.5L IVF in ED Hold ACE, ARB, HCTZ Monitor Avoid nephrotoxic agents as able Essential hypertension CAD Continue toprol, ASA, statin Hold losartan, lisinopril, HCTZ Dementia Lives alone, has STM deficits Continue aricept Daughter is DPOA Anxiety Continue home zoloft Diet: Heart Healthy VTE Prophylaxis: Lovenox SubQ Code status: DNR/ DNI Above assessment and plan discussed with Dr. whose insight is reflected above. Subjective HISTORY OF PRESENT ILLNESS Patient is a 80 y.o. female with past medical history significant for anxiety, CLL, hypertension, and dementia who presented to local ED with fatigue, vomiting, and diarrhea. Patient has STM issues and information largely obtained from daughter and medical record. Patient is vaccinated for Covid (3/17, 4/10/21). She began feeling ill on 12/18 with vomiting and diarrhea. She has had increasing lethargy over the last 24 hours. She was found to be hypoxic with saturation 83% on room air at home when EMS found patient. She was placed on 4L NC in ED with improvement in oxygen saturations. Labs were notable for BUN 52, creatinine 1.11, WBC 31. She was Covid-19 positive. Chest x-ray showed bilateral patchy ill-defined airspace disease. She was given decadron 6 mg IV, zofran 4 mg IV, and 1.5 L of IVF in ED. She was transferred to another hospital. Patient Active Problem List Diagnosis ? Coronary artery disease due to lipid rich plaque ? Other hyperlipidemia ? Essential hypertension ? History of myocardial infarction ? Bilateral hearing loss, unspecified hearing loss type ? Arthritis of knee, right ? Chronic lymphocytic leukemia (HCC) ? Major neurocognitive disorder (HCC) ? Anxiety ? Pneumonia due to COVID-19 virus OBJECTIVE BP 115/59 | Pulse 76 | Temp 36.5 ?C (Oral) | Resp 20 | Ht 1.626 m | Wt 67.8 kg | SpO2 90% | BMI 25.66 kg/m? Physical Exam Constitutional: General: She is not in acute distress. Appearance: Normal appearance. HENT: Head: Normocephalic. Mouth/Throat: Mouth: Mucous membranes are dry. Pharynx: Oropharynx is clear. Eyes: Pupils: Pupils are equal, round, and reactive to light. Cardiovascular: Rate and Rhythm: Normal rate and regular rhythm. Pulses: Normal pulses. Heart sounds: Normal heart sounds. Pulmonary: Effort: Pulmonary effort is normal. No respiratory distress. Breath sounds: No wheezing. Comments: Diminished throughout Nc in nares Abdominal: General: Bowel sounds are normal. There is no distension. Palpations: Abdomen is soft. Tenderness: There is no abdominal tenderness. There is no guarding. Musculoskeletal: General: Normal range of motion. Right lower leg: No edema. Left lower leg: No edema. Skin: General: Skin is warm and dry. Neurological: General: No focal deficit present. Mental Status: She is alert. Mental status is at baseline. She is disoriented. Comments: Disoriented to month and holiday Stated she was in urgent care, thought it was Fremont Psychiatric: Comments: Calm, cooperative, pleasant 1/4/22 progress notes: CHIEF COMPLAINT: Pneumonia due to COVID-19 virus Assessment/Plan ASSESSMENT / PLAN: Principal Problem: Pneumonia due to COVID-19 virus Active Problems: Essential hypertension Chronic lymphocytic leukemia (HCC) Major neurocognitive disorder (HCC) Anxiety Moderate protein-calorie malnutrition (HCC) Acute hypoxic respiratory failure 2/2 Covid pneumonia, improving Covid + in ED 12/22 Symptom onset: 12/18 Vaccinated (3/17, 4/10). No booster CXR with bilateral patchy ill-defined airspace disease Prone position as able/IS VBG without concerns. Completed decadron/remdesivir. Wean oxygen as able E.Coli UTI -pan-sensitive -switched rocephin to keflex due to pulling out IVs -treat through 1/7 Vomiting - resolved Diarrhea - resolved Likely 2/2 Covid Denies abdominal pain Received 1.5L of IVF in ED Anti-emetics prn Imodium prn Hyperkalemia: Resolved. CLL, stable Follows with Dr. heme/onc Outpatient follow up AKI, resolved Hold ACE, ARB, HCTZ Monitor Avoid nephrotoxic agents as able Essential hypertension, soft bps CAD Continue toprol with hold parameters, ASA, statin Hold losartan, lisinopril, HCTZ Dementia with sundowning inpatient Lives alone Continue aricept Daughter is DPOA Anxiety Continue home zoloft Diet: Heart Healthy VTE Prophylaxis: Lovenox SubQ Code status: DNR/ DNI Plan to discharge to subacute rehab on 01/05/2022 if oxygen needs stabilized Subjective SUBJECTIVE: Patient has needed between 4 and 6 L of oxygen overnight. Worse with activity. Worse with sleep. She was very sleepy this a.m.. She does open eyes and communicate, but quickly falls back asleep. Blood pressure soft. Afebrile. Review of Systems Unable to perform ROS: mental status change Objective OBJECTIVE: BP (!) 105/42 | Pulse 81 | Temp 37.1 ?C (Oral) | Resp 16 | Ht 1.626 m | Wt 67.8 kg | SpO2 93% | BMI 25.66 kg/m? FIO2 (%): 45 % Physical Exam Constitutional: Appearance: She is ill-appearing. Comments: Sleepy, but arouses to voice. Quickly falls back asleep. Cardiovascular: Rate and Rhythm: Normal rate and regular rhythm. Pulmonary: Effort: No respiratory distress. Breath sounds: Normal breath sounds. No wheezing or rales. Abdominal: General: There is no distension. Palpations: Abdomen is soft. Tenderness: There is no abdominal tenderness. Musculoskeletal: Right lower leg: No edema. Left lower leg: No edema. Skin: General: Skin is warm and dry. Neurological: Mental Status: She is alert and oriented to person, place, and time. Cranial Nerves: No cranial nerve deficit.


VAERS ID: 2005608 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-12-22
Onset:2021-12-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Neck pain, Oropharyngeal pain
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (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:
Current Illness:
Preexisting Conditions:
Allergies: Amoxicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore throat inside and out 12/22-1/1/22 Fatigue 12/23-1/5/22


VAERS ID: 2005805 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / 3 LA / 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient presented to clinic to receive booster dose of vaccine. Her second dose of vaccine was in October 2021, so had only been 2 months since her last dose. She did not report any medical conditions that would warrant a third dose of the primary series. In effect, she came in very early for her booster vaccine, and it was not noted at the time. We now need to know what the patient should be advised in regards to receiving any additional booster doses, or does this dose suffice as her booster dose?


VAERS ID: 2005996 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (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: 13 year old received the pediatric Covid-19 Pfizer dose when they should have received the adult dose.


VAERS ID: 2006024 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-12-14
Onset:2021-12-23
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029H21B / 3 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Asthenia, Blood test, Computerised tomogram normal, Dyspnoea, Gastrooesophageal reflux disease, Hypersensitivity, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific dysfunction (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: trazadone and gabapentin to aid with sleep
Current Illness: none
Preexisting Conditions: none
Allergies: tree nut allergy
Diagnostic Lab Data: Dec 28 blood work Dec 30 CT scan of torso
CDC Split Type:

Write-up: Dec 23 evening - experienced itchiness on head and arms Dec 24 morning - woke with allergic reaction symptoms -$g severe itchiness/hives on torso, arms and head, acid reflux, shortness of breadth, low energy, took over the counter Benadryl every 4 hours throughout day, symptoms got better Dec 25 morning - woke with allergic reaction symptoms -$g severe itchiness/hives on torso, arms and head, acid reflux, shortness of breadth, low energy, took over the counter Benadryl every 4 hours throughout day, symptoms got better Dec 26 morning - woke with allergic reaction symptoms at 1am -$g severe itchiness/hives on torso, arms and head, acid reflux, shortness of breadth, low energy -$g went to The local hospital ER, administered steroid, Zyrtec and Pepcid and released Dec 26 day -symptoms got better up until 2pm then declined again Dec 27 morning - woke with allergic reaction symptoms at 1am -$g severe itchiness/hives on torso, arms and head, acid reflux, shortness of breadth, low energy -$g administered Epi pen for tree nut allergy, went to The local hospital ER, administered steroid, Zyrtec and Pepcid and released Dec 27 day - prescription picked up for aforementioned medicines, started that during the day symptoms improved Dec 28 day - saw primary care -$g no confirmed diagnosis, symptoms NOT for food allergy, suspect symptoms from Moderna booster shot administered on Dec 14, did blood work Dec 29 day - blood work indicated possible blood clot and infection Dec 30 evening - had CT scan of torso performed -$g no blood clots Dec 31 - Jan 5 - symptoms are hives on skin on arms and head when irritated or scratched, shortness of breath at times, acid reflux at times, elevated resting heart rate ~80bpm (typically 60), lower energy level


VAERS ID: 2006105 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 3 LA / IM

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

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

Write-up: Client''s mother reported the client had only gotten 1 dose of Pfizer so far and needed a 2nd dose. It was not determined until after vaccination that the client had already received 2 doses of Pfizer.


VAERS ID: 2006385 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-22
Onset:2021-12-23
   Days after vaccination:304
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Hypoxia
SMQs:, Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient fully vaccinated (Moderna) but not boosted, admitted to the hospital with COVID-19 and associated hypoxia. Patient was discharged on 12/27/21.


VAERS ID: 2006451 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-12-11
Onset:2021-12-23
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8757 / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hepatomegaly, Kawasaki's disease, Laboratory test abnormal, Pyrexia, Rash
SMQs:, Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Cardiomyopathy (broad), Vasculitis (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: admited to hospital
CDC Split Type:

Write-up: 12/23-developed rash and fever 12/25-admited to hospital for abnormal labs; enlarged liver. Dx with kawasaki disease


VAERS ID: 2006458 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3594 / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Ear pain, Injection site reaction, Respiratory tract congestion, Sensory disturbance, Tinnitus, Vertigo
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: About an hour after booster vaccination I felt a sensation of something spreading underneath the skin from the injection site up to the shoulder, up the neck and under the arm a bit and then Ringing in the ear started 1 hour after booster vaccination and have had it for the 13 days since. Still have it. Also some congestion and pain in the ear. Some vertigo the first 3 days as well.


VAERS ID: 2007225 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: New York  
Vaccinated:2021-12-13
Onset:2021-12-23
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Antinuclear antibody negative, Laboratory test normal, Red blood cell sedimentation rate normal, 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: none
Current Illness: healthy
Preexisting Conditions: none
Allergies: morphine
Diagnostic Lab Data: 1/4/2022 labs ordered: CBC/Diff Ambiguous Default; Comp. Metabolic Panel (14); Urinalysis, Routine; Lipid Panel; SARS-CoV-2 Antibody, IgG; QuantiFERON-TB Gold Plus; ANA; Hemoglobin A1c; TSH; Vitamin D, 25-Hydroxy; SARS-CoV-2 Ab, Nucleocapsid; Allergens w/Total IgE Area 1; Food Allergy Profile; Sedimentation Rate-Westergren; Vitamin B12; Ambig Abbrev CMP14
CDC Split Type:

Write-up: Patient began to develop migrating hives that have persisted on a daily basis for greater than 2 weeks. They have included most of the body and include wheal and flare reactions. They are only controlled with daily Benadryl and methylprednisolone. This appears to be a new onset of chronic urticaria. ANA is negative. ESR is normal. Routine labs are normal.


VAERS ID: 2007250 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Mobility decreased, Pain in extremity
SMQs:, Parkinson-like events (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Severe pain running from shoulder to thumb, limited range of motion, for 3 weeks now, Tylenol 8, hot and cold compresses,


VAERS ID: 2009841 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-22
Onset:2021-12-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Arthralgia, Headache, Myalgia, Nausea, Neck pain, Pain, Tinnitus, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hearing impairment (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril, low-dose aspirin, Folate, Thiamin, Colace, baclofen, tramadol, Tylenol
Current Illness: Hypertension, low back pain, abnormalities of gate and mobility, Morbid obesity, liver disease
Preexisting Conditions: Hypertension, Osteoarthritis,
Allergies: Foods: Coconut, Cilantro, bell peppers; Medications: Doxycycline
Diagnostic Lab Data: No test or treatments preformed or offered.
CDC Split Type:

Write-up: Muscle and joint aches, severe headache with pain traveling down right-side of neck, ringing in ears, nausea, vomiting No treatment aside from medications already receiving prior to Maderna booster vaccine. Outcome: Side daily nausea and vomiting, and headaches


VAERS ID: 2010078 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Decreased appetite, Headache, Heavy menstrual bleeding, Oropharyngeal pain, Pain, Palpitations, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vit C, D3, B12, fish oil, multivitamin, probiotic
Current Illness: n/a
Preexisting Conditions: psoriasis
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type: 306

Write-up: racing heart fever chills headache body aches sore throat loss of appetite heavy period bleeding - mid cycle and not due


VAERS ID: 2010113 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Heart rate increased, Nausea, Pain, Pyrexia, Restlessness, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Akathisia (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 01/20/21
Other Medications: levothyroxine 88mcg rosuvastatin calcium 20mg aspirin 81mg
Current Illness: none
Preexisting Conditions: hypothyroidism
Allergies: sulfa drugs
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Achiness, fever, severe chills/teeth chattering, rapid heartbeat, nausea, vomiting, restlessness


VAERS ID: 2010189 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-22
Onset:2021-12-23
   Days after vaccination:245
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021821A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Covid positive through community gathering


VAERS ID: 2010236 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-12-03
Onset:2021-12-23
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Cough, Dyspnoea, Fatigue, Feeling abnormal, Hypersomnia, Malaise, Sputum discoloured
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Infective pneumonia (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: 12/2021 Pfizer COVID-19
Other Medications: Losartan; Crestor; Protonic; Singular; Eliquis; Dicyclomine; Linzess; Omega 3; Vit. A, B, Complex and E, Multivitamin; Trulicity; Humulin Insulin; Togera; Toulon; Proventil; Atrovent; Nebulizer; Resprinat; Prednisone; Cough Med
Current Illness: No
Preexisting Conditions: Diabetes; Respiratory and Cardiac Issue
Allergies: Latex; Morphine; Codeine; Dog and Cat Hair; Peltrone; Lidocaine; Contrast Dye; Aspirin; Mold; Mildew
Diagnostic Lab Data: no
CDC Split Type: vsafe

Write-up: 12/23 I developed difficulty breathing associated by a lot of yellow/greenish mucus more so in the mornings. Malayized and very tired resulting in me sleeping a lot. I just have this blah feeling. Terrible coughing resulting in extreme pain in the thoracic area mainly on the left side. I went to the ER but they took too long so I left so I went home and self administer with prednisone and additional breathing treatments and checked my pulse ox until it finally reached back to 96 because it had fallen to 84 during my SOB experience. And to date I am still experiencing these symptoms.


VAERS ID: 2010344 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / IM

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

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

Write-up: The patient came in for his first dose of Moderna, 0.5ml, there was a mix up between the pharmacy and the vaccinator and it was discovered he had only received a booster dose of 0.25ml. The patient was contacted and returned to the clinic for an additional "booster" dose of 0.25ml equaling the full 0.5ml dose required for the first shot of Moderna.


VAERS ID: 2010412 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-10-26
Onset:2021-12-23
   Days after vaccination:58
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Fatigue, Headache, Myalgia, Nasal congestion, Oropharyngeal pain, Productive cough, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), 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? No
Previous Vaccinations:
Other Medications: Birth Control
Current Illness: None
Preexisting Conditions: None
Allergies: Ibuprofen, Shellfish
Diagnostic Lab Data: 12/23 Rapid COVID home test - Positive 12/24 COVID PCR test - Positive
CDC Split Type:

Write-up: 12/23: Sore throat, Persistent productive cough, nasal congestion. 12/24-27: Sore throat, productive cough, nasal congestion, headaches, fatigue, muscle aches, chills 12/28-1/1: Improving symptoms, occasional cough/congestion.


VAERS ID: 2010654 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-12-20
Onset:2021-12-23
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Aortic valve incompetence, Cardiomegaly, Chest pain, Computerised tomogram thorax abnormal, Dyspnoea, Echocardiogram, Lung opacity, Pleural effusion
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Interstitial lung disease (narrow), Systemic lupus erythematosus (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Methyl B12, sertraline, magnesium, birth control
Current Illness: Strep throat- 1 month prior
Preexisting Conditions: Pernicious anemia (parietal cell anti-bodies leading to B12 deficiency).
Allergies: None
Diagnostic Lab Data: Mild left lung base opacities which could represent infection and/or atelectasis (via CT scan, 12/23/21). Small left pleural effusion (via CT scan, 12/23/21), Mild cardiomegaly with left ventricular prominence (via CT scan, 12/23/21), Mild 1+ Aortic Insufficiency. Possible bicuspid valve cannot be excluded. Suggest further imaging like cardiac MRI to better visualize (Echocardiogram 1/6/22). Estimated Right Atrial Pressure is 8 (Echocardiogram 1/6/22).
CDC Split Type:

Write-up: Middle of the night 12/22/21- Left chest pain and shortness of breath. Hard to breathe unless sitting up completely. Very difficult to breathe lying down, even with head and chest elevated to 60 degrees. Could not breathe when laying on either side. Visit to Urgent Care, Primary Care Physician, and ER all that day. Prescribed antibiotics and steroids. Chest pain resided in a few days with treatment. Follow up Echocardiogram and chest X-ray recommended.


VAERS ID: 2010688 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-21
Onset:2021-12-23
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033H21A / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Decreased appetite, Fatigue, Headache, Hereditary motor and sensory neuropathy, Nausea, Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Congenital, familial and genetic disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Sore arm and a little fatigue with the first two doses.
Other Medications: I take chronic medications all the time.
Current Illness: None.
Preexisting Conditions: I have asthma; Sjogren.
Allergies: I am allergic to Levaquin.
Diagnostic Lab Data: I had a CMT.
CDC Split Type: vsafe

Write-up: I started with a low fever that went up to a 102. I had a terrible headache, nausea, vomited. I had very body aches. And I didn''t have an appetite. I experienced fatigue.


VAERS ID: 2010716 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product preparation issue, Underdose
SMQs:, Medication errors (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: 5ml syringes that had been provided by Health Authority were used to draw up diluent for mixing the 5-11 year old Pfizer COVID-19 vaccine vial on 12/23/21. Diluent drawn up and injected into the vaccine vial was 1.6ml rather than 1.3ml. Diluent was measured on the 5ml syringes incorrectly: Counting each mark as 0.1 rather than 0.2ml. This resulted in the vial being mixed with 0.3ml extra diluent. Vial had a bonus dose (so 11 doses total). Patient was given a vaccine dose at 90% of the correct concentration. Error has been reported to Pfizer. Families are currently being contacted by letter and by phone to be alerted of the error and offered a re-dose if they would like this. No adverse effects to patients have been reported.


VAERS ID: 2010721 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect product formulation administered, No adverse event, Product preparation issue
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: 5ml syringes that had been provided by local Authority were used to draw up diluent for mixing the 5-11 year old Pfizer COVID-19 vaccine vial on 12/23/21. Diluent drawn up and injected into the vaccine vial was 1.6ml rather than 1.3ml. Diluent was measured on the 5ml syringes incorrectly: Counting each mark as 0.1 rather than 0.2ml. This resulted in the vial being mixed with 0.3ml extra diluent. Vial had a bonus dose (so 11 doses total). Patient was given a vaccine dose at 90% of the correct concentration. Error has been reported to Pfizer. Families are currently being contacted by letter and by phone to be alerted of the error and offered a re-dose if they would like this. No adverse effects to patients have been reported.


VAERS ID: 2010722 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event, Product preparation issue
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: 5ml syringes that had been provided by Health Authority were used to draw up diluent for mixing the 5-11 year old Pfizer COVID-19 vaccine vial on 12/23/21. Diluent drawn up and injected into the vaccine vial was 1.6ml rather than 1.3ml. Diluent was measured on the 5ml syringes incorrectly: Counting each mark as 0.1 rather than 0.2ml. This resulted in the vial being mixed with 0.3ml extra diluent. Vial had a bonus dose (so 11 doses total). Patient was given a vaccine dose at 90% of the correct concentration. Error has been reported to Pfizer. Families are currently being contacted by letter and by phone to be alerted of the error and offered a re-dose if they would like this. No adverse effects to patients have been reported.


VAERS ID: 2010731 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product preparation issue, Underdose
SMQs:, Medication errors (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: 5ml syringes that had been provided by health authority were used to draw up diluent for mixing the 5-11 year old Pfizer COVID-19 vaccine vial on 12/23/21. Diluent drawn up and injected into the vaccine vial was 1.6ml rather than 1.3ml. Diluent was measured on the 5ml syringes incorrectly: Counting each mark as 0.1 rather than 0.2ml. This resulted in the vial being mixed with 0.3ml extra diluent. Vial had a bonus dose (so 11 doses total). Patient was given a vaccine dose at 90% of the correct concentration. Error has been reported to Pfizer. Families are currently being contacted by letter and by phone to be alerted of the error and offered a re-dose if they would like this. No adverse effects to patients have been reported.


VAERS ID: 2010734 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event, Product preparation issue
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: 5ml syringes that had been provided by Health Authority were used to draw up diluent for mixing the 5-11 year old Pfizer COVID-19 vaccine vial on 12/23/21. Diluent drawn up and injected into the vaccine vial was 1.6ml rather than 1.3ml. Diluent was measured on the 5ml syringes incorrectly: Counting each mark as 0.1 rather than 0.2ml. This resulted in the vial being mixed with 0.3ml extra diluent. Vial had a bonus dose (so 11 doses total). Patient was given a vaccine dose at 90% of the correct concentration. Error has been reported to Pfizer. Families are currently being contacted by letter and by phone to be alerted of the error and offered a re-dose if they would like this. No adverse effects to patients have been reported.


VAERS ID: 2010735 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect product formulation administered, No adverse event, Product preparation issue
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: 5ml syringes that had been provided by Health Authority were used to draw up diluent for mixing the 5-11 year old Pfizer COVID-19 vaccine vial on 12/23/21. Diluent drawn up and injected into the vaccine vial was 1.6ml rather than 1.3ml. Diluent was measured on the 5ml syringes incorrectly: Counting each mark as 0.1 rather than 0.2ml. This resulted in the vial being mixed with 0.3ml extra diluent. Vial had a bonus dose (so 11 doses total). Patient was given a vaccine dose at 90% of the correct concentration. Error has been reported to Pfizer. Families are currently being contacted by letter and by phone to be alerted of the error and offered a re-dose if they would like this. No adverse effects to patients have been reported.


VAERS ID: 2010738 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect product formulation administered, No adverse event, Product preparation issue
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: 5ml syringes that had been provided by Health Authority were used to draw up diluent for mixing the 5-11 year old Pfizer COVID-19 vaccine vial on 12/23/21. Diluent drawn up and injected into the vaccine vial was 1.6ml rather than 1.3ml. Diluent was measured on the 5ml syringes incorrectly: Counting each mark as 0.1 rather than 0.2ml. This resulted in the vial being mixed with 0.3ml extra diluent. Vial had a bonus dose (so 11 doses total). Patient was given a vaccine dose at 90% of the correct concentration. Error has been reported to Pfizer. Families are currently being contacted by letter and by phone to be alerted of the error and offered a re-dose if they would like this. No adverse effects to patients have been reported.


VAERS ID: 2010751 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product preparation issue, Underdose
SMQs:, Medication errors (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: 5ml syringes that had been provided were used to draw up diluent for mixing the 5-11 year old Pfizer COVID-19 vaccine vial on 12/23/21. Diluent drawn up and injected into the vaccine vial was 1.6ml rather than 1.3ml. Diluent was measured on the 5ml syringes incorrectly: Counting each mark as 0.1 rather than 0.2ml. This resulted in the vial being mixed with 0.3ml extra diluent. Vial had a bonus dose (so 11 doses total). Patient was given a vaccine dose at 90% of the correct concentration. Error has been reported to Pfizer. Families are currently being contacted by letter and by phone to be alerted of the error and offered a re-dose if they would like this. No adverse effects to patients have been reported.


VAERS ID: 2010754 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect product formulation administered, No adverse event, Product preparation issue
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: 5ml syringes that had been provided by Health Authority were used to draw up diluent for mixing the 5-11 year old Pfizer COVID-19 vaccine vial on 12/23/21. Diluent drawn up and injected into the vaccine vial was 1.6ml rather than 1.3ml. Diluent was measured on the 5ml syringes incorrectly: Counting each mark as 0.1 rather than 0.2ml. This resulted in the vial being mixed with 0.3ml extra diluent. Vial had a bonus dose (so 11 doses total). Patient was given a vaccine dose at 90% of the correct concentration. Error has been reported to Pfizer. Families are currently being contacted by letter and by phone to be alerted of the error and offered a re-dose if they would like this. No adverse effects to patients have been reported.


VAERS ID: 2010758 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product preparation issue, Underdose
SMQs:, Medication errors (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: 5ml syringes that had been provided by Health Authority were used to draw up diluent for mixing the 5-11 year old Pfizer COVID-19 vaccine vial on 12/23/21. Diluent drawn up and injected into the vaccine vial was 1.6ml rather than 1.3ml. Diluent was measured on the 5ml syringes incorrectly: Counting each mark as 0.1 rather than 0.2ml. This resulted in the vial being mixed with 0.3ml extra diluent. Vial had a bonus dose (so 11 doses total). Patient was given a vaccine dose at 90% of the correct concentration. Error has been reported to Pfizer. Families are currently being contacted by letter and by phone to be alerted of the error and offered a re-dose if they would like this. No adverse effects to patients have been reported.


VAERS ID: 2010761 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product preparation issue, Underdose
SMQs:, Medication errors (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: 5ml syringes that had been provided by local Authority were used to draw up diluent for mixing the 5-11 year old Pfizer COVID-19 vaccine vial on 12/23/21. Diluent drawn up and injected into the vaccine vial was 1.6ml rather than 1.3ml. Diluent was measured on the 5ml syringes incorrectly: Counting each mark as 0.1 rather than 0.2ml. This resulted in the vial being mixed with 0.3ml extra diluent. Vial had a bonus dose (so 11 doses total). Patient was given a vaccine dose at 90% of the correct concentration. Error has been reported to Pfizer. Families are currently being contacted by letter and by phone to be alerted of the error and offered a re-dose if they would like this. No adverse effects to patients have been reported.


VAERS ID: 2010766 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event, Product preparation issue
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: 5ml syringes that had been provided by Health Authority were used to draw up diluent for mixing the 5-11 year old Pfizer COVID-19 vaccine vial on 12/23/21. Diluent drawn up and injected into the vaccine vial was 1.6ml rather than 1.3ml. Diluent was measured on the 5ml syringes incorrectly: Counting each mark as 0.1 rather than 0.2ml. This resulted in the vial being mixed with 0.3ml extra diluent. Vial had a bonus dose (so 11 doses total). Patient was given a vaccine dose at 90% of the correct concentration. Error has been reported to Pfizer. Families are currently being contacted by letter and by phone to be alerted of the error and offered a re-dose if they would like this. No adverse effects to patients have been reported.


VAERS ID: 2010771 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event, Product preparation issue
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: 5ml syringes that had been provided by Health Authority were used to draw up diluent for mixing the 5-11 year old Pfizer COVID-19 vaccine vial on 12/23/21. Diluent drawn up and injected into the vaccine vial was 1.6ml rather than 1.3ml. Diluent was measured on the 5ml syringes incorrectly: Counting each mark as 0.1 rather than 0.2ml. This resulted in the vial being mixed with 0.3ml extra diluent. Vial had a bonus dose (so 11 doses total). Patient was given a vaccine dose at 90% of the correct concentration. Error has been reported to Pfizer. Families are currently being contacted by letter and by phone to be alerted of the error and offered a re-dose if they would like this. No adverse effects to patients have been reported.


VAERS ID: 2010773 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect product formulation administered, No adverse event, Product preparation issue
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: 5ml syringes that had were used to draw up diluent for mixing the 5-11 year old Pfizer COVID-19 vaccine vial on 12/23/21. Diluent drawn up and injected into the vaccine vial was 1.6ml rather than 1.3ml. Diluent was measured on the 5ml syringes incorrectly: Counting each mark as 0.1 rather than 0.2ml. This resulted in the vial being mixed with 0.3ml extra diluent. Vial had a bonus dose (so 11 doses total). Patient was given a vaccine dose at 90% of the correct concentration. Error has been reported to Pfizer. Families are currently being contacted by letter and by phone to be alerted of the error and offered a re-dose if they would like this. No adverse effects to patients have been reported.


VAERS ID: 2010775 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event, Product preparation issue
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: 5ml syringes that had been provided by Health Authority were used to draw up diluent for mixing the 5-11 year old Pfizer COVID-19 vaccine vial on 12/23/21. Diluent drawn up and injected into the vaccine vial was 1.6ml rather than 1.3ml. Diluent was measured on the 5ml syringes incorrectly: Counting each mark as 0.1 rather than 0.2ml. This resulted in the vial being mixed with 0.3ml extra diluent. Vial had a bonus dose (so 11 doses total). Patient was given a vaccine dose at 90% of the correct concentration. Error has been reported to Pfizer. Families are currently being contacted by letter and by phone to be alerted of the error and offered a re-dose if they would like this. No adverse effects to patients have been reported.


VAERS ID: 2010780 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Product preparation issue
SMQs:, Medication errors (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: 5ml syringes that had been provided by local Authority were used to draw up diluent for mixing the 5-11 year old Pfizer COVID-19 vaccine vial on 12/23/21. Diluent drawn up and injected into the vaccine vial was 1.6ml rather than 1.3ml. Diluent was measured on the 5ml syringes incorrectly: Counting each mark as 0.1 rather than 0.2ml. This resulted in the vial being mixed with 0.3ml extra diluent. Vial had a bonus dose (so 11 doses total). Patient was given a vaccine dose at 90% of the correct concentration. Error has been reported to Pfizer. Families are currently being contacted by letter and by phone to be alerted of the error and offered a re-dose if they would like this. No adverse effects to patients have been reported.


VAERS ID: 2010784 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product preparation issue, Underdose
SMQs:, Medication errors (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: 5ml syringes that had been provided by Health Authority were used to draw up diluent for mixing the 5-11 year old Pfizer COVID-19 vaccine vial on 12/23/21. Diluent drawn up and injected into the vaccine vial was 1.6ml rather than 1.3ml. Diluent was measured on the 5ml syringes incorrectly: Counting each mark as 0.1 rather than 0.2ml. This resulted in the vial being mixed with 0.3ml extra diluent. Vial had a bonus dose (so 11 doses total). Patient was given a vaccine dose at 90% of the correct concentration. Error has been reported to Pfizer. Families are currently being contacted by letter and by phone to be alerted of the error and offered a re-dose if they would like this. No adverse effects to patients have been reported.


VAERS ID: 2010786 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product preparation issue, Underdose
SMQs:, Medication errors (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: 5ml syringes that had been provided by Health Authority were used to draw up diluent for mixing the 5-11 year old Pfizer COVID-19 vaccine vial on 12/23/21. Diluent drawn up and injected into the vaccine vial was 1.6ml rather than 1.3ml. Diluent was measured on the 5ml syringes incorrectly: Counting each mark as 0.1 rather than 0.2ml. This resulted in the vial being mixed with 0.3ml extra diluent. Vial had a bonus dose (so 11 doses total). Patient was given a vaccine dose at 90% of the correct concentration. Error has been reported to Pfizer. Families are currently being contacted by letter and by phone to be alerted of the error and offered a re-dose if they would like this. No adverse effects to patients have been reported.


VAERS ID: 2010789 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product preparation issue, Underdose
SMQs:, Medication errors (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: 5ml syringes that had been provided were used to draw up diluent for mixing the 5-11 year old Pfizer COVID-19 vaccine vial on 12/23/21. Diluent drawn up and injected into the vaccine vial was 1.6ml rather than 1.3ml. Diluent was measured on the 5ml syringes incorrectly: Counting each mark as 0.1 rather than 0.2ml. This resulted in the vial being mixed with 0.3ml extra diluent. Vial had a bonus dose (so 11 doses total). Patient was given a vaccine dose at 90% of the correct concentration. Error has been reported to Pfizer. Families are currently being contacted by letter and by phone to be alerted of the error and offered a re-dose if they would like this. No adverse effects to patients have been reported.


VAERS ID: 2010791 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product preparation issue, Underdose
SMQs:, Medication errors (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: 5ml syringes that had been provided by Health Authority were used to draw up diluent for mixing the 5-11 year old Pfizer COVID-19 vaccine vial on 12/23/21. Diluent drawn up and injected into the vaccine vial was 1.6ml rather than 1.3ml. Diluent was measured on the 5ml syringes incorrectly: Counting each mark as 0.1 rather than 0.2ml. This resulted in the vial being mixed with 0.3ml extra diluent. Vial had a bonus dose (so 11 doses total). Patient was given a vaccine dose at 90% of the correct concentration. Error has been reported to Pfizer. Families are currently being contacted by letter and by phone to be alerted of the error and offered a re-dose if they would like this. No adverse effects to patients have been reported.


VAERS ID: 2010795 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product preparation issue, Underdose
SMQs:, Medication errors (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: 5mL syringes were used to draw up diluent for mixing the 5-11 year old Pfizer COVID-19 vaccine vial on 12/16/2021. Diluent drawn up and injected into the vaccine vial was 1.6mL (rather than 1.3mL). Diluent was measured on the 5mL syringes incorrectly (counting each mark as 0.1mL rather than 0.2mL). This resulted in the vial being mixed with 0.3mL extra diluent. Vial had a bonus dose (so 11 doses total). Patient given a vaccine dose at 90% of the correct concentration. Error has been reported to Pfizer. Families are currently being contacted by letter and by phone to be alerted of the error and offered a re-dose if they would like this. No adverse effects to patients have been reported.


VAERS ID: 2010799 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product preparation issue, Underdose
SMQs:, Medication errors (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: 5ml syringes that had been provided by Health Authority were used to draw up diluent for mixing the 5-11 year old Pfizer COVID-19 vaccine vial on 12/23/21. Diluent drawn up and injected into the vaccine vial was 1.6ml rather than 1.3ml. Diluent was measured on the 5ml syringes incorrectly: Counting each mark as 0.1 rather than 0.2ml. This resulted in the vial being mixed with 0.3ml extra diluent. Vial had a bonus dose (so 11 doses total). Patient was given a vaccine dose at 90% of the correct concentration. Error has been reported to Pfizer. Families are currently being contacted by letter and by phone to be alerted of the error and offered a re-dose if they would like this. No adverse effects to patients have been reported.


VAERS ID: 2010802 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL0007 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event, Product preparation issue
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: 5ml syringes that had been provided by Health Authority were used to draw up diluent for mixing the 5-11 year old Pfizer COVID-19 vaccine vial on 12/23/21. Diluent drawn up and injected into the vaccine vial was 1.6ml rather than 1.3ml. Diluent was measured on the 5ml syringes incorrectly: Counting each mark as 0.1 rather than 0.2ml. This resulted in the vial being mixed with 0.3ml extra diluent. Vial had a bonus dose (so 11 doses total). Patient was given a vaccine dose at 90% of the correct concentration. Error has been reported to Pfizer. Families are currently being contacted by letter and by phone to be alerted of the error and offered a re-dose if they would like this. No adverse effects to patients have been reported.


VAERS ID: 2012973 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-12-20
Onset:2021-12-23
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Catheterisation cardiac normal, Chest pain, Chills, Electrocardiogram normal, Fatigue, Myocarditis, Pain, Pyrexia, Troponin I increased
SMQs:, Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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: None
Preexisting Conditions: Mild Intermittent Asthma
Allergies: None
Diagnostic Lab Data: Troponin I: 3.8 (12/24/21) Left heart catheterization: normal vessels and normal LVEF (12/24/21) EKG: normal sinus rhythm without ST elevations or depressions
CDC Split Type:

Write-up: Patient received his 3rd Moderna COVID booster shot on Monday 12/20/21 and began to have fever, chills, fatigue and bodyaches that evening and the next day. Those symptoms resolved by Wednesday but Thursday morning 12/23/21 he began to have some intermittent chest pain. His chest pain worsened and persisted on 12/24/21 and he was subsequently seen in the ER where he was diagnosed with myocarditis with an elevated troponin up to 3.8 but with no EKG changes or abnormalities on left heart catheterization. He was discharged home with instructions to take it easy and use ibuprofen as needed. He took ibuprofen a couple of times for a couple of days and has not needed it since. He feels back to his normal self at this time (1/6/21) and he has no further symptoms. He has been cleared to return to activity as tolerated.


VAERS ID: 2014105 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-21
Onset:2021-12-23
   Days after vaccination:216
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Fatigue, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: fatigue, short of breath + COVID test


VAERS ID: 2014111 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-20
Onset:2021-12-23
   Days after vaccination:125
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D218 / 2 UN / UN

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

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

Write-up: cough +COVID test


VAERS ID: 2014280 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-12-17
Onset:2021-12-23
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041J21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Menstruation irregular
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: prolonged period after 2nd dose of Moderna covid-19 vaccine (2/4/21 vaccination date), patient age 42, adverse event 2/16/21 - 2
Other Medications: Wellbutrin XL 300 mg, multivitamin, vitamin c, vitamin d3, magnesium oxide
Current Illness: upper respiratory infection November 2021
Preexisting Conditions: chronic constipation, history of liver dysfunction, migraines, small fiber neuropathy
Allergies: shea nut/butter, neosporin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: My menstrual period arrived 2 days early, on 12/23/21. It was not due until 12/25/21. I continued to experience menstrual bleeding for 12 days, with my last day of bleeding 1/3/22. My typical period lasts only 3 days. I sent a message to my doctor on 1/3/22 to ask if I should be concerned about the extended bleeding and was reassured that I should not be concerned at this time.


VAERS ID: 2014428 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: New York  
Vaccinated:2021-12-03
Onset:2021-12-23
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030H21B / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Alanine aminotransferase normal, Anion gap, Aspartate aminotransferase normal, Blood albumin normal, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood calcium normal, Blood chloride normal, Blood cholesterol increased, Blood creatinine normal, Blood glucose normal, Blood potassium normal, Blood pressure increased, Blood sodium normal, Blood test normal, Blood thyroid stimulating hormone normal, Carbon dioxide decreased, Condition aggravated, Dizziness, Dyspnoea, Full blood count, Glomerular filtration rate normal, High density lipoprotein decreased, Lipids normal, Low density lipoprotein normal, Metabolic function test, Protein total normal, Thyroxine free normal, Urine analysis
SMQs:, Anaphylactic reaction (broad), Dyslipidaemia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Lipodystrophy (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: Nifedipine ER 60MG, 1x daily Labeltelol 200mg, 3x daily
Current Illness: none
Preexisting Conditions: Hypertension, obesity, high cholesterol
Allergies: none
Diagnostic Lab Data: Most within normal ranges: 12/28/2021 Free T4/TSH LDL Cholesterol Lipid Panel: HDL37.0, Cholesterol 234 Comprehensive metabolic panel CBC Glucose: 96 UN: 10 Creatinine: .70 Sodium: 137 mmol/L Potassium: 4.3 Chloride: 105 CO2 21 mmol/L Anion Gap:11 Calcium: 9.2 Total Protein 7.2 Albumin 4.6 Bilirubin: .4 Alk Phos: 76 ALT 19 AST 19 GFR, value: 103
CDC Split Type:

Write-up: I take my blood pressure medicine as prescribed. I never had any side effects from them. I have been taking these same meds for over a year. I went to my doctors office on 12/23/21 because that day or a few days prior to that I started feeling really dizzy out of the blue. I check my blood pressure with an electronic cuff I have at home, and it seems to be spiked everytime I am dizzy. My diet contains very little salt in it at all because of my hypertension already. I even went to the ER on 12/28/21 because it was 171/97 and I felt very dizzy and short of breath. I took two labetelol during that spike and it went back down to normal range. Ever since 1/1/2022, I have been weight training at a gym and on a very strict diet with no foods exceeding 250mg to 300mg of sodium. It consists of: 1 bagel, plain cream cheese, 1 hard boiled egg, 1- 12oz cup of black coffee with a generic powdered creamer, 1tsp sugar, 1% cottage cheese (1/2 c), sliced peaches (1cup), chopped romaine 1 cup, carrots 1.5oz, tomatoes 2oz, mozzarella cheese .2 cups, dressing 2Tbsp, shrimp- frozen-cooked 5.5oz, cocktail sauce 1Tbsp, 1 medium size banana, boneless skinless chicken breast 4 oz, bbq sauce 1Tbsp, baby red potatoes 6oz, olive oil, 2tsp. I am STILL getting dizzy from blood pressure spikes and I still take my blood pressure meds as perscribed. When I went to the ER they said my blood work was fine. There is something else causing my dizziness or blood pressure spikes. Several people told me to report this in case it was due to the vaccine.


VAERS ID: 2014492 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

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

Write-up: COVID VACCINE ADMINISTERED POST EXPIRATION DATE


VAERS ID: 2014504 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: COVID VACCINE BOOSTER GIVEN FROM EXPIRED VIAL


VAERS ID: 2014512 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: COVID BOOSTER DOSE ADMINISTRED FROM EXPIRED LOT


VAERS ID: 2014519 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

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

Write-up: COVID BOOSTER DOSE ADMINISTERED FROM EXPIRED LOT


VAERS ID: 2014529 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: COVID VACCINE BOOSTER ADMINISTERED FROM EXPIRED LOT


VAERS ID: 2014541 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

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

Write-up: COVID BOOSTER ADMINISTERED FROM EXPIRED LOT


VAERS ID: 2014548 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

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

Write-up: COVID BOOSTER ADMINISTERED FROM EXPIRED LOT


VAERS ID: 2014562 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

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

Write-up: COVID BOOSTER ADMINISTERED FROM EXPIRED LOT


VAERS ID: 2014574 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: COVID BOOSTER ADMINISTERED FROM EXPIRED LOT


VAERS ID: 2014758 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: California  
Vaccinated:2021-12-22
Onset:2021-12-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 069H21A / 3 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood cholesterol increased, Blood test, Chills, Dizziness, Headache, Pain, Palpitations, Pyrexia
SMQs:, Dyslipidaemia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Lipodystrophy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna dose 2- 03/04/2021- I had similar symptoms to dose 3 and my blood sugar was high.
Other Medications: vitamin D3; calcium/magnesium/zinc
Current Illness: none
Preexisting Conditions: focal nodule hyperplasia; 1st and second degree heart block
Allergies: cipro
Diagnostic Lab Data: Blood work 01/03/2022- high cholesterol
CDC Split Type: vsafe

Write-up: I had a fever that lasted about 36 -48 hours, body aches, headache and chills the days following the vaccine. I had heart palpitations the following week and almost passed out on 12/29/2021. I was really dizzy for a few days. I saw the doctor the following Monday (01/03/2022). She told me it was because of the vaccine and it should go away. She just told me to keep an eye on it. The palpitations have gotten better in the last few days.


VAERS ID: 2014860 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-15
Onset:2021-12-23
   Days after vaccination:311
Submitted: 0000-00-00
Entered: 2022-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Endotracheal intubation, Lung opacity, Mechanical ventilation, Pleural effusion, Positive airway pressure therapy, SARS-CoV-2 test positive
SMQs:, Angioedema (broad), Interstitial lung disease (narrow), Systemic lupus erythematosus (broad), Acute central respiratory depression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Home duonebs, budesonide and BiPAP Intubated on 12/30 at outside hospital. Ventilator settings: CMV - CXR at OSH showed increasing bilateral mixed interstitial alveolar opacities with small bilateral pleural effusions - Ventilator bundle ordered - COVID+ on 12/28/21, previous infection


VAERS ID: 2017707 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-04-09
Onset:2021-12-23
   Days after vaccination:258
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Blood glucose, Blood iron, Blood magnesium, Cerebrovascular accident, Feeling abnormal, Pain in extremity, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: blood sugar; Result Unstructured Data: 507; Test Name: iron; Result Unstructured Data: depleted; Test Name: magnesium; Result Unstructured Data: depleted
CDC Split Type: USMODERNATX, INC.MOD20214

Write-up: stroke; so weak/so weak, which has never happened; did not feel safe/pretty bad state/felt bad every single day; shaky; arm was really really sore; This spontaneous case was reported by a consumer and describes the occurrence of CEREBROVASCULAR ACCIDENT (stroke) in a 64-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 033F21A, 038B21A and 039B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 09-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 07-May-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 22-Dec-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 23-Dec-2021, the patient experienced PAIN IN EXTREMITY (arm was really really sore). On 24-Dec-2021, the patient experienced TREMOR (shaky). On an unknown date, the patient experienced CEREBROVASCULAR ACCIDENT (stroke) (seriousness criteria hospitalization and medically significant), ASTHENIA (so weak/so weak, which has never happened) and FEELING ABNORMAL (did not feel safe/pretty bad state/felt bad every single day). The patient was hospitalized on 26-Dec-2021 due to CEREBROVASCULAR ACCIDENT. At the time of the report, CEREBROVASCULAR ACCIDENT (stroke), ASTHENIA (so weak/so weak, which has never happened), FEELING ABNORMAL (did not feel safe/pretty bad state/felt bad every single day), PAIN IN EXTREMITY (arm was really really sore) and TREMOR (shaky) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Blood glucose: 507 (High) 507. On an unknown date, Blood iron: depleted (Low) depleted. On an unknown date, Blood magnesium: depleted (Low) depleted. Concomitant medications were not reported. Treatment medications were not reported. Company Comment This case concerns a 64-year-old, female patient with no relevant medical history reported, who experienced the unexpected event of cerebrovascular accident. The event occurred on an unknown number of days after the third dose of mRNA-1273. The rechallenge was not applicable since the events happened after the third dose. The benefit-risk relationship of mRNA-1273 is not affected by this report.; Sender''s Comments: This case concerns a 64-year-old, female patient with no relevant medical history reported, who experienced the unexpected event of cerebrovascular accident. The event occurred on an unknown number of days after the third dose of mRNA-1273. The rechallenge was not applicable since the events happened after the third dose. The benefit-risk relationship of mRNA-1273 is not affected by this report.


VAERS ID: 2017717 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-22
Onset:2021-12-23
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012H21B / 3 LA / OT

Administered by: Unknown       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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20214

Write-up: This spontaneous case was reported by a consumer and describes the occurrence of SEIZURE (Seizure) in a 58-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 012H21B) for an unknown indication. No Medical History information was reported. On 22-Nov-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 23-Dec-2021, the patient experienced SEIZURE (Seizure) (seriousness criteria hospitalization and medically significant). The patient was hospitalized from 23-Dec-2021 to 23-Dec-2021 due to SEIZURE. The patient was treated with LEVETIRACETAM (KEPPRA [LEVETIRACETAM]) for Adverse event, at an unspecified dose and frequency and VALPROATE SEMISODIUM (DEPAKOTE) for Adverse event, at a dose of 1 dosage form twice a day. At the time of the report, SEIZURE (Seizure) outcome was unknown. No concomitant medication reported. Exactly a month after receiving the booster dose of the Moderna COVID 19 vaccine, she had a seizure (23 Dec 2021). The seizure was at home and she had to be taken with an ambulance to the hospital. She was in the hospital for one day, with husband called the ambulance at about 3:30 am and she was back home by 6:30 pm. Initially she was not taking any medication, but she was later prescribed Keppra. She had a bad reaction to Keppra and was switched to Depakote 500 mg twice a day. She has an appointment with her doctor tomorrow. She has never had seizure or nothing before in her entire life. Company comment: This spontaneous case concerns a 58-year-old female patient with no medical history reported, who experienced the unexpected serious (medically significant and hospitalization) event of Seizure (AESI) after mRNA- 1273 vaccine. The event occurred approximately 1 month after the booster dose of mRNA- 1273 vaccine. The patient was hospitalized for one day. Treatment with Levetiracetam was prescribed and then switched to Valproate. Very limited information is available regarding diagnostic work-up and potential triggers of the event. The benefit-risk relationship of mRNA- 1273 vaccine is not affected by this report. This case was linked to MOD-2021-433967, MOD-2021-433968 (Patient Link). Sender''s Comments: This spontaneous case concerns a 58-year-old female patient with no medical history reported, who experienced the unexpected serious (medically significant and hospitalization) event of Seizure (AESI) after mRNA- 1273 vaccine. The event occurred approximately 1 month after the booster dose of mRNA- 1273 vaccine. The patient was hospitalized for one day. Treatment with Levetiracetam was prescribed and then switched to Valproate. Very limited information is available regarding diagnostic work-up and potential triggers of the event. The benefit-risk relationship of mRNA- 1273 vaccine is not affected by this report.


VAERS ID: 2017776 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-02-15
Onset:2021-12-23
   Days after vaccination:311
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Mass, Pruritus, Urticaria, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Hives and itchiness in the scull,freaking out on hives; Hives and itchiness on the insides of their thighs,spread to their legs and arms and hands; Wheezing randomly; A lump in the upper chest area; This spontaneous case was reported by a consumer and describes the occurrence of URTICARIA (Hives and itchiness in the scull,freaking out on hives), PRURITUS (Hives and itchiness on the insides of their thighs,spread to their legs and arms and hands), WHEEZING (Wheezing randomly) and MASS (A lump in the upper chest area) in a 37-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 0691T21A, 026A21A and 031L20A) for COVID-19 vaccination. No Medical History information was reported. On 15-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 15-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 17-Dec-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 23-Dec-2021, the patient experienced URTICARIA (Hives and itchiness in the scull,freaking out on hives), PRURITUS (Hives and itchiness on the insides of their thighs,spread to their legs and arms and hands), WHEEZING (Wheezing randomly) and MASS (A lump in the upper chest area). At the time of the report, URTICARIA (Hives and itchiness in the scull,freaking out on hives), PRURITUS (Hives and itchiness on the insides of their thighs,spread to their legs and arms and hands), WHEEZING (Wheezing randomly) and MASS (A lump in the upper chest area) had not resolved. No concomitant medications were reported No treatment information was provided Patient state he did not have Covid-19 nor a heart condition diagnosed before


VAERS ID: 2018569 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-23
Onset:2021-12-23
   Days after vaccination:244
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 LA / -

Administered by: Work       Purchased by: ?
Symptoms: COVID-19, Drug ineffective, SARS-CoV-2 test
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: RITONAVIR
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Exercise induced asthma (sports induced/exercise induced asthma diagnosed when she was a teen); Overweight (Caller states she is otherwise pretty healthy other than being a little overweight)
Allergies:
Diagnostic Lab Data: Test Date: 20211223; Test Name: Rapid Covid test; Test Result: Positive ; Comments: at home rapid Covid test
CDC Split Type: USPFIZER INC202101851403

Write-up: She reports testing positive for Covid 19 today. She has been vaccinated with 2 doses of the Pfizer Covid 19 vaccine; She reports testing positive for Covid 19 today. She has been vaccinated with 2 doses of the Pfizer Covid 19 vaccine; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP) from medical information team and product quality group for a Pfizer sponsored program (172086). The reporter is the patient. A 37 year-old female patient received bnt162b2 (BNT162B2), administered in deltoid left, administration date 23Apr2021 (Lot number: EW0172) at the age of 36 years as dose 2, single and administered in deltoid left, administration date 02Apr2021 (Lot number: EP7533) as dose 1, single for covid-19 immunisation. Relevant medical history included: "sports induced/exercise induced asthma" (unspecified if ongoing), notes: sports induced/exercise induced asthma diagnosed when she was a teen; "overweight" (unspecified if ongoing), notes: Caller states she is otherwise pretty healthy other than being a little overweight. Concomitant medication(s) included: RITONAVIR. Vaccination history included: Flu shot, administration date: Oct2020, for Immunization. The following information was reported: DRUG INEFFECTIVE (medically significant), COVID-19 (medically significant) all with onset 23Dec2021, outcome "unknown" and all described as "She reports testing positive for Covid 19 today. She has been vaccinated with 2 doses of the Pfizer Covid 19 vaccine". The patient underwent the following laboratory tests and procedures: sars-cov-2 test: (23Dec2021) positive, notes: at home rapid Covid test. Reporter stated testing positive for Covid 19 today. patient had been vaccinated with 2 doses of the Pfizer Covid 19 vaccine. She states that she would like to be in the trial for vaccinated patients who test positive to receive nirmatrelvir/ritonavir (Paxlovid). In response to the query it was provided that the study appears to no longer be enrolling. Relayed to reporter to check back in time to see when this product may become available to her. For those 18 years of age and older who have COVID-19 symptoms and have tested positive for COVID-19 within the last 5 days, but do not have any health conditions putting them at risk for severe illness, or have these conditions but are fully vaccinated. No Longer Enrolling. Reporter states she tried to call for the monoclonal antibody infusion and got a 3/4 for scoring and didn''t qualify No follow-up attempts are possible. No further information is expected.


VAERS ID: 2018596 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: New York  
Vaccinated:2021-12-02
Onset:2021-12-23
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8762 / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Drug ineffective, SARS-CoV-2 test
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Seasonal allergy
Allergies:
Diagnostic Lab Data: Test Date: 20211223; Test Name: COVID-19 test; Test Result: Positive
CDC Split Type: USPFIZER INC202101852784

Write-up: Tested positive to COVID-19; Tested positive to COVID-19; This is a spontaneous report received from a contactable consumer from medical information team. The reporter is the parent. A 13-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE; Solution for injection), administered in the left arm, administration date 02Dec2021 20:00 or 21:00 (Lot number: FJ8762) at the age of 13 years as dose 1, single for COVID-19 immunization. Relevant medical history included: "Seasonal allergies" (unspecified if ongoing). There were no concomitant medications. The patient had no prior vaccinations within 4 weeks of the COVID-19 vaccine. The following information was reported: The patient''s mother reported that she and her son have got their first shot of Pfizer-BioNTech COVID-19 vaccine. On 23Dec2021, they had the appointment for the second dose, however, both have tested positive to COVID-19. The pharmacist told the mother to wait one month but she read on the Internet that she could get it after 10 days. The mother asked when can they get the second dose of the vaccine. The patient has not received the second dose yet. The patient underwent the following laboratory tests and procedures: COVID-19 test: (23Dec2021) positive. Therapeutic measures were taken as result of the event which included taking over the counter pills. The outcome of the event was not recovered. No follow-up attempts are possible. No further information is expected.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202101850682 same reporter, drug, and event; different patient


VAERS ID: 2018625 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-11-11
Onset:2021-12-23
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 3 LA / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data: Test Name: Nasal Swab; Test Result: Positive
CDC Split Type: USPFIZER INC202101856054

Write-up: dose received: 3; contracted COVID-19 as a breakthrough case; contracted COVID-19 as a breakthrough case; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP) from product quality group. The reporter is the patient. A 25-year-old male patient received bnt162b2 (BNT162B2), intramuscular, administered in arm left, administration date 11Nov2021 14:00 (Lot number: EW0196) at the age of 25 years as dose 3 (booster), single, intramuscular, administered in arm right, administration date 16Apr2021 09:00 (Lot number: EP6955) as dose 2, single and intramuscular, administered in arm right, administration date 26Mar2021 09:00 (Lot number: EP6955) as dose 1, single for covid-19 immunisation. The patient had no relevant medical history. The patient had no history of allergies. The patient''s concomitant medications were not reported. Vaccination history included: Flu shot. The following information was reported: IMMUNISATION (medically significant), outcome "unknown", described as "dose received: 3"; VACCINATION FAILURE (medically significant), COVID-19 (medically significant) all with onset 23Dec2021 17:00, outcome "not recovered" and all described as "contracted COVID-19 as a breakthrough case". The event "contracted covid-19 as a breakthrough case" and "contracted covid-19 as a breakthrough case" was evaluated at the physician office visit. The patient underwent the following laboratory tests and procedures: sars-cov-2 test: (Unknown date) positive. Therapeutic measures were not taken as a result of vaccination failure, covid-19. On 28Dec2021, product investigation results were received. For Lot Number EW0196: Conclusion of Previously Completed Investigation:The complaint for lack of effect of the PFIZERBIONTECH COVID-19 VACCINE lot EW0196 was investigated. The investigation included a review of manufacturing and packaging batch records, deviation investigations, and an analysis of complaint history for the reported lot.The final scope included the reported finished goods lot EW0196, fill lot EP8741, and the formulated drug product lot EP8622.A complaint sample was not returned. No related quality issues were identified during the investigation. There is no impact to product quality. No root cause or corrective/preventative actions were identified as the complaint was not confirmed. All release testing performed prior to the release of the reported batch was within specifications. For Lot Number: EP6955: Conclusion of Previously Completed Investigation:The complaint for lack of effect of the PFIZERBIONTECH COVID-19 VACCINE lot EP6955 was investigated. The investigation included a review of manufacturing and packaging batch records, deviation investigations, and an analysis of complaint history or the reported lot. The final scope included the reported finished goods lot EP6955, fill lot EP6954, and he formulated drug product lot EP6953. A complaint sample was not returned, and photographs were not received. No related quality issues were identified during the investigation. There is no impact to product quality. No root cause or corrective/preventative actions were identified as the complaint was not confirmed. All release testing performed prior to the release of the reported batch was within specifications. When more than one investigation is found in the family, the Conclusion field could result in repeating rows for the table. If the Conclusion is blank in the table above, then the investigation record is likely an Offline Contractor Investigation and the conclusion must be obtained directly from the child investigation record(s) of the linked Complaint Record.


VAERS ID: 2018643 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Texas  
Vaccinated:2021-09-23
Onset:2021-12-23
   Days after vaccination:91
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Diarrhoea, Drug ineffective, Headache, Productive cough, Pyrexia
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101858596

Write-up: Cough became productive; splitting headache; fever; diarrhea; dry cough; chills; Contracted Covid-19 after being fully vaccinated; Contracted Covid-19 after being fully vaccinated; This is a spontaneous report received from contactable reporter(s) (Consumer or other non HCP) from a sales representative and product quality group. The reporter is the patient. A patient (no qualifiers provided) received bnt162b2, administration date 23Sep2021 (Lot number: 301308A) as dose 2, single and administration date 01Sep2021 (Lot number: FC3188) as dose 1, single for covid-19 immunisation. The patient''s relevant medical history and concomitant medications were not reported. The following information was reported: COVID-19, vaccination failure all with onset 2021, outcome unknown; headache, pyrexia, diarrhea, cough and chills onset 23Dec2021; productive cough onset 24Dec2021, outcome unknown. Symptoms begin on 22Dec2021. No follow-up attempts are possible. No further information is expected. Additional information: description of event: contracted Covid-19 after being fully vaccinated. Symptoms began on 22Dec2021. On 23Dec2021 had splitting headache, fever, diarrhea, dry cough and chills. Cough became productive on 24Dec2021. Event took place after use of product. Follow-up attempts are completed. No further information is expected.


VAERS ID: 2018720 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-06-14
Onset:2021-12-23
   Days after vaccination:192
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / -
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Blood pressure measurement, Blood test, COVID-19, Catatonia, Computerised tomogram, Decreased appetite, Dehydration, Disorientation, Drug ineffective, Gait inability, Head injury, Hyperhidrosis, Hypersomnia, Hypotension, Nail discolouration, Near death experience, Oxygen saturation, Pallor, SARS-CoV-2 test, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Dystonia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (narrow), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20211223; Test Name: blood pressure; Result Unstructured Data: Test Result:80/40; Test Name: blood testing; Result Unstructured Data: Test Result:Normal; Test Name: CT Scan; Result Unstructured Data: Test Result:Unknwon results; Test Name: Oxygen level; Result Unstructured Data: Test Result:92; Test Date: 20211223; Test Name: Antigen test; Test Result: Positive ; Test Date: 20211223; Test Name: PCR test; Test Result: Positive
CDC Split Type: USPFIZER INC202101870639

Write-up: Drug ineffective; he was suffering from COVID symptoms,; he was tested for COVID and came positive; I thought he had died and he was all sweat, he was very disoriented, he could not walk; fainted completely just because of the syncope; he fainted, he hit on his head; he hit up the wall and he tried to grab it because he fainted; face went white, his eyes were open, that he would not respond; we have to get him on an ambulance to the hospital with blood pressure of 80/40; his blood pressure systolic was 80 and diastolic was in 40; he turned white, his lips turned grey, he would not respond for few minutes, he completely got all sweated and that happened three times; he was found to be dehydrated; he has been sleeping a lot since the 23 he was constantly sleeping; he lost his appetite and he is feeling some loss of taste, he feels that things do not taste like they used to taste, that he hardly does have a taste; he was quite catatonic; two hours before I have seen like his foot nails, I had noticed them like grey, not very white; he was very weak; I thought he had died and he was all sweat, he was very disoriented, he could not walk; I thought he had died and he was all sweat, he was very disoriented, he could not walk; I thought he had died and he was all sweat, he was very disoriented, he could not walk; This is a spontaneous report received from a contactable reporter(s) (Pharmacist) from product quality group. The reporter is the parent. A 28 year-old male patient received bnt162b2 (BNT162B2), administered in arm left, administration date 14Jun2021 (Lot number: EW0196) at the age of 28 years as dose 2, single for covid-19 immunisation; ibuprofen (ADVIL [IBUPROFEN]) (Batch/Lot number: unknown) at 200 mg; dextromethorphan hydrobromide, guaifenesin (ROMPE PECHO DM) (Batch/Lot number: unknown). The patient''s relevant medical history and concomitant medications were not reported. Vaccination history included: Bnt162b2 (Dose 1, LOT# EW0177), administration date: May2021, when the patient was 28 years old, for COVID-19 Immunization. The following information was reported: DRUG INEFFECTIVE (medically significant) with onset 23Dec2021, outcome "unknown", described as "Drug ineffective"; COVID-19 (medically significant) with onset 23Dec2021, outcome "unknown", described as "he was suffering from COVID symptoms,; he was tested for COVID and came positive"; NEAR DEATH EXPERIENCE (medically significant), HYPERHIDROSIS (non-serious), DISORIENTATION (non-serious), GAIT INABILITY (non-serious) all with onset 23Dec2021, outcome "unknown" and all described as "I thought he had died and he was all sweat, he was very disoriented, he could not walk"; SYNCOPE (medically significant) with onset 23Dec2021, outcome "unknown", described as "fainted completely just because of the syncope"; HEAD INJURY (non-serious) with onset 23Dec2021, outcome "unknown", described as "he fainted, he hit on his head; he hit up the wall and he tried to grab it because he fainted; face went white, his eyes were open, that he would not respond"; HYPOTENSION (non-serious) with onset 23Dec2021, outcome "unknown", described as "we have to get him on an ambulance to the hospital with blood pressure of 80/40; his blood pressure systolic was 80 and diastolic was in 40"; PALLOR (non-serious) with onset 23Dec2021, outcome "unknown", described as "he turned white, his lips turned grey, he would not respond for few minutes, he completely got all sweated and that happened three times"; DEHYDRATION (non-serious) with onset 23Dec2021, outcome "unknown", described as "he was found to be dehydrated"; HYPERSOMNIA (non-serious) with onset 23Dec2021, outcome "unknown", described as "he has been sleeping a lot since the 23 he was constantly sleeping"; DECREASED APPETITE (non-serious) with onset 23Dec2021, outcome "unknown", described as "he lost his appetite and he is feeling some loss of taste, he feels that things do not taste like they used to taste, that he hardly does have a taste"; CATATONIA (non-serious) with onset 23Dec2021, outcome "unknown", described as "he was quite catatonic"; NAIL DISCOLOURATION (non-serious) with onset 23Dec2021, outcome "unknown", described as "two hours before I have seen like his foot nails, I had noticed them like grey, not very white"; ASTHENIA (non-serious) with onset 23Dec2021, outcome "unknown", described as "he was very weak". The patient underwent the following laboratory tests and procedures: blood pressure measurement: (23Dec2021) 80/40; blood test: (unspecified date) normal; computerised tomogram: (unspecified date) unknwon results; oxygen saturation: (unspecified date) 92; sars-cov-2 test: (23Dec2021) positive; (23Dec2021) positive. The action taken for ibuprofen and dextromethorphan hydrobromide, guaifenesin was unknown. Therapeutic measures were taken as a result of covid-19, near death experience, syncope, head injury, hypotension, pallor, dehydration, catatonia, nail discolouration, asthenia, hyperhidrosis, disorientation, gait inability. Clinical course: The patient had been very ill days before with the lot of cough, aches and nasal congestion and aches in his body in his feet and feeling nausea until this. Just before the patient fainted, he had taken two Advil 200 mg each like ten minutes not before and he had taken a teaspoon of a syrup the patient mother had purchased, he had taken it like 1 hour before brand name Rompe Pecho. One hour before he felt symptoms that he was nauseous and he was having his lunch he felt nausea he stood up from where he was eating, towards the bathroom to vomit and suddenly the next thing the patient mother heard was something from the wall that fall and it was because he hit up the wall and he tried to grab it because he fainted there in the floor which was his first fainting, then came two others which was ''unreal'', the third one was ''unreal''. Well he was taken to the hospital, he was stabilized and arrived like at 01:30 or 2:00, he was discharged seven hours after. The patient was hydrated, he was found to be dehydrated to rehydrate it, so it was the normal saline he has two IV pushed. He was taken to isolation, and they did not put him on any oxygen assistance mechanism. The patient was discharged on the 23Dec2021 having to take Vitamin C 6000 mg, 3000 mg in the morning and 3000 in the afternoon, which he has not taken that many (later pharmacist stated as he was taking only 2000 a day), he has taken less, he was discharged with Azithromycin 500 mg, 3 tablets for to take once for 3 days (pharmacist stated 1 tablet per day for 3 days only). He was also discharged with having to take Dologesic (later pharmacist stated this medication for discomfort and some fever to keep the fever in control) which was having acetaminophen and anti-histaminic, the patient was also discharged with one tablet of Zinc without specifying the dose, he was also recommended to take ''Tussmel'' which was really, a mixture for the decongestant and all that and patient mother did not give him that, he was having Tylenol every 6 hours two 500 mg Tylenol and well he was on fever, he was given the Medrol 4, the Medrol pack which has the 21 tablet the medicine prednisolone 4 mg, Medrol pack (pharmacist confirmed this as 21 tablet that are taken on certain frequency for 6 consecutive days which are methylprednisolone 4 mg tablet) and zinc tablet are 50 mg (further not clarified). On 27Dec2021, it was the first day, the patient had hardly a cough because he kept coughing till yesterday (26Dec2021), the patient had cough like four time in the whole day, that was all, he has not have a fever, he feels more energetic, he feels great. But he has been sleeping a lot since the 23 he was constantly sleeping, you know he would wake up, he lost his appetite and he was feeling some loss of taste, he feels that things do not taste like they used to taste, that he hardly does have a taste. Follow-up attempts are completed. No further information is expected.; Sender''s Comments: Based on the temporal relation, the association between the events of Drug Ineffective, COVID-19, Near Death experience and syncope and the suspect product of BNT162B2 cannot be completely ruled out. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.


VAERS ID: 2018721 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:0000-00-00
Onset:2021-12-23
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Benign breast neoplasm, COVID-19, Cough, Dyspnoea, Hyperhidrosis, Influenza, Nasal congestion, Pulmonary pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: fever; Result Unstructured Data: Test Result:103.3; Comments: I got a very high fever 103.3
CDC Split Type: USPFIZER INC202101870644

Write-up: I got COVID; I got a very high fever 103.3 was the highest I measured; I have been having the very heavy sweats during the night, general malaise, it started with a lot of pressure inside my lung that I could not breath; cough and the nasal congestion; I got a reaction on my nipple; I got a growth a benign growth on my left nipple; I just had symptoms like COVID or influenza; I have been having the very heavy sweats during the night, general malaise, it started with a lot of pressure inside my lung that I could not breath; I have been having the very heavy sweats during the night, general malaise, it started with a lot of pressure inside my lung that I could not breath; cough and the nasal congestion; This is a spontaneous report received from a contactable reporter(s) (Pharmacist) from product quality group. The reporter is the patient. A 59 year-old female patient received bnt162b2 (BNT162B2), administered in arm left (Lot number: EW0196) at the age of 59 years as dose 2, single for covid-19 immunisation. The patient''s relevant medical history and concomitant medications were not reported. Vaccination history included: Bnt162b2 (Dose: 1, Lot: EW0177), administration date: May2021, for COVID-19 immunization. The following information was reported: COVID-19 (medically significant) with onset 23Dec2021, outcome "unknown", described as "I got COVID"; PYREXIA (non-serious) with onset 23Dec2021, outcome "unknown", described as "I got a very high fever 103.3 was the highest I measured"; DYSPNOEA (non-serious), HYPERHIDROSIS (non-serious), PULMONARY PAIN (non-serious) all with onset 23Dec2021, outcome "unknown" and all described as "I have been having the very heavy sweats during the night, general malaise, it started with a lot of pressure inside my lung that I could not breath";it started with a lot of pressure inside her lung that she could not breath and that was for the first day and then ''eatables'' then to start the next day was starting to cough and the nasal congestion came like on day three. Her symptoms started on 23Dec. NASAL CONGESTION (non-serious), COUGH (non-serious) all with onset 23Dec2021, outcome "unknown" and all described as "cough and the nasal congestion"; BENIGN BREAST NEOPLASM (non-serious) with onset 23Dec2021, outcome "unknown", described as "I got a reaction on my nipple; I got a growth a benign growth on my left nipple"; INFLUENZA (non-serious) with onset 23Dec2021, outcome "unknown", described as "I just had symptoms like COVID or influenza". The patient underwent the following laboratory tests and procedures: pyrexia: 103.3, notes: I got a very high fever 103.3. Clinical course: Pharmacist further stated, "In his case was that he got COVID although he has my two doses, he got COVID and he got a very high fever 103.3 was the highest he measured. He has been having the very heavy sweats during the night, general malaise, it started with a lot of pressure inside his lung that he could not breath and that was for the first day and then ''eatables'' then to start the next day was starting to cough and the nasal congestion came like on day three. His symptoms started on 23Dec2021. Pharmacist stated, "In my case, he got it on the left arm and actually two days after he got a reaction on his nipple and we do not know, he got black a reaction and he had to have a biopsy on his nipple and that came two days after he got his first vaccine, it came out as benign growth, but it was very interesting that he got that immediately two days after the vaccination and his son, he think he also because we are right handed so got vaccinated on the left hand, on the left arm. Pharmacist further added, he got a growth a benign growth on his left nipple which was not there it''s invisible and he got a biopsy done.; Sender''s Comments: Based on the information provided and plausible temporal association, the causality between BNT162B2 and events cannot be completely excluded. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.


VAERS ID: 2018724 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-30
Onset:2021-12-23
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / OT

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Drug ineffective, SARS-CoV-2 test
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20211223; Test Name: Nasal Swab; Test Result: Positive ; Comments: Nasal Swab
CDC Split Type: USPFIZER INC202101870698

Write-up: Contracted COVID; Contracted COVID; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP). A 22-year-old male patient received bnt162b2 (BNT162B2), intramuscular, administered in arm right, administration date 30Jun2021 13:00 (Batch/Lot number: unknown) at the age of 21 years as dose 2, single and intramuscular, administered in arm right, administration date 23Jun2021 (Batch/Lot number: unknown) as dose 1, single for covid-19 immunisation. The patient''s relevant medical history and concomitant medications were not reported. The following information was reported: drug ineffective, COVID-19 (medically significant) all with onset 23Dec2021, outcome recovered (2021). Therapeutic measures were not taken as a result of drug ineffective, covid-19. Clinical course: No other vaccine in four weeks. It was unknown if the patient had Covid prior vaccination. Patient had covid tested post vaccination. No Known allergies. The lot number for bnt162b2 was not provided and will be requested during follow up.


VAERS ID: 2018738 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-02-18
Onset:2021-12-23
   Days after vaccination:308
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 2 LA / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20211223; Test Name: PCR testing; Test Result: Positive ; Comments: Nasal Swab
CDC Split Type: USPFIZER INC202101871708

Write-up: I was confirmed positive for Covid-19; I was confirmed positive for Covid-19; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP) from product quality group. The reporter is the patient. A 25 year-old male patient received bnt162b2 (BNT162B2), intramuscular, administered in arm left, administration date 18Feb2021 (Lot number: EL3247) at the age of 25 years as dose 2, single and intramuscular, administered in arm left, administration date 28Jan2021 (Lot number: EL3247) as dose 1, single for covid-19 immunisation. The patient''s relevant medical history and concomitant medications were not reported. The following information was reported: vaccination failure, COVID-19 all with onset 23Dec2021, outcome recovered (2021). Therapeutic measures were not taken as a result of vaccination failure, covid-19. No follow-up attempts are possible. No further information is expected.


VAERS ID: 2018846 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-12-17
Onset:2021-12-23
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 83030BD / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood test, Gynaecological examination, Inappropriate schedule of product administration, Menstrual disorder, Postmenopausal haemorrhage, Smear cervix
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: Blood test; Result Unstructured Data: Test Result:all good; Test Name: Pelvic exam; Result Unstructured Data: Test Result:Unknown Results; Test Name: PAP smear; Result Unstructured Data: Test Result:Unknown Results
CDC Split Type: USPFIZER INC202101885066

Write-up: Date for first shot: Consumer stated, "First shot was done on 06Apr2021."; I am having periods which I shouldn''t have because I am very post menopausal; I started bleeding; menopausal female; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP). The reporter is the patient. A 61 year-old female patient received bnt162b2 (COMIRNATY), administered in arm left, administration date 17Dec2021 14:00 (Lot number: 83030BD) at the age of 61 years as dose 2, single for covid-19 immunisation. The patient''s relevant medical history and concomitant medications were not reported. Vaccination history included: Bnt162b2 (DOSE: 1), administration date: 06Apr2021, for Covid-19 Immunization. The following information was reported: POSTMENOPAUSAL HAEMORRHAGE (medically significant) with onset 23Dec2021, outcome "not recovered", described as "I started bleeding; menopausal female"; INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (non-serious), outcome "unknown", described as "Date for first shot: Consumer stated, "First shot was done on 06Apr2021.""; MENSTRUAL DISORDER (non-serious) with onset 23Dec2021, outcome "not recovered", described as "I am having periods which I shouldn''t have because I am very post menopausal". The events "i started bleeding; menopausal female" and "i am having periods which i shouldn''t have because i am very post menopausal" were evaluated at the physician office visit. The patient underwent the following laboratory tests and procedures: blood test: all good; gynaecological examination: unknown results; smear cervix: unknown results. Therapeutic measures were not taken as a result of postmenopausal haemorrhage, menstrual disorder. Clinical course: The consumer reported that she was very healthy forever and she still believing, it''s been 8 days now and pretty convinced that it''s because of the shot, there is no other reason to this, she had been post menopausal for probably about 8 years. She was having a uterine ultrasound next week and she have to go to the hospital for that. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. No follow-up attempts are possible. No further information is expected.


VAERS ID: 2019237 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ8785 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Migraine, Nausea, Photosensitivity reaction
SMQs:, Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No prescriptions. No over-the-counter medications. Occasional multi-vitamin (1-2x/week). Occasional B-vitamin supplement (2-3x/week).
Current Illness: No illnesses at the time of vaccination and no illnesses the month prior. My husband tested positive for Covid-19 on September 16th. My son, my husband, and I were all in quarantine together for 14 days. My husband recovered completely. My son and I never experienced symptoms.
Preexisting Conditions: I have no chronic or long-standing health conditions and have never had a migraine in my life. I have only ever experienced a couple headaches in my entire life.
Allergies: No known allergies to medications, foods, or other products.
Diagnostic Lab Data: I have not been to see my medical provider since I received the booster shot and have been plagued with an intense HA or migraine since then.
CDC Split Type:

Write-up: About two hours after receiving the booster shot, I began to get a really intense headache. I do not normally get headaches, so I drank a lot of water and tried to wait it out. The headache continued to intensify to the point of needing to lie down in a dark room. Over the next four days, I had symptoms of a classical migraine (even though I had never had one before in my life). I had photosensitivity, was very nauseated, and often had to go lie in a dark room. I took the maximum dose of OTC Aleve but it did not alleviate the headache. On the fifth day, Dec 28th, I woke up with an intense headache but it did not have the same migraine-like quality to it. Later on that day, it progressed to a migraine again and I was back to bed. Since Dec. 29th, I have had a non-stop headache that ranges from moderately severe to debilitating (back in bed in a dark room). I continue to take the recommended dosage of OTC NSAIDs or ibuprofen. Today, as of reporting this, it is Saturday, Jan. 8th and I continue to have a severe headache.


VAERS ID: 2019340 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-12-22
Onset:2021-12-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Feeling abnormal, Tinnitus
SMQs:, Dementia (broad), Hearing impairment (narrow)

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: Atorvastatin - 10mg/daily Omeprazole - 20mg/daily Vitamin D - 1000iu/daily
Current Illness: None
Preexisting Conditions: None
Allergies: None known
Diagnostic Lab Data: None yet. I''m doing an audiogram on January 17th, 2022 and have a follow-up with my ENT doctor on January 18th, 2022.
CDC Split Type:

Write-up: Shortly after I woke up the morning after having received the vaccine, I noticed humming/buzzing in my ears, consistent with tinnitus symptoms, and also "medicine head" or "brain fog". This was about 24 hours after receiving the injection. The symptoms have persisted since the initial onset and have not improved. I originally received both doses of the Pfizer Covid vaccine April 9th 2021 and April 30th 2021. This was my booster dose and I chose Moderna based on the higher effectiveness rate.


VAERS ID: 2019404 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-12-21
Onset:2021-12-23
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site swelling, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: Patient reported standard sore arm following injection which went away after a couple of days but noticed 4-5 days later that the pain returned and that he had a bump on his arm right around the site of injection. Patient came into the pharmacy approximately a week and a half later to have it looked at. Arm still had a small (5-15mm) but noticeable solid bump under the skin which he described as mildly painful. Recommended tylenol or ibuprofen to help with the pain and to continue to monitor the bump for a few more days. If it doesn''t improve.


VAERS ID: 2019529 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-12-11
Onset:2021-12-23
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2022-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031H21A / UNK - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Mechanical urticaria, 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: progesterone + estradiol for early menopause
Current Illness: none
Preexisting Conditions: none
Allergies: sulfa/bactrim
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe hives and itching beginning 11 days post booster as well as dermatographia. Has not subsided yet.


VAERS ID: 2019832 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-12-23
Onset:2021-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041J21A / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer dose 2 reports pinpoint magnetism (reports similar issue), dose 1 (felt amped up like on "adderall")
Other Medications: -Lion''s Mane
Current Illness: -None
Preexisting Conditions: -None
Allergies: - NKA
Diagnostic Lab Data: -None yet
CDC Split Type:

Write-up: -After the vaccine, the patient experienced magnetic charge underneath where the booster was given and feels it all the way to fingertips and back. -When patient puts magnet where the vaccine was given, he states that the magnet sticks to the site. He feels like he has a "bionic arm" and is concerned with quality control and what he is experiencing. -Feels like as time goes on, it gets worse


VAERS ID: 2019881 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-12-11
Onset:2021-12-23
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2022-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chronic spontaneous urticaria, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), 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? 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: biaxin; flagel
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Chronic Spontaneous Urticaria after receiving my Booster shot on 12-11-2021. On Dec. 23rd, I had severe itching with major hives on my back, legs, groin and arms. This has continued to date...1/9/2022. I take Zyrtec during the day and Benadryl at night along with cortisone creme. I have never been so itchy for such a long period of time. I have no severe allergies, very healthy and now I severe itching and hives. All due to this booster.....what is happening to the inside of my body and organs? Something and someone needs to contact me......!!!!


VAERS ID: 2019903 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-12-17
Onset:2021-12-23
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2022-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Anaemia postoperative, Aortic dissection, Aortic valve repair, Blood loss anaemia, Cerebrovascular accident, Chest discomfort, Chest pain, Dizziness, Dysphagia, Intensive care, Malnutrition, Pericardial haemorrhage, Supraventricular tachycardia, Urinary retention
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 16 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: multivitamin
Current Illness: na
Preexisting Conditions: na
Allergies: na
Diagnostic Lab Data: ? *Ascending aortic dissection 12/24/2021 Yes ? Acute urinary retention 01/06/2022 Unknown ? Oropharyngeal dysphagia 01/04/2022 Unknown ? Moderate protein-calorie malnutrition 01/04/2022 Unknown ? Acute postoperative pulmonary insufficiency 01/03/2022 Unknown ? Supraventricular tachycardia 12/30/2021 No ? Acute ischemic left MCA stroke 12/27/2021 No ? S/P aortic dissection repair 12/24/2021 No ? Acute blood loss as cause of postoperative anemia 12/24/2021 No
CDC Split Type:

Write-up: Patient is a 57 y.o. male with no significant PMH who presented with chest pain and tightness, dizziness. He was found to have a pericardial hematoma with an aortic dissection that extended from the aortic root to the SMA. He was taken class A to the OR where it was repaired and was admitted to the CVICU with the following conditions: Active Hospital Problems Diagnosis Date Noted POA ? Chest pain 12/24/2021 Yes ? Ascending aortic dissection 12/24/2021 Yes ? S/P aortic dissection repair 12/24/2021 No Condition: Critically ill


VAERS ID: 2020353 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-12-22
Onset:2021-12-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Dizziness, Dyspnoea, Lip swelling, Malaise, Presyncope, Pruritus, Pyrexia, Rash, Swollen tongue, Tachycardia
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: After 1st dose of covid vaccine
Other Medications: None
Current Illness: None. Hypersensitivity reaction and angioedema in Nov 2021 after 1st dose of covid vaccine.
Preexisting Conditions: None
Allergies: Polyethylene sorbitan, polyethylene glycol, eggs, pollen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe rigors, fever, malaise, extreme generalized weakness, lip and tongue swelling, generalized skin rash with itching, shortness of breath, dizziness, presyncope, tachycardia.


VAERS ID: 2020426 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-14
Onset:2021-12-23
   Days after vaccination:253
Submitted: 0000-00-00
Entered: 2022-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 2 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Drug ineffective, SARS-CoV-2 test
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20211223; Test Name: COVID-19 test; Test Result: Positive ; Result Unstructured Data: Positive; Test Date: 20211226; Test Name: COVID-19 test; Test Result: Positive ; Result Unstructured Data: positive
CDC Split Type: USMODERNATX, INC.MOD20214

Write-up: Lack of efficacy; tested positive for COVID/still had COVID symptoms; This spontaneous case was reported by an other health care professional and describes the occurrence of DRUG INEFFECTIVE (Lack of efficacy) and COVID-19 (tested positive for COVID/still had COVID symptoms) in a 63-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 047B21A and 034C21A) for COVID-19 vaccination. No Medical History information was reported. On 14-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 12-May-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 23-Dec-2021, the patient experienced DRUG INEFFECTIVE (Lack of efficacy) and COVID-19 (tested positive for COVID/still had COVID symptoms). At the time of the report, DRUG INEFFECTIVE (Lack of efficacy) and COVID-19 (tested positive for COVID/still had COVID symptoms) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 23-Dec-2021, SARS-CoV-2 test: positive (Positive) Positive. On 26-Dec-2021, SARS-CoV-2 test: positive (Positive) positive. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medication and treatment information was reported. The patient tested positive for COVID on 23-Dec-2021 via the quick view test. The patient had a booster dose appointment that was scheduled on 27-Dec-2021 which the patient called off as the patient still had COVID symptoms. The patient reported that the patient got tested again on 26-Dec-2021 and was tested positive. The patient reported about experiencing the side effects got shaky, runny nose, could not stop shaking, cold chills, scuffy throat, throat was raw and dry, fatigue and the patient''s life had been miserable for last 5 days. The patient queried whether the patient needed a booster dose after getting infected and hated getting additional immunity. Patient tested positive twice in the last week including a lab test and queried how could he said which variant did have Delta or Omicron. This is a spontaneous case concerning a 63-year-old, male patient with no relevant medical history, who experienced the unexpected non-serious event of Drug Ineffective and Covid-19 as an added event. The events occurred approximately 7 months after the second dose of mRNA-1273 COVID 19 Vaccine. The rechallenge was unknown since no information about the first dose was disclosed. The events outcome were reported as unknown. The benefit-risk relationship of mRNA-1273 COVID 19 Vaccine, is not affected by this report. Most recent FOLLOW-UP information incorporated above includes: On 27-Dec-2021: Narrative updated. On 30-Dec-2021: Added lab data.; Sender''s Comments: This is a spontaneous case concerning a 63-year-old, male patient with no relevant medical history, who experienced the unexpected non-serious event of Drug Ineffective and Covid-19 as an added event. The events occurred approximately 7 months after the second dose of mRNA-1273 COVID 19 Vaccine. The rechallenge was unknown since no information about the first dose was disclosed. The events outcome were reported as unknown. The benefit-risk relationship of mRNA-1273 COVID 19 Vaccine, is not affected by this report.


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