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

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



Case Details (Reverse Sorted by Onset Date)

This is page 168 out of 6,867

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VAERS ID: 1558175 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-03-03
Onset:2021-08-10
   Days after vaccination:160
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM 9809 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN 6206 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Illness
SMQs:

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

Write-up: admitted to on 8/10. No details of symptoms of course of illness could be obtained.


VAERS ID: 1558179 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Unknown  
Location: Kentucky  
Vaccinated:1951-11-01
Onset:2021-08-10
   Days after vaccination:25485
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 03L20A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Exposure to SARS-CoV-2, Infusion, Malaise, 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: Positive COVID has symptoms and positive contact symptoms are mild and seem to be improving she got the infusion treatment


VAERS ID: 1558197 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-31
Onset:2021-08-10
   Days after vaccination:132
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN NOT LISTED / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Infusion, Malaise, 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: Positive COVID mild symptoms has had infusion treatment. Lot number is not listed.


VAERS ID: 1558350 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Blood test abnormal, Chest X-ray normal, Chest pain, Computerised tomogram thorax normal, Echocardiogram normal, Fibrin D dimer increased, Headache, Heart rate increased, Injection site pain, Insomnia, Nausea, Pain, Thyroid hormones increased
SMQs:, Acute pancreatitis (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypothyroidism (broad), Hyperthyroidism (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none; On July 22nd I did have a hepatitis vaccine.
Current Illness: none
Preexisting Conditions: Vasovagal syncope (2 fainting episodes, no cause known)
Allergies: none
Diagnostic Lab Data: August 13th Chest Pain increased, went to two hospitals. ER visit: Clear Chest X ray; Abnormal Bloodwork -$g slightly elevated thyroid; Blood work showed high D-Dimer, and so a chest CT was done which was also clear. Tried sleeping for one hour after 1 Tylenol and Advil upon arrival home. Woke up with nausea and severe chest Pain resulting in 2nd ER visit. Chest X-Ray and repeated labs were clear, other than D-Dimer and thyroid. Chest Echo done, nothing wrong. Orthopedics test done. High pulse after sitting up and standing up. Leveled out after drinking more water.
CDC Split Type:

Write-up: At present Chest Pain since 1/2 hour after vaccination now occurring 5+ days . Anxiety present over symptoms for hour after vaccination. Body aches and soreness at injection site present on 11th only. Headaches on and off still present. Insomnia in relation to chest pain.


VAERS ID: 1558372 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pruritus, Rash, 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: Lexapro ,Buspirone, Omeprazole, linzess, Singular, Zyrtec, gabapentin,
Current Illness: No
Preexisting Conditions: Asthma
Allergies: Sulfur naproxen amoxicillin and penicillin and I''m allergic to nuts.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Since I got the shot Tuesday as today it''s Saturday August 14th I still have my rash, the welt and the itching. Using ice and Benadryl cream to try to stop the itching.


VAERS ID: 1558412 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-08
Onset:2021-08-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Inflammation, Lymph node pain, Nausea, Pyrexia, Rash, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid 88mcg
Current Illness: None
Preexisting Conditions: Inactive thyroid gland
Allergies: Sulfa drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever- 4 days, headache, nausea-2 days, inflamed, itchy, rash on upper arm-started at Day 2, still experiencing Day 6. Extremely sore underarm lymph node Days 3, 4, and 5.


VAERS ID: 1558425 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: pt lost consciousness briefly and was evaluated by EMS


VAERS ID: 1558454 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007021A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Crying, Dyspnoea, Emotional disorder, Facial pain, Feeling abnormal, Hypoaesthesia, Lethargy, Musculoskeletal stiffness, Paraesthesia, Visual impairment
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Arthritis (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydrochlorothiazide 25mg
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Initial sign was stiffness in the joint of the left shoulder and numbness /tingling in left hand. Later that evening chills but no fever, restlessness during the night. The next morning tired and facial soreness (same issues as in March when tested positive for covid). Lethargy proceeded throughout the day. Fell asleep by 7:15 pm and sleep through to next morning approximately 6 am. Proceeded to start my day with continued lethargy, strange eyesight issues (not knowing what it feels like to be ''tripping'' I would have to say the things that were presented have to be pretty close to ''tripping''). Odd things standing out when I looked around possibly like 3d. Inanimate objects projecting themselves very ''loudly'' to me. While looking at my cell phone it was pulled out at the corners stretching it diagonally like it was animated. Very emotional, crying for no reason. Very odd experience. Later that day it was very tiring to go up and down stairs and would take my breathe away. Again, this was a previous experience in March. Friday still tired but could function for the most part, VERY short on patience to the point of intolerable and feeling like a stroke or heart attach was coming on (probably a panic attach). Today, Saturday the 14th feeling relatively normal again.


VAERS ID: 1559247 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-03-14
Onset:2021-08-10
   Days after vaccination:149
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Pneumonia cryptococcal, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (narrow), 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, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine, baby aspirin, atorvastatin, calcium carbonate, vitamin d, fish oil, empagliflozin, fluconazole, glimepiride, levothyroxine, losartan, metformin, MVI
Current Illness:
Preexisting Conditions: HTN, HLD, DM2, hypothyroidism, OSA, cryptococcal neoformas PNA (diagnosed 4/2021 still on medication)
Allergies: ACE inhibitors
Diagnostic Lab Data: COVID status positive (8/10/21).
CDC Split Type:

Write-up: Patient received Janssen COVID vaccine on 3/14/21. On 8/10/21, patient was admitted to our facility for COVID PNA with acute hypoxic respiratory failure (COVID status positive 8/10/21). As of today (8/14/21), patient is still admitted in the inpatient unit med/surg floor.


VAERS ID: 1559260 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-03-25
Onset:2021-08-10
   Days after vaccination:138
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19 pneumonia, Pneumonia aspiration, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen CR, MVI, omeprazole
Current Illness:
Preexisting Conditions: Dementia
Allergies: Sulfa
Diagnostic Lab Data: COVID status positive 8/10/21.
CDC Split Type:

Write-up: Patient received COVID vaccine Pfizer 2 dose series on 3/2/21 and 3/25/21. On 8/10/21, patient was found down at home and admitted for COVID infection/pneumonia. Patient was also found to have probable superimposed bacterial aspiration pneumonia and acute respiratory failure with hypoxia. As of today (8/14/21), patient is still admitted in the med/surg unit.


VAERS ID: 1562830 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

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

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

Write-up: Systemic: face numbness-Mild


VAERS ID: 1569058 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-08
Onset:2021-08-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Jaw clicking, Joint stiffness, Pain, Pain in jaw, Sleep disorder
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Osteonecrosis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac 20 mg, Magnesium 500 MG, Estroven, Vitex, Allegra 12 hr, Proposed OTC
Current Illness: None
Preexisting Conditions: Fibromyalgia, seasonal allergies
Allergies: Phenergan
Diagnostic Lab Data: I have an upcoming appointment with my PCP on August 26th, at which point I will address this adverse event.
CDC Split Type:

Write-up: Less than 36 hours following vaccine in left arm, I awoke in the middle of the night with sore, stiff left jaw with loud popping in my jaw whenever opening my mouth. My left jaw has popped loudly every time I open my mouth or chew ever since. It is so loud that others can hear it. Upon wet weather, it became very achy. I have never had any symptoms at all with my left jaw before the vaccine. In addition, it has been accompanied by occasional dizziness.


VAERS ID: 1569116 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066021A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Headache, Heart rate increased, Hyperhidrosis, Impaired driving ability, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pantoprazole 1 @ 40mg ppd, Saw Palmetto (450 mg/day)
Current Illness: None.
Preexisting Conditions: Reflux.
Allergies: None known.
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Dizziness to a point where driving a motor vehicle would have been unsafe. Occurred initially while swimming (lap swimming, outdoors). Coincided with symptoms of heat exhaustion, to include nausea, weakness, rapid pulse, and profuse sweating. Heat injury symptoms subsided within 1-2 hours. Dizziness continued for 3 days, followed by mild headache for an additional 1 day.


VAERS ID: 1569168 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Apathy, Asthenia, Balance disorder, Blood pressure increased, Condition aggravated, Decreased appetite, Depression, Dizziness, Fatigue, Feeling abnormal, Lethargy, Middle insomnia, Tinnitus
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Depression (excl suicide and self injury) (narrow), Hearing impairment (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Sensitive to EMFs and other environmental triggers (Formaldahyde) - using certain cellphones, an iPhone - all have given me headaches in the past, made me feel unwell, general ill feeling with dark cloudiness and fog of the brain. Am an athlete - cyclist, spinning instructor, tennis player. I did have some hypertension in 2020. In 2019 was noticing my blood pressure was creeping up over the previous few years - 135/79. Hence, was taking regular blood pressure readings with a home monitor. But in the last eight months in 2021, was able to get my blood pressure down to 122/77 using healthy foods (diet change) and an increase in cycling.
Allergies: NONE
Diagnostic Lab Data: Medical testing will happen tomorrow. Doctor will draw blood.
CDC Split Type:

Write-up: Two days prior to vaccination, I went to medical facility to have a Covid test. They took my vitals (which we discussed because they were so good - nurse asking me about being a cyclist.). Vitals: 122/77, 46 heart rate. Monday, August 9th - I got my first shot of Pfizer vaccine. By that night and into the next 4 days, I am down with low energy, lethargic, just dark, depression, cloudy fog on the brain. Some moments seemed to be better. Saturday, August 14th, I woke up - as I had been doing all week - in the middle of the night at 3:30am to go pee. I decided to get up and take my blood pressure, because my ears were ringing and I felt as if my "blood was boiling" (as if I had down 12 espresso shots). Sure enough, my reading was 155/97. I went to an urgent care yesterday to see what they could do. They said they couldn''t do anything and that I would need to either go to ER or see a cardiologist. They could draw blood to see a panel but there was really nothing else they could do. Today (Sunday August 15th) - nothing has changed. Feeling "off balance", slightly dizzy, bad ringing in the ears and no energy, and blood pressure has kept up around the same level between 140/40 and 155/95. The ear ringing has not stopped. Not hungry. Feel really run down and not wanting to do anything.


VAERS ID: 1569190 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cytomel Synthroid Adderall Rosuvastatin Baby aspein
Current Illness: None
Preexisting Conditions: Hashimotos Hx of cerebral carotid artery dissection with 2 pseudo aneurysms
Allergies: Midazolam Several Environmental have Epi pen
Diagnostic Lab Data: None taken
CDC Split Type:

Write-up: Chest tightness at first Hard to breathe Feeling light headed Feeling faint


VAERS ID: 1569200 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-25
Onset:2021-08-10
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Haemorrhage urinary tract, Heavy menstrual bleeding
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: At the onset of menses, the volume of bleeding was approximately twice to triple that of which I have experienced previously across my history of menstrual cycles with the exception of immediate postpartum bleeding. I also observed substantially heavier and larger clots than I typically see at the time of my period. I track my fertility including temperature and cervical mucus observations. In the intervening days between the adminstration of the Pfizer shot and the onset of my period of August 10th, I also observed oddities in my pattern of temperatures .


VAERS ID: 1569249 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia, Anosmia, Chills, Dizziness, Fatigue, Hyperhidrosis, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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:
Current Illness: NK
Preexisting Conditions: none
Allergies: NK
Diagnostic Lab Data: none to date. I will be going to seek care tomorrow
CDC Split Type:

Write-up: Body aches, fever, chills, sweats, fatigue, dizzyness, loss of taste & smell (three days post vacinne)


VAERS ID: 1569926 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-06
Onset:2021-08-10
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dermatitis acneiform, Eye swelling, Pruritus, Swelling face, 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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient woke up Tuesday 8/10/21 with rash on face, neck, shoulder, legs, hands and had itching and hives. Patient went to the Dr on Wednesday 8/11/21 and the Dr prescribed patient cream for itching. Then Thursday 8/12/21 the patient had swelling in face and eyes. The patient self treated with calamine lotion and Aveeno wash. The patient started taking Allegra over the counter on Sunday 8/15/21. The patient says their symptoms have gotten better since taking Allegra. The patient has follow up appointment with Dr on Wednesday 8/18/21.


VAERS ID: 1571209 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Injection site pain, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Nausea, chills, headache, body ache, pain at the site of injection, fatigue


VAERS ID: 1571815 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-08
Onset:2021-08-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / -

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

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

Write-up: Skin bumps on right lower side of cheek, right side of neck, and under chin.


VAERS ID: 1573638 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-17
Onset:2021-08-10
   Days after vaccination:54
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Hyponatraemia, Seizure like phenomena
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (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), Convulsions (narrow), Hyponatraemia/SIADH (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

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

Write-up: E87.1 - Hyponatremia N17.9 - AKI (acute kidney injury) R56.9 - Seizure-like activity


VAERS ID: 1573804 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-05
Onset:2021-08-10
   Days after vaccination:186
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, COVID-19, Cough, Diarrhoea, Dyspnoea, Exposure to SARS-CoV-2, Fatigue, Hypophagia, SARS-CoV-2 test positive, Urine output decreased, Weight decreased
SMQs:, Acute renal failure (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Taste and smell disorders (narrow), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hospital Chronic Kidney Disease Stage 5 Glomerular Filtration Rate Less Than 15 Peripheral Arterial Disease
Allergies:
Diagnostic Lab Data: Coronavirus 2 PCR Detect, V symptomatic POSITIVE
CDC Split Type:

Write-up: Patient is a 75 y.o. male with medical comorbidities significant for prior CVA, hypertension, hyperlipidemia, type 2 diabetes mellitus c/b diabetic retinopathy, s/p gastric bypass NASH, OSA, CAD, PAD s/p right SFA to peroneal artery bypass, CKD Stage IIIB and recent hospitalization (06/23-07/02) for intestinal perforation requiring ex lap for repair of gastrojejunostomy marginal ulcer. His hospitalization was complicated by acute renal failure requiring iHD which improved prior to discharge, and delirium. He presented to the ED today for evaluation for 3 days of cough and poor oral intake. In the ED he was afebrile and hemodynamically stable. Oxygenating well on room air. Labs were notable for


VAERS ID: 1573808 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-22
Onset:2021-08-10
   Days after vaccination:80
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Cardiomegaly, Chest pain, Imaging procedure
SMQs:, Cardiac failure (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Chest pains-for 3 days


VAERS ID: 1573836 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-03-01
Onset:2021-08-10
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Asymptomatic COVID-19, 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: NONE
Preexisting Conditions: GENERALIZED ANXIETY DISORDER, PTSD, SEVERE RECURRENT MAJOR DEPRESSION WITHOUT PSYCHOTIC FEATURES, GERD, HYPERMOBILITY OF A JOINT, JOINT PAIN, DYSPHAGIA
Allergies: LATEX, SEAFOOD
Diagnostic Lab Data: 08/10/21: POSITIVE SARS-COV-2 RNA
CDC Split Type:

Write-up: POSITIVE COVID TEST 08/10/21. NO SIGNS OR SYMPTOMS.


VAERS ID: 1573854 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-17
Onset:2021-08-10
   Days after vaccination:174
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Nervous Degeneration Macular Neuralgia Post Herpetic Radiculopathy Lumbar Fifth Right Exudative Age-Related Macular Degeneration Unspecified Stage Bilateral Hemorrhage Retinal Bilateral Pain Low Back Respiratory Apnea Sleep Obstructive Circulatory Hypertension Essential Primary Murmur Heart Digestive Gastroesophageal Reflux Disease Without Esophagitis Constipation Genitourinary Urinary Urge Incontinence Incontinence Urinary Stress And Urge Musculoskeletal Osteoporosis Spondylosis Lumbar Without Myelopathy Other Specified Inflammatory Spondylopathies Sacral And Sacrococcygeal Region Endocrine/Metabolic Hypothyroidism On Replacement Hematologic Anemia Infectious/Inflammatory COVID-19 Infection Other Stenosis Spinal Lumbar Cancer Lung Adenocarcinoma Personal History Smoking Tobacco Use Personal History Major Depressive Disorder Single Episode Unspecified History Of Falling Insomnia Replacement Intraocular Lens Status Post Blurred Vision Low Vision Left Eye Category 1 Normal Vision Right Eye Refraction Disorder
Allergies:
Diagnostic Lab Data: Coronavirus 2 PCR Detect, V symptomatic POSITIVE
CDC Split Type:

Write-up: weakness


VAERS ID: 1573871 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-06
Onset:2021-08-10
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Lymphadenopathy
SMQs:, Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Left armpit lymph gland swollen and sore where shot was administered


VAERS ID: 1573879 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Chills, Dizziness, Rash, SARS-CoV-2 test negative, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: pre natal vit, motrin ,senokot
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: tested for covid at hospital, result neg
CDC Split Type:

Write-up: Dizziness,inittally, evening of vaccination rash on chest, back ache, and chills. next day Cp, throat tightness . Seen at hospital


VAERS ID: 1573909 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 - / -

Administered by: Public       Purchased by: ?
Symptoms: Cough, Dizziness, Dyspnoea, Headache, Malaise, Muscle strain, Pyrexia, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: sertrallne 25mg
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: dizziness, headaches, coughing, felt under the weather, congestion, couldnt breath, fever, fells like shes pulled a muscle in the right side wants us to know she tested positive for anti bodies in may of 2020


VAERS ID: 1573995 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-08
Onset:2021-08-10
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test
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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexapro; laprbutro; trazadone; insulin
Current Illness: No
Preexisting Conditions: Hypertension; heart disease; diabetes; depression
Allergies: No
Diagnostic Lab Data: COVID testing; rapid test.
CDC Split Type: vsafe

Write-up: Contracted COVID-19.


VAERS ID: 1574020 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Fatigue, Nausea, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Buspirone 5mg PRN
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: 22-year-old female presents to the ER with possible reaction to a Covid vaccine. Patient states that she received her Covid vaccine. Approximate 10 minutes later she states she started having tingling down her right arm where she got the vaccine. The staff report that patient went to get up and felt lightheaded and dizzy and nauseated and almost passed out. They state that they immediately brought her here to the ER. Currently here in the ER patient denies any problems swallowing or problems breathing. States she does not feel short of breath. Patient states she just feels really tired. She reports she has not ate today and has only had a couple sips of liquids. States she is been in her usual state health up until the incident today. Denies any cough congestion. Denies any chest pain shortness of breath. Denies any vomiting or diarrhea. Denies any headaches or visual changes or focal weaknesses of the extremities. Denies any itching currently or rash.


VAERS ID: 1574024 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-05-20
Onset:2021-08-10
   Days after vaccination:82
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0126 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Gait disturbance, Inflammation, Myositis, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: EBV ( had mono last year )
Allergies: n/a
Diagnostic Lab Data: bloodwork, doctor visits.
CDC Split Type:

Write-up: My healthy active 18 yr old son can barely walk. Inflammation of both legs, incredible pain. Diagnosed with Myositis, 100% sure this is related to the vaccine. There was no reason for a healthy 18 yr old to be forced to get a vaccine that he did not need other than his college mandating it in order to play sports. Now he may not even be able to play. He has Covid one year ago and was fine - his immune system fought the infection as it was designed to.


VAERS ID: 1574027 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-07-13
Onset:2021-08-10
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray normal, Chest discomfort, Chest pain, Dizziness, Feeling abnormal, Fibrin D dimer normal, Full blood count normal, Hypertension, Metabolic function test, Nausea, Neutrophil count increased, Palpitations, Troponin normal, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Beyond Balance MC-Bar1; Beyond Balance MC-Bab2; Beyond Balance MC-BB1; FormiPlus oral drops
Current Illness: Treatment for chronic lyme disease (symptoms of lyme x 10 years)
Preexisting Conditions: Lyme disease, babesia, other possible tick borne illness
Allergies: True allergy to fish/shellfish; gluten intolerance; intolerance to night shade vegetables, chocolate, alcohol
Diagnostic Lab Data: Cbc wnl (wbc 10.5, neutrophil slightly elevated Trop negative D dimer wnl Bmp wnl Chest xray normal Upcoming appointment with cardiologist and holter event monitor for 30 days
CDC Split Type:

Write-up: At 4 am I awoke feeling poorly and had an alert from my watch that my heart rate was 140; I went to work (I am an ICU nurse) and felt fine until 08:30 when I felt heart palpitations, dizziness, light headedness, chest pain and pressure and I felt like I was going to pass out. I checked my pulse and it was 140. I asked my coworkers to put me on the monitor so they put me on pulse ox and checked my blood pressure. On pulse ox my oxygen saturation was 98%, my heart rate was 125 to 130 with some dropped beats that were non-perfusing. I was hypertensive at 160/90. This episode lasted about 10 minutes. After my heart rate normalized so did my blood pressure but I still felt lightheaded and dizzy and nauseated. After leaving work, I went to my doctors office. As I was being assessed by the nurse at 2:40 PM I felt another episode coming on. My heart rate was 150, I felt lightheaded and dizzy, nauseated, I felt like I was going to pass out, and I had chest pain and chest pressure. I had to lay back flat with my feet elevated so that I would not pass out. I was normotensive when the nurse checked my blood pressure. By the time the nurse got me on a 12 lead EKG, my heart rate has slowed down to 90 to 115, and appeared to be a sinus arrhythmia with increases in rate by 20 beats with any movement. For about 30 to 40 minutes I was unable to sit up because I still felt discomfort in my chest and I felt like I would pass out if I sat up. After I was able to move my heart was in a normal sinus rhythm and I was transferred to urgent care for further monitoring. In urgent care I had some blood sample sent including a CBC, BMP, D dimer, and troponin. The D dimer was normal and the troponin was negative. The BMP was normal, and the CBC was normal with the exception of A slight bump of my white blood cell count to 10.5, and a slightly elevated neutrophil count. I also received a chest x-ray which was normal. After I was discharged, I had another event at home with a heart rate of 100-115. This episode lasted about 30 minutes and I had to lie on my back with my feet elevated for the duration.


VAERS ID: 1574028 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 LA / IM

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

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

Write-up: patient called us and we went through questionnaire. She never told us that she got the Pfizer vaccine back in May/2021. She requested the Janssen vaccine on 8/10 and it was administered. We only found out when we documented the vaccine in the program. I have made 3 calls to patient , I never got the phone call back.


VAERS ID: 1574034 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-01-27
Onset:2021-08-10
   Days after vaccination:195
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 AR / IM

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

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

Write-up: COVID positive after vaccination


VAERS ID: 1574057 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: No adverse event, 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: Denies
Current Illness: Denies
Preexisting Conditions: Denies
Allergies: Denies
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: Patient was inadvertently given pfizer vaccine that had been outside of refrigeration for 7 hours. No acute reaction at the of observation. Pfizer contacted for guidance per CDC, and immunization manager notified. Advised to seek counsel of , who immunization manager sought counsel with.


VAERS ID: 1574178 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-17
Onset:2021-08-10
   Days after vaccination:146
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Dyspnoea, Fatigue, Inappropriate schedule of product administration, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Anemia ? Anticoagulant long-term use 1/2/2007 ? Anxiety ? Bronchial asthma ? CAD (coronary artery disease) ? Cardiac pacemaker 5/29/2018 ? Chronic back pain ? CKD (chronic kidney disease) stage 3, GFR 30-59 ml/min (CMS/HCC) ? COPD (chronic obstructive pulmonary disease) (CMS/HCC) ? DA (degenerative arthritis) ? DJD (degenerative joint disease) ? Elevated cholesterol ? GERD (gastroesophageal reflux disease) ? Hyperlipidemia ? Hypertension ? Left hand pain 8/29/2018 ? Measles ? MI (myocardial infarction) (CMS/HCC) ? Mumps ? Numbness of left hand 8/29/2018 ? Osteoarthritis 2/6/2018 ? PAD (peripheral artery disease) (CMS/HCC) 2/6/2018 ? Paroxysmal atrial fibrillation (CMS/HCC) 1/2/2007 ? Pneumonia ? Prostate CA (CMS/HCC) 01/2016 Stage T2c Gleason Grade 3+4 ? Recurrent UTI H/O recurrent nonfebrile UTI and asymptomatic bacteriuria without renal or bladder nidus for UTI ? Type 2 diabetes mellitus (CMS/HCC
Allergies: Plavix, contrast dye, Nexium, NSAIDS
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admitted to hospital on 8/10/2021 with confirmed Covid, symptoms of generalized weakness, increased SOB, exhaustion and fever. Dose # 1 given 2/24/21 Dose#2 given 3/17/2021


VAERS ID: 1574187 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

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

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

Write-up: Severe headache lasting 7 days. Pain/Ache at base of the skull. Diarrhea x 4 days. Fatigue.


VAERS ID: 1574203 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-15
Onset:2021-08-10
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 1 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute myocardial infarction, Anticoagulant therapy, Asthenia, Atrial fibrillation, Decreased appetite
SMQs:, Myocardial infarction (narrow), Supraventricular tachyarrhythmias (narrow), Embolic and thrombotic events, arterial (narrow), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? 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: Patient complains of increase weakness and decrease in appetite and it continued to get worse so he came to the ED. Pt was found to have A. Fib, NSTEMI and was on Eliquis prior to these symptoms and admission to hospital.


VAERS ID: 1574219 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-01-09
Onset:2021-08-10
   Days after vaccination:213
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Fatigue, Myalgia, Pain, Pyrexia, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine (SYNTHROID) 100 mcg tablet; multivitamin 400 mcg tablet
Current Illness: None
Preexisting Conditions: Nervous; Carpal tunnel syndrome; Genitourinary; Disorder of female genital organ Carcinoma in situ of cervix; Endocrine/Metabolic Hypothyroidism Other Melanocytic nevus Other abnormal clinical finding Pap smear of cervix with high grade squamous intraepithelial lesion (HGSIL) Recurrent pregnancy loss
Allergies: No Known Allergies
Diagnostic Lab Data: COVID-19 PCR
CDC Split Type:

Write-up: Fever or Chills, Fatigue, Muscle or body aches. Congestion or running nose


VAERS ID: 1574305 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-30
Onset:2021-08-10
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053C21A / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Crying, Pain, Pain in extremity
SMQs:, Depression (excl suicide and self injury) (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: UNKNOWN
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT CALLED AND REPORTED THAT SHE HAS PAIN IN THE RIGHT ARM THAT IS RADIATING, SHE WAS CRYING. SHE REPORTS THAT SHE WENT TO THE EMERGENCY ROOM LAST TUESDAY BUT THEY REFUSED TO TREAT HER. SUGGESTED THAT PATIENT USE ICE PACKS, TYLENOL, IBUPROFEN, AND SEE PHYSICIAN.


VAERS ID: 1574332 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-01-06
Onset:2021-08-10
   Days after vaccination:216
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK 4176 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Oropharyngeal pain, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: cholecalciferol, vitamin D3, 25 mcg (1,000 unit) tablet Fluoxetine (PROzac) 40 mg capsule ketoconazole (NIZORAL) 2 % shampoo levothyroxine (SYNTHROID) 137 mcg tablet multivit-min/iron/folic acid/K (BARIATRIC MULTIVITAMINS ORAL) pantoprazole
Current Illness: None
Preexisting Conditions: Respiratory Lung nodule Circulatory Heart murmur Digestive GERD (gastroesophageal reflux disease) Vitamin D deficiency Vitamin A deficiency Endocrine/Metabolic Postoperative hypothyroidism Other Anxiety History of thyroid cancer Memory problem H/O diverticulitis of colon S/P laparoscopic sleeve gastrectomy
Allergies: Sulfamethoxazole-trimethoprim Hives / Urticaria, Itching, Swelling Levonorgestrel Itching
Diagnostic Lab Data: COVID-19 PCR
CDC Split Type:

Write-up: Fatigue Sore throat Congestion or running nose


VAERS ID: 1574375 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-02-24
Onset:2021-08-10
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Diarrhoea, Dizziness postural, Hypoglycaemia, Influenza, Influenza A virus test positive, SARS-CoV-2 test positive
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Hypoglycaemia (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Allopurinol 100mg po daily; aspirin 81mg po daily; calcitriol 0.25mcg po daily; hydroxychloroquine 200mg po BID; furosemide 20mg po BID; leflunomide 20mg po daily; simvastatin 40mg po at bedtime
Current Illness: unknown
Preexisting Conditions: CKD, HTN, gout, hyperlipidemia, osteoarthritis, rheumatoid arthritis, PVD
Allergies: Amoxicillin
Diagnostic Lab Data: 8/10: Flu A and SARS CoV-2 AG positive
CDC Split Type:

Write-up: Pt was admitted on 8/10/21 for severe hypoglycemia due to a medication prescribed as an outpatient. She was tested for FluA and SARS CoV-2 AG on admission and was found to be positive for both. She denied SOB, cough or fever at admission. She also denied headache, head congestion or sore throat. She reported dizziness with positional changes and diarrhea. She was monitored for 2 days without any change in respiratory status. She was discharged on 8/13.


VAERS ID: 1574438 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-08
Onset:2021-08-10
   Days after vaccination:94
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 1 - / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 2 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram, Magnetic resonance imaging, Mental status changes
SMQs:, Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad)

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

Write-up: Altered mental status, acute onset. No prior history of mental illness or neurologic conditions.


VAERS ID: 1574454 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-10
Onset:2021-08-10
   Days after vaccination:122
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM0150 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: atrial fibrillation, type 2 diabetes, thrombocythemia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received Pfizer vaccine on 4/10/21 (Lot EM0150) and 5/1/21 (Lot EW0151). Hospitalized with pneumonia due to covid-19 on 8/10/21


VAERS ID: 1574466 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-02-24
Onset:2021-08-10
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Diarrhoea, Dizziness postural, Hypoglycaemia, Influenza, Influenza A virus test positive, SARS-CoV-2 test positive
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Hypoglycaemia (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Allopurinol 100mg po daily; aspirin 81mg po daily; calcitriol 0.25mcg po daily; hydroxychloroquine 200mg po BID; lasix 20mg po BID; leflunomide 20mg po daily; simvastatin 40mg daily
Current Illness:
Preexisting Conditions: HTN, CKD, PVD, OA, RA, Gout, HLD
Allergies: Amoxicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was admitted on 8/10/21 for hypoglycemia related to an outpatient medication. She denied fever, cough, SOB, headache, head congestion or sore throat. She complained of diarrhea and dizziness with position changes. She tested positive for Flu A and SARS CoV-2. She was observed for 2 days and discharged home on 8/13/21 without any respiratory changes or complications.


VAERS ID: 1574490 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Unknown  
Vaccinated:2020-12-22
Onset:2021-08-10
   Days after vaccination:231
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 2 LA / IM

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

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

Write-up: Employee has a COVID positive PCR after being vaccinated


VAERS ID: 1574512 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC8181 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Coordination abnormal, Dizziness, Hypoaesthesia, Pain in extremity, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: Labs ordered today (8/16/2021), results will be in tomorrow.
CDC Split Type:

Write-up: Received shot in afternoon of Monday Aug 9th, felt fine, perhaps a little dizzy and uncoordinated later that night. Woke up the next morning with sore arm and tingling/numb fingertip in left middle finger, and parts of the peripheral fingers. Paresthesia has lasted for one week now. No weakness, but numbness and tingling have continued.


VAERS ID: 1574615 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Thrombosis, Ultrasound scan
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Bee stings
Diagnostic Lab Data: Ultrasounds of left leg x 2.
CDC Split Type:

Write-up: Went to the ED 8/12/21. Blood clot left leg. Baby aspirin, NSAIDS


VAERS ID: 1574617 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Palpitations, Troponin
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: Anxiety, ADHD
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data: Pt was sent to ED for Troponin levels
CDC Split Type:

Write-up: pt has shortness of breath, palpitation and chest pain which began 1 day after Pfizer vaccine. symptoms are mild and fading but still present


VAERS ID: 1574878 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-08-05
Onset:2021-08-10
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenopia, Eye haemorrhage, Eye irritation, Headache, Nausea, Ocular discomfort, Respiratory tract congestion
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Corneal disorders (broad), Retinal disorders (broad)

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

Write-up: 5 days following second dose of Pfizer covid vaccine started experiencing pressure around both eyes. Pressure was so severe that it popped a blood vessel in the left eye and had irritation and heavy pressure on the right eye. Also had a mild congestion headache along with nausea. All 5 days or so after the second shot. Patient did not seek any medical treatment or check with any doctor. Reported us when came to pharmacy for family member''s vaccination.


VAERS ID: 1577491 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-08-10
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Injection site pain, Injection site reaction
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210826213

Write-up: ARM STIFFNESS AROUND INJECTION SITE; SORE ARM AROUND INJECTION SITE; This spontaneous report received from a patient via a company representative concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 10-AUG-2021 for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On 10-AUG-2021, the patient experienced arm stiffness around injection site. On 10-AUG-2021, the patient experienced sore arm around injection site. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the sore arm around injection site and arm stiffness around injection site was not reported. This report was non-serious.


VAERS ID: 1577639 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-01-28
Onset:2021-08-10
   Days after vaccination:194
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, Cough, Fatigue, Feeling cold, Headache, Myalgia, Pyrexia, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 mg tablet biotin 5 mg tablet calcium carbonate (TUMS) 200 mg calcium (500 mg) chewable tablet cyclobenzaprine (FLEXERIL) 5 mg tablet(Expired) estradioL (ESTRACE) 0.01 % (0.1 mg/gram) vaginal cream gabapentin (NEU
Current Illness: nONE
Preexisting Conditions: Nervous Dysmenorrhea Tension headache Migraine headache Circulatory Hemorrhoids Digestive Esophageal reflux Obesity Gastroesophageal reflux disease with esophagitis Gallbladder disease Genitourinary Acquired absence of kidney Amenorrhea due to Depo Provera Recurrent vaginitis Endocrine/Metabolic Hypoestrogenism Other Fibrocystic disease of both breasts Hay fever On Depo-Provera for contraception Kidney donor Lipoma of anterior chest wall
Allergies: AmoxicillinOther (document details in comments), Itching, Rash Bee Venom Protein (Honey Bee)Other (document details in comments), Anaphylaxis CherryAnaphylaxis
Diagnostic Lab Data: COVID-19 PCR
CDC Split Type:

Write-up: Fever or Chills Cough Fatigue Muscle or body aches Headache New loss of taste or smell Congestion or running nose


VAERS ID: 1577878 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 RA / 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: temperature excursion - vaccine stored too long in freezer temperatures


VAERS ID: 1577937 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003F21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Rash
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1 day post vaccine pt experienced difficulty breathing and a rash on his stomach. Pt was given some benadryl at home and this helped the symptoms. Pt also stated his daughter had some prednisone at home that she gave to him.


VAERS ID: 1578035 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 RA / 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: temperature excursion - vaccine stored too long in freezer temperatures


VAERS ID: 1578045 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / 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: temperature excursion - vaccine stored too long in freezer temperatures


VAERS ID: 1578206 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 RA / IM

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

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

Write-up: DIZZINESS POST INJECTION AND CONTINUED DIZZINESS


VAERS ID: 1578212 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-02-20
Onset:2021-08-10
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Nasal congestion, SARS-CoV-2 test, Sinus disorder
SMQs:, Anaphylactic reaction (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: benzonatate (TESSALON PERLES) 100 mg capsule dilTIAZem CD (CARDIZEM CD) 120 mg 24 hr capsule lansoprazole (PREVACID) 30 mg capsule magnesium 200 mg tablet metoprolol succinate XL (TOPROL-XL) 50 mg 24 hr tablet olmesartan-hydrochlorothiazide
Current Illness:
Preexisting Conditions: Nervous Bilateral exudative age-related macular degeneration (CMS/HCC) Respiratory Obstructive sleep apnea syndrome Circulatory Frequent PVCs Palpitations Essential hypertension Aortic stenosis, mild Digestive Morbid obesity (CMS/HCC) Gastroesophageal reflux disease Genitourinary Stage 3 chronic kidney disease Musculoskeletal Osteopenia Endocrine/Metabolic Mixed hyperlipidemia Impaired fasting glucose Other Fatigue Adjustment disorder with mixed emotional features
Allergies: LatexRash
Diagnostic Lab Data: COVID-19 PCR
CDC Split Type:

Write-up: cough, nasal congestion and sinus problem


VAERS ID: 1578264 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088021A / 2 RA / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0X9C21A / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Skin burning sensation
SMQs:, Peripheral neuropathy (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: trozidone, adorol, trintellix, zyrtec allergy, flonaze, gabapintin, lorazapan, lamotrigine, sleep aid, ib profen, tramadol
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: whole right side of body was hot as fire and couldnt move that side few minutes


VAERS ID: 1578269 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: New York  
Vaccinated:2021-01-28
Onset:2021-08-10
   Days after vaccination:194
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Headache, Rhinorrhoea, 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: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose 01/07/21 pfizer,Lot#EL3248 2nd dose: 01/28/21 Pfizer,Lot# EN5318 Diagnosed covid positive:08/10/21 Symptom onset:08/10/21 Exposure:Home Symptoms:Runny nose, headache


VAERS ID: 1578292 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? 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: Systemic: pain in hands and feet. described more in additional details-Medium, Additional Details: Patient is experiencing pain and tingling in his extremeties (hands and feet). He has been consistently having this pain since the day after his 2nd dose of pfizer. He has never experienced anything like this before dispite other health conditions. tylenol and muscle relaxers have mininally helped his pain. The pain does get better and worse but that has been consistent overall. Patient was advised to see a provider.


VAERS ID: 1578314 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-07
Onset:2021-08-10
   Days after vaccination:125
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Moderna on 4/7 and 5/18. Positive on 8/11 admitted 8/10-current


VAERS ID: 1578328 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006O21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chills, Condition aggravated, Diarrhoea, Headache, Impaired work ability, Migraine, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

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

Write-up: I used to have Migraines, but I have not had any for over 10 years. The morning after the first dose of the vaccine I had chills, nausea, body aches and diarrhea I started to get a headache. I had to call into work for two days. I have had a Migraine every morning since the shot, and it has been nine days so far. The Migraines have come every morning and they last about two hours. I have tried Ibuprofen, but it does not seem to work. Today it has been coming and going and it is later in the day. They do not seem to be getting better so far. I have been trying some rest to cope with the pain. The headaches are a little milder and different than the ones I had in the past. Light does not hurt at the moment.


VAERS ID: 1578452 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7425 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chest X-ray, Electrocardiogram, Headache, Heart rate increased, Laboratory test, Nausea, Thyroid function test abnormal, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypothyroidism (broad), Hyperthyroidism (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: oral contraceptives for menstral cramps
Current Illness: none
Preexisting Conditions: none
Allergies: nkda
Diagnostic Lab Data: At the ER they did and EKG, CXR, and labs. She came back with elevated thyroid studies. Her thyroid studies in April 2021 were normal. They sent her home on thyroid med and atenolol for the abnormal heart beat. Now she has to see Endocrinology and Neurology. She had headaches for 1.5 weeks with the 1st dose.
CDC Split Type:

Write-up: Vomiting 08/10, headaches started 08/11, landed in the ER 08/13 at around 12:30am, treated and released for headaches and nausea. By Sat 08/14 around 9pm we are back at the ER for the headaches, vomiting and now rapid heart beat (in the 150''s). During these days ibuprofen and acetaminophen weren''t working. She did take Zofran for the nausea on 08/11 and 08/13. Hospital gave her fluids and meds through the IV that helped everything except rapid heart beat.


VAERS ID: 1578483 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: -montelukast (SINGULAIR) 5 MG Oral Tablet Chewable CHEW AND SWALLOW 1 TABLET BY MOUTH EVERY DAY -ofloxacin (FLOXIN) 0.3 % Otic Solution Place 4 drops into the right ear 2 times daily for 7 days. -Multiple Vit-C-FA (Multivitamin) Oral Tabl
Current Illness: Seasonal Allergies Sinusitis
Preexisting Conditions: Eczema
Allergies: No Known Allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient experienced vasovagal syncope about 10 minutes after receiving the Pfizer BioNTech vaccine. Medical staff assisted the patient by checking response and lifting legs. Patient quickly regained consciousness in about 2 minutes. Patient rested and monitored for another 15 minutes. Symptoms did not return and patient was able to go home.


VAERS ID: 1578514 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-15
Onset:2021-08-10
   Days after vaccination:117
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Brain natriuretic peptide, Cardiac stress test, Diverticulitis, Echocardiogram, Electrocardiogram, Full blood count, Laboratory test, Troponin increased
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific inflammation (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: stress test, EKG, ECHO, cardiac markers, CBC with diff, BNP,
CDC Split Type:

Write-up: diverticulitis, elevated troponin


VAERS ID: 1578533 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Gait inability, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

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

Write-up: Patient cannot feel anything below her waist after the vaccine and cannot walk. This lasted for less than 10 minutes then it went away. Patient is a healthy woman.


VAERS ID: 1578558 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-01-07
Onset:2021-08-10
   Days after vaccination:215
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 2 - / IM

Administered by: Work       Purchased by: ?
Symptoms: Exposure during pregnancy, Illness, SARS-CoV-2 test
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal Vitamin,
Current Illness: Thanksgiving - cold symptoms
Preexisting Conditions: Currently 13 weeks pregnant
Allergies: None
Diagnostic Lab Data: PCR Covid test
CDC Split Type:

Write-up: 12/18/20 Pfizer Covid vaccine 1/7/2021 Pfizer Covid vaccine 8/10/21 ill 8/16/21 + Covid PCR 8/21/21


VAERS ID: 1578578 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blister, Burning sensation, Scab
SMQs:, Severe cutaneous adverse reactions (broad), Peripheral neuropathy (broad), Hypersensitivity (broad)

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

Write-up: Reports burning sensation in feet 3 hours after immunization while working outside and wearing boots. When took boots off, noticed blisters around ankle of one foot and across toe line of other foot. Took a diphenhydramine and blisters scabbed over 24 hours later.


VAERS ID: 1578585 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-07
Onset:2021-08-10
   Days after vaccination:184
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Exposure to SARS-CoV-2, Headache, Rhinorrhoea, 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: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose 01/10/21 pfizer,Lot#012L20A 2nd dose:02/07/21 Pfizer,Lot# 012M20A Diagnosed covid positive:08/11/21 Symptom onset:08/10/21 Exposure:Home Symptoms:Runny nose, head ache


VAERS ID: 1578591 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019B21A / 2 LA / IM

Administered by: Other       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: Atorvastatin Ca, Meloxicam, Methocarbamol
Current Illness: na
Preexisting Conditions: hyperlipidemia, Chronic obstructive lung disease, Vit d deficiency
Allergies: na
Diagnostic Lab Data: na
CDC Split Type:

Write-up: Moderna dose #2 was given at 2 wks instead of 28 days


VAERS ID: 1578596 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-06
Onset:2021-08-10
   Days after vaccination:185
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Rhinorrhoea, 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: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose 01/09/21 Moderna,Lot#012L20A 2nd dose: 02/06/21 Moderna,Lot# 012L20A Diagnosed covid positive:08/10/21 Symptom onset:08/10/21 Exposure: Symptoms:Runny nose


VAERS ID: 1578621 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-08-07
Onset:2021-08-10
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Blood test, Headache, Paraesthesia, Vision blurred
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: mens one a day silver , claritin, phenylephrine 10mg
Current Illness: n/a
Preexisting Conditions: intestinal adhesions, spinal fusion l4 l5 s1
Allergies: compazine
Diagnostic Lab Data: dr blood drawn on 8-17-21
CDC Split Type:

Write-up: tingling over entire body low level. vision blurry . balance issues in the am. headache


VAERS ID: 1578637 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Decreased appetite, Fatigue, Headache, Injection site induration, Injection site pruritus, Pain in extremity, Peripheral swelling, Skin warm
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluoxetine HCI 20mg Levothyroxine sodium 75mcg Hydrochlorothiazide 25mg Vitamin K2 & D3. 125mcg/100mcg All of the above are once per day.
Current Illness: None
Preexisting Conditions: Asthma Herpes HBP Hypothyroidism Depression OCD
Allergies: Penicillin Sulfa drugs Certain grasses. Blue fescue, Kentucky bluegrass Mold Certain animals. Rabbits, guinea pigs
Diagnostic Lab Data: Waiting on doctor appointment
CDC Split Type:

Write-up: Headaches Extreme fatigue Swollen arm Arm is very hot to the touch and sore Arm is hard at injection site Arm is very itchy at injection site Loss of appetite


VAERS ID: 1578684 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-09
Onset:2021-08-10
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anosmia, COVID-19, Cough, Oropharyngeal pain, SARS-CoV-2 test positive, Throat irritation
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Tetanus as a child
Other Medications: Vitamins
Current Illness:
Preexisting Conditions:
Allergies: Penicillin, Tetanus Shot; Seasonal Allergies; Cat Dander
Diagnostic Lab Data: Covid-19 positive 08/13/2021.
CDC Split Type: vsafe

Write-up: I started to have a little tickle in my throat. I tested positive on 08/13/2021. After that I just had a sore throat. I have to cough every time I take a deep breath. I am normally in good physical shape. Currently I have no sense of smell and that happened after about a week. It has been nine days.


VAERS ID: 1578690 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-08
Onset:2021-08-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / SYR

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

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

Write-up: Patient stated that he started getting a pain in his arm the second ay after receiving the vaccine. The patient also stated that he is having cramps in his arm.


VAERS ID: 1578721 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lip swelling, Swelling of eyelid, Urticaria
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? 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: Member woke up morning after receiving vaccine with hives, and on 8/17/21 is reporting swollen eyelids and lips.


VAERS ID: 1578964 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7585 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Decreased appetite, Dysarthria, Gait disturbance, Impaired work ability, Neurological symptom
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypoglycaemia (broad)

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

Write-up: Patient reported that she went to ER on 8/11/2021 with stroke like symptoms and ER informed her she did not have stroke. She reported feeling confused, slurry speech, not able to walk straight and appetite. Denied fever, hallucinations and chills. Patient reported that she went to her primary care doctor yesterday and she received hydration IV and she reported feeling better today and that she went back to work.


VAERS ID: 1579218 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: None- dental work
Preexisting Conditions: None known @ this time; Hx of dental decay
Allergies: MILK (lactose intolerant)
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Possible pain, redness, swelling after a few days @ injection site; Possible: tiredness, headache, muscle pain, chills, fever, nausea. Pt was monitored for 15 min post injection, no reactions were observed nor reported; pt did not report he had received vaccine previously; provider informed


VAERS ID: 1579616 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / UNK LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Muscle spasms, Myalgia, Vaginal haemorrhage
SMQs:, Rhabdomyolysis/myopathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Dystonia (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Random spotting about an hour after vaccine was given , lasting 4-5 days. Cycle wasn''t scheduled to began until 1?/? weeks later and it''s regular so it begins on schedule. Moderate left arm cramping began 4 days after vaccine, in index finger and continued up forearm. Cramping lasted about 5mins and remained sore for 3 days afterwards.


VAERS ID: 1579753 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088DZIA / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache, Injection site erythema, Injection site swelling, Insomnia, Lymph node pain, Oedema peripheral, Pyrexia
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna covid first dose April 8, 2021
Other Medications: Synthroid, Premarin, centrum silver daily vitamin, calcium plus D3
Current Illness: None
Preexisting Conditions: Migraine
Allergies: Penicillin, keflex
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Headache, fever (101.4) x 2 days, insomnia 1 night, Lymph node pain and swelling under arm, 4 days, softball size red area with heat and swelling at injection site 5 days. Had dizziness when turning over in bed on night 4. It has eased up but is still present off and on during the day, especially when I look down. Otherwise I am back to normal.


VAERS ID: 1582360 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-07-22
Onset:2021-08-10
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Anion gap increased, Blood ketone body, COVID-19, Chest pain, Dyspnoea exertional, Fibrin D dimer increased, Pain, SARS-CoV-2 test positive
SMQs:, Lactic acidosis (broad), Haemorrhage laboratory terms (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tumour lysis syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Omeprazole, sucralfate, lamotrigine
Current Illness: Gastric sleeve procedure on July 31st.
Preexisting Conditions: Acute Myocarditis, Hyperthyroidism, Class 2 obesity in adult, Metabolic acidosis, GERD,
Allergies: Topiramate Sulfamethoxazole-trimethoprim
Diagnostic Lab Data: +COVID on 8/12/21 Labs noted an anion gab of 25.2 and Beta hydroxybutyrate level of 5.62 which would coincide with her post-op diet. D-dimer elevated 2.33.
CDC Split Type:

Write-up: patient is a 19 y.o. female with history of hypothyroidism, prediabetes, GERD, anxiety and depression and obesity who recently underwent gastric sleeve bypass 7/31/2021 and now presents with chest pain and shortness of breath on exertion. Patient reports on and off chest pain for two days, no SOB, diaphoresis, blurred vision, or dizziness. Says this resolved without intervention. She reports the episodes of chest increased in frequency and intensity, radiated straight through to her back and up into her neck. She even noted accompanying SOB with exertion. Says at one point she thought she was having a heart attack so presented to the ED for further assessment. Denies sick contacts. Reports no issues with her surgical incisions. Has been following her post-bypass diet. In the ED she was afebrile, vital signs stable. Of note, patient received first dose of COVID-19 vaccine 7/22/2021. She was admitted for further care and work-up.


VAERS ID: 1582449 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Headache, Paraesthesia oral, Swelling face, Visual impairment
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Topiramate, Tylenol w/codiene, Lyrica. Kumigan solution, Restatis, Oxygen, Mobix, Celexa, Provera, Clondidine, buspirone, meclizine, cetirizine, proair inhaler, minipressm omeprazeol. norvasc, diclofenac sodium, Wellbutrin SR,
Current Illness:
Preexisting Conditions: Hypertension, Depressive Disorder, Fibromyalgia, Nocturnal Enuresis, Rheumatoid Arthritis, Spinal Stenosis, Lumbosacral root lesions, COPD, GERD, DDD, Sciatica, Menopausal -Post, oxygen dependent, mixed hyperlipidemia, hypoglycemia, Chronis Post Traumatic headache
Allergies: Benadryl. Ultram, Sulfa, Flagyl, chicken, robaxin,
Diagnostic Lab Data:
CDC Split Type:

Write-up: Called and said that since getting the first vaccine yesterday, she has been having a tingling in her lip and then in the night she woke up with a terrible headache and also now she is coughing terribly. She also reported that she has swelling in both cheeks and vision changes.


VAERS ID: 1582638 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-11
Onset:2021-08-10
   Days after vaccination:152
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: bisoprolol (ZEBETA) 10 mg tablet calcium carbonate-vitamin D3 600 mg(1,500mg) -200 unit per tablet lisinopriL (ZESTRIL) 40 mg tablet multiple vitamins (HEXAVITAMIN) tablet tablet spironolactone (ALDACTONE) 25 mg tablet
Current Illness:
Preexisting Conditions: Nervous Myalgia Trochanteric bursitis, left hip Circulatory Hypertension Paroxysmal supraventricular tachycardia (CMS/HCC) Reactive hypertension Renal artery aneurysm (CMS/HCC) Digestive Adenomatous polyp of colon Atony of colon Esophageal reflux Irritable bowel syndrome Tubular adenoma of colon Genitourinary CKD (chronic kidney disease) stage 3, GFR 30-59 ml/min Musculoskeletal Osteoporosis Hammer toe Acquired hallux valgus Endocrine/Metabolic Hyperglycemia Hyperlipidemia Other Depression with anxiety Vaccination not carried out
Allergies: PseudoephedrinePalpitations AdhesiveOther (document details in comments) AmlodipineOther (document details in comments), Nausea Only DiltiazemNausea Only LatexDermatitis, Rash OtherOther (document details in comments)
Diagnostic Lab Data: POCT COVID-19 PCR
CDC Split Type:

Write-up: Dizziness Shortness of Breath


VAERS ID: 1582677 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 - / -

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

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

Write-up: fainted while driving after her vax


VAERS ID: 1582696 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2020-12-31
Onset:2021-08-10
   Days after vaccination:222
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH E10140 / 1 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 2 AR / SYR

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

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

Write-up: POSITIVE COVID 8/11/21


VAERS ID: 1582701 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-08-07
Onset:2021-08-10
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

Write-up: Pt''s wife call on 8/17/21 to inform pharmacy that her husband developed shingles approximately 3 or 4 days after receiving COVID vaccination.


VAERS ID: 1582728 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 1 LA / IM

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

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

Write-up: Moderna COVID-19 Vaccine EUA The child came with her mother to get vaccination. There is no adverse event reported. Moderna vaccine was administered to her when she does not fall within the age group for EUA. It completely escaped my attention and I had a recollection yesterday. The parent telephone number provided was called but no one picked however a voicemail message was left for her to call the pharmacy at her earliest convenience.


VAERS ID: 1582762 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-01
Onset:2021-08-10
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Muscle spasms
SMQs:, Dystonia (broad)

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

Write-up: Left shoulder where I received the shot, my shoulder won?t stop spazzing out. My shoulders keep having these random spasms everyday since the shot. I would have them before like once a month after a serious workout but not everyday since the shot.


VAERS ID: 1582768 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-07
Onset:2021-08-10
   Days after vaccination:215
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID-19/SARS COV2, 8/17/21 Positive
CDC Split Type:

Write-up: COVID-19 positive $g14 days post vaccine series


VAERS ID: 1582792 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-03-25
Onset:2021-08-10
   Days after vaccination:138
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019B21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Fatigue, Polymerase chain reaction positive, Rhinorrhoea
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allergy Shots
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: PCR test collected on 8-13-2021 and resulted positive on 8-13-2021
CDC Split Type:

Write-up: Symptoms started on 8/10/2021 with chills, runny nose, fatigue.


VAERS ID: 1582884 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Anaphylactic shock
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Calcium, clariton, Wixela, anastrozone
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Sulfa drugs
Diagnostic Lab Data: IV Benadryl, IV prednisone
CDC Split Type:

Write-up: Anaphylactic shock


VAERS ID: 1582951 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-02-23
Onset:2021-08-10
   Days after vaccination:168
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: Waldenstrom''s macroglobulinemia, HTN, COPD, hypothyroidism, valvular heart disease, Afib, CAD and CHF
Allergies: Cephalexin monohydrate, lisinopril, morphine
Diagnostic Lab Data: Positive covid PCR 8/10/21
CDC Split Type:

Write-up: Hospitalized and positive for Covid after being fully vaccinated


VAERS ID: 1583015 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-02-10
Onset:2021-08-10
   Days after vaccination:181
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Chills, Fatigue, Headache, Nasal congestion, Pyrexia, SARS-CoV-2 test positive, Upper-airway cough syndrome
SMQs:, Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I take Amour Thyroid meds; Loratadine.
Current Illness: none
Preexisting Conditions: none
Allergies: Penicillin
Diagnostic Lab Data: none
CDC Split Type: vsafe

Write-up: On 08/10/2021 Tested positive for COVID-19. Began with lose of taste/smell, chills, congestion, fever, drainage, headache and fatigue. Dr called in Zpac and taking Tylenol every 6 hours.


VAERS ID: 1583104 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Dry mouth, Nausea, Pallor, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Dehydration (broad)

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

Write-up: 5 - 10 MINUTES AFTER SHOT ADMINISTRATION PATIENT BECAME PALE AND COMPLAINED OF PAIN IN UPPER RIGHT CHEST. DEVELOPED NAUSEA, VOMITING, AND DRY MOUTH. I ADMINISTERED 25 MG DIPHENHYDRAMINE LIQUID BY ORAL ROUTE. MOM DIDN''T WANT TO STAY FOR MONITORING AGAINST OUR ADVISE. COUNSELED MOM TO WATCH FOR ANY SYMPTOMS OF PROGRESSING ALLERGY INCLUDING TINGLING IN THE LIPS, TONGUE, MOUTH, TROUBLE BREATHING, HIVES, OR ANYTHING ELSE OF CONCERN. I ADVISED THEM TO TAKE PATIENT TO ER IF ANYTHING CHANGED. ON 8/11/2021 I FOLLOWED UP WITH PATIENT WHO WAS DOING WELL. MOM STATED SYMPTOMS HAD SUBSIDED. THE DIPHENHYDRAMINE MADE HER TIRED.


VAERS ID: 1583119 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-28
Onset:2021-08-10
   Days after vaccination:104
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Fatigue, Headache, Myalgia, Nausea, Olfactory nerve disorder, Oropharyngeal pain, Pyrexia, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Hypertension
Allergies: Unknown
Diagnostic Lab Data: Covid 19 - Rapid Antigen on 8/10/21 = Positive Result
CDC Split Type:

Write-up: Case received both Moderna vaccines 1= 3/24/21 LOT# 017B21A and 2=4/28/21 LOT# 046B21A. Case had onset of Covid 19 symptoms on 8/6/21 which included fever, subjective fever, chills, muscle aches, runny nose, sore throat, new olfactory disorders, headache, fatigue, cough and nausea. Case was still symptomatic at time of Disease Investigation on 8/16/21


VAERS ID: 1583157 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-24
Onset:2021-08-10
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Malaise, 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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Coronavirus 2 PCR Detect, V symptomatic POSITIVE
CDC Split Type:

Write-up: patient brought to ED for multitude of symptoms not feeling well for approx 2 weeks, maybe 1 week prior for Covid like s/s.


VAERS ID: 1583163 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Muscle spasms
SMQs:, Dystonia (broad)

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

Write-up: Sever muscle spasms the night after vaccination. Continued muscle spasms in the abdominal area.


VAERS ID: 1583341 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Mobility decreased, Pain in extremity, Peripheral swelling, Tenderness
SMQs:, Cardiac failure (broad), Angioedema (broad), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: Patient came to the pharmacy on 8/18/21 @ 11:10am and said that the day after she received her Moderna vaccine in the left arm, her right arm started hurting and became swollen. She said she could not move her right arm therefore she said she went to her physician and her physician told her to take her gout medication at an increased dose. She said it lasted for about 5 days; the swelling went down but he arm was still a little tender.


VAERS ID: 1583343 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-20
Onset:2021-08-10
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 1 LA / IM

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

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

Write-up: Unauthorized Age Group No medical adverse events from vaccine


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