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From the 6/4/2021 release of VAERS data:

Found 323,133 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 169 out of 3,232

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VAERS ID: 1289610 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Fatigue, Headache, Pain in extremity, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Sore arm, vomiting, dizziness, fatigue, headache


VAERS ID: 1289614 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 2054214 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Asthenia, Body temperature increased, Chills, Dizziness, Fatigue, Headache, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Esomeprazole,montelukast, Arnuity inhaler , anoro inhaler Bone and immune health supplement
Current Illness: Sinus infection
Preexisting Conditions: Asthma outdoor allergies
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever of 100.8 severe headache very tired and weak severe body aches muscle aches sick to stomach severe chills slightly dizzy


VAERS ID: 1289625 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

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

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

Write-up: Dizziness. Hx of needle phobia. Observed for 30 min. Vitals stable and released.


VAERS ID: 1289635 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

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

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

Write-up: Dizziness. Hx of needle phobia. Observed for 30 min. Vitals stable and released.


VAERS ID: 1289747 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Asthenia, Dizziness, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: VSafe

Write-up: Status post vaccination patient reported nausea, abdominal pain, and light headedness. Patient stated he went to car and was unsure whether he fainted or not as he felt weak. This occurred within a time frame of 20 minutes post vaccination. Vitals were checked and BP, temp, and pulse within normal range. Patient stated he was feeling much better and the event only lasted a short period of time. Patient was given a cold water bottle and observed at the pharmacy. Vitals were rechecked after another period of 15 minutes and were unremarkable. No medications were administered and no further medical attention required. Notably was a hot day (temperature in the 90s) and patient stated he had not eaten anything all day since cereal in the morning (vaccination administered at 5PM). Patient stated he was feeling much better.


VAERS ID: 1289763 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

Administered by: School       Purchased by: ?
Symptoms: Head discomfort, Headache
SMQs:

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: Propranolol 40mg x2/day
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: After 24 hours, slight headache and pressure. Resolved by next morning.


VAERS ID: 1289770 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Angiogram, Dyspnoea, Fibrin D dimer increased, SARS-CoV-2 test negative, Troponin increased
SMQs:, Anaphylactic reaction (broad), Haemorrhage laboratory terms (broad), Myocardial infarction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: DM2, HTN, OSA, Mod. Persistent Asthma, Afib, CHF
Allergies: History of Anaphylaxis to an Unknown Sulfonamide Antibiotic within the last 9 years.
Diagnostic Lab Data: No tryptase was performed and it had been 24 hours prior to her transfer to our facility. She has a D-Dimer elevation (1585) and elevation in troponin at 0.46. CTA is currently pending. COVID 19 PCR is negative.
CDC Split Type:

Write-up: After vaccination at 915 AM, patient developed isolated shortness of breath at 1730. The shortness of breath was progressive and not relieved by albuterol. Presented to a local ED at 1930 where she was given an unknown dose of steroid and was, by history, hypoxic enough that intubation was discussed. She was not intubated, but was transferred to hospital for allergy and cardiology assessment. This SOB was the only symptom that she developed. She was euvolemic on my exam today and does not appear to have had diuresis prior to my assessment. Her asthma is well controlled by history. She was placed on high flow o2 via NC and improved substantially overnight. She was on 3L of o2 at the time of my assessment (1215) today. There are several confounders to her case. She has a history of methamphetamine abuse and though she denies recent ingestion (last use was reportedly months ago) her UDS is positive at 0600 today.


VAERS ID: 1289773 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Chills, Decreased appetite, Eye irritation, Injection site pain, Migraine, Pain, Tooth extraction
SMQs:, Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Corneal disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Severe migraine, low fever of 100.6, burning eyes, chills, extreme body pains and aches, throbbing of socket from recently removed tooth. Loss of appetite. Localized injection site pain. Took Tylenol every 4 hours for first 8 hours then switched to Tylenol PM. Lots of liquids and sleep. Ice pack on injection site


VAERS ID: 1289811 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-30
Onset:2021-05-04
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Echocardiogram normal, Electrocardiogram ST segment elevation, Pericarditis, Troponin increased
SMQs:, Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol, Xanax, Symbicort, Wellbutrin
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Cisapride, animal dander, pollen
Diagnostic Lab Data: EKG showed diffuse ST elevation consistent with pericarditis. Initial troponin 2.52 and rose as high as 6.95 before declining. Echocardiogram was normal. Patient was transferred to Hospital on 5/4/21 and discharged to home on 5/5/21.
CDC Split Type:

Write-up: Patient presented to the ED on 5/4/21 with chest pain. Patient received initial dose of of COVID vaccine on 4/2/21 and stated he received his second dose on 4/30/21.


VAERS ID: 1289818 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blindness, Hyperhidrosis, Hyperventilation, Pallor, Syncope, Tinnitus
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Within 3 minutes of receiving the vaccine, Subject experienced syncope, had ringing in the ears, loss of vision, was pale, diaphoretic, and hyperventilation. BP 102/49 and 96/58. Staff responded, provided supportive care. Subject regained consciousness. Reported on 5/5/2021 made a full recovery. It is noted he reports he worked out that morning, had not eaten or had water that day. Did not seek medical attention.


VAERS ID: 1289933 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-08
Onset:2021-05-04
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030B212A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, COVID-19, Deep vein thrombosis, Dyspnoea exertional, Gastrointestinal disorder, Pulmonary embolism, SARS-CoV-2 test positive
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Pulmonary hypertension (broad), Arthritis (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient received his first dose of COVID vaccine on 4/8 and developed GI symptoms ~ 4/16. Patient tested positive for COVID on 4/25 when he presented to the ED. However, he was sent home at that time since he was stable to go home and was not hypoxic. Pt presented to the ED again on 5/4 due to dyspnea on exertion and pain in the back of his knee. Patient was found to be positive for DVT and PE and was started on therapeutic Lovenox. Patient doesn''t have a history of VTE, but he does have a family history of VTE. Since patient wasn''t found to be hypoxic, COVID treatment wasn''t started in the hospital.


VAERS ID: 1290080 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anaphylactic reaction, Angioedema, Dysphagia, Intensive care, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Diltiazem CD, amitryptyline, blisovi fe, cetirizine, B-12 tablets, hydroxyzine, levocetirizine, Potassium & magnesium aspartat, multivitamin, proair HFA
Current Illness: allergy, asthma, arrhythmia , heart palpitations
Preexisting Conditions:
Allergies: chocolate (anaphylaxis), shellfish (anaphylaxis), sulfa (hives, itching), augmentin (not specified), fish (swelling), latex (burning itching), penicillins (not specified)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Angioedema and anaphylaxis approximately 15 minutes after the vaccine was administered. She was given IV solumedrol, benadryl, and famotidine which improved her tongue swelling. Afterwards she was admitted to an inpatient observation unit at the hospital. Around 9pm patient developed recurrent tongue swelling and difficulty swallowing. 0.5 mg of epi was administered. There was some initial improvement followed by additional worsening after 5 minutes. She was ultimately transferred to the ICU for a continuous epi infusion.


VAERS ID: 1290106 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8136 / 1 RA / IM

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

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

Write-up: Pfizer vaccination administered to a 15 year old patient. They indicated 16 years old on the consent form, but DOB indicated the child was 15.


VAERS ID: 1290131 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Shortness of breath at 2 am 05/05/2021 . Lasted for about 30 minutes. Fever and body aches started at 10 pm 05/04/2021.


VAERS ID: 1290150 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 1 LA / IM

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

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

Write-up: Vaccine adminitration error. Moderna Vaccine given to 17 year old.


VAERS ID: 1290236 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Nausea, Paraesthesia, Somnolence, Visual impairment
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: HPV vaccine
Other Medications: Iron supplement
Current Illness: anemia - taking iron supplement
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: 17:39 HR 47 BP 92/52 O2 99 17:44 HR 100 BP 99/57 O2 99 17:45 HR 72 BP 120/55 O2 98 17:58 HR 71 BP 102/63 O2 99
CDC Split Type:

Write-up: Approximately two minutes after vaccine injection, pt started to feel dizzy, saw spots, felt like she was going to pass out. Someone got a wheelchair and we took her back to observation/treatment area. Patient was very drowsy, felt nauseous, hands were tingling, and was cold and clammy. We asked her to text her Mom, who was sitting out in the parking lot, to have her come inside. Pt reported passing out with HPV vaccine and on blood draws. We moved patient to pt bed and took vitals (listed below). Patient was able to recover without any medication administration under close observation. After about 20 mins in obs/treatment area, she was feeling better and we moved her to the observation room with her Mom. We had leftover vaccine syringes, so Mom received her first dose of vaccine. They waited together until Mom''s 15 mn obs time was over. Patient and someone left the clinic feeling fine and under their own power around 1845.


VAERS ID: 1290277 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 1 LA / IM

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

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

Write-up: Pt received Moderna, was 17 at time of injection.


VAERS ID: 1290280 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-05
Onset:2021-05-04
   Days after vaccination:60
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Hypoxia, Mental status changes, Pyrexia, SARS-CoV-2 test positive
SMQs:, Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: received 1st covid vaccine 2/12/21 2nd dose 3/5/21 at hospital admitted to medical center for covid symptoms including hypoxia, fever, and altered mental status testing positive for covid 5/4/2021


VAERS ID: 1290382 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Crying, Dyspnoea, Feeling of body temperature change, Hyperhidrosis, Oedema peripheral, Pyrexia, Screaming, Sleep disorder, Tension, Tremor
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Fever headache swelling I can''t breathe
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I got the vaccine at 2pm. At 12am when I was asleep, I woke up shaking, crying, screaming, I couldn''t breathe, I was very cold and hot at the same time. I was sweating too much. My wife at home tried to calm down, I took my blood pressure and it was 170-160. As a result of this we went to the hospital where they admitted me for more than 4 hours, while they controlled my tension and fever. The next day a large swelling appeared under my left arm, a gland or I don''t know what it will be, but it is a very large swelling


VAERS ID: 1290415 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / SYR

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

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

Write-up: Rapid Heart Beat that lasted several hours.


VAERS ID: 1290629 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Chills, Fatigue, Headache, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Janssen COVID -19 Vaccine EUA Headache, extremely tired, burning up & chills off and on all night, muscle aches. Lasted about 24 hours.


VAERS ID: 1290762 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-05-04
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205421A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Hypoaesthesia oral, Paraesthesia oral
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre 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:
Current Illness: Alcohol use (moderately, a couple glasses of wine per week); Cigarette smoker (5-10 CIGARETTES A DAY)
Preexisting Conditions: Comments: The patient had no known allergies.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210507557

Write-up: NUMBNESS OF TONGUE AND LIPS; TINGLING ON TONGUE AND LIPS; DIZZINESS; This spontaneous report received from a patient concerned a 43 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included alcohol user, and smoker, and other pre-existing medical conditions included no known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 205421A expiry: UNKNOWN) dose was not reported, administered on 04-MAY-2021 13:30 for prophylactic vaccination. No concomitant medications were reported. On 04-MAY-2021, the subject experienced numbness of tongue and lips. On 04-MAY-2021, the subject experienced tingling on tongue and lips. On 04-MAY-2021, the subject experienced dizziness. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from numbness of tongue and lips, dizziness, and tingling on tongue and lips. This report was non-serious.


VAERS ID: 1291343 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Per CDC guidelines, if a patient has an allergy or contraindication to any of the components of the mRNA COVID-19 vaccines, the Johnson & Johnson COVID-19 vaccine may be given as a ''dose 2'', so long as it is at least 28 days from the first dose of the mRNA vaccine. Vaccine was given before consent form was fully reviewed. Patient stated she is getting Johnson & Johnson as dose 2 because her first dose of Moderna was administered 2/2021 so her second dose of Moderna was "missed." This reason is not CDC supported.


VAERS ID: 1291345 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / N/A - / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamins D3 &K2
Current Illness:
Preexisting Conditions: Possibly vertigo
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 101 fever, 4 does of Motrin, relieved after 20 hours


VAERS ID: 1291393 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever of 104.5; chills; body aches; fatigue; and nausea.


VAERS ID: 1291422 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN EW0179 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anaphylactic reaction, Angioedema, Blood test, Chills, Hyperhidrosis, Lip swelling, Muscle spasms, Myalgia, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Dystonia (broad), Oropharyngeal allergic conditions (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lithium Lamotrigine Klonopin Ambien Doxycycline Trifluoperazine Birth control pill
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Not released by hospital, but blood was drawn.
CDC Split Type:

Write-up: 10 hours after vaccination, began fever, sweating, muscle aches and cramping, chills, and vomiting. 30 hours after vaccine lips swelled and began experiencing angioedema and anaphylaxis.


VAERS ID: 1291444 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-04-26
Onset:2021-05-04
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Lymph node pain, Lymphadenopathy, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Ceclore, Codine, Erythromycin
Diagnostic Lab Data: None at this time, but I am considering seeking a doctor visit if I can get my insurance straightened out and this hasn?t subsided.
CDC Split Type:

Write-up: My 2nd vaccine injection was in April 26. The next day the lymph node at my collar bone was very swollen and tender. This continued for several days until May 4th when the lymph node was no longer visibly swollen or tender to touch; however, muscle soreness in my shoulders and neck, as well as a right sided headache, has unexpectedly set in.


VAERS ID: 1291460 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal discomfort, Diarrhoea
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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: Claritin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Diarrhea and stomach upset


VAERS ID: 1291496 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-04-26
Onset:2021-05-04
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (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: Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Redness and itching.


VAERS ID: 1291502 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-07
Onset:2021-05-04
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Food allergy, Throat irritation, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, Farxiga, Amlodipine, Glipizide, Irbestatin, Atrovastatin, Lantus SoloStar insulin, 81mg Aspirin, Fish Oil, Vitamin D.
Current Illness: No other illnesses beside chronic issues noted below.
Preexisting Conditions: I am diabetci (16 years) and have high blood pressure and high cholesterol of which I have under control with medicine noted above. My A1C is less than 7.0 (varies between 6.1 and 6.9)
Allergies: I have never had an allergic reaction to any food in the past. Approximately 10 days ago, I ate some tempura shrimp from the store and felt a little itch, but attributed it to an allergy from the environment. Yesterday, I again had tempura shrimp from the store and broke out with major hives on my face, back chest, stomach, and legs. Ended up taking 4 benadryl tabs (25 mg) and corizone cream to address the issue with symptoms subsiding 2 to 3 hours later and fully resolved by morning. Never had an allergic reaction to shrimp in the past which I have enjoyed several times yearly at a restaurant during their all you can eat shrimp event. I have requested an allergy test from my doctor and have a virtual appointment with him on May 17.
Diagnostic Lab Data:
CDC Split Type:

Write-up: None stated.


VAERS ID: 1291506 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Axillary pain, Lymphadenopathy, Pain
SMQs:, 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: Paxil 25mg and Zyrtec
Current Illness: Wisdom tooth removal 2 weeks prior
Preexisting Conditions: Asthma
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: I have TERRIBLE pain in my left armpit. Has been going on for two days. The pain radiates and is a bit swollen as well.


VAERS ID: 1291525 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Public       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Insomnia, Nausea, Peripheral coldness, Sleep disorder, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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: Nothing, except vitamins c and d
Current Illness: Sneezing, runny nose, slight caught - even 1 day prior to vaccination. Small temperature 37.0-37.2 - 1 week before vaccination
Preexisting Conditions: Chronical tonsillitis, Staphylococcus aureus - since 17 years old was increased in blood up-to 2000. Inflammation proteins, autoantibodies found raised in 2020. Pneumonia in 2018, lungs small inflammation - in 2019/2020.
Allergies: Lactose intolerance, household chemicals, antibiotics and some other drugs
Diagnostic Lab Data: weight 44 kg, age 31.
CDC Split Type:

Write-up: after 15 min - fatigue, nausea. P.S. I walked ~9km to home. Thought it will help. At home - 3 hours after - temperature 37.5, strong nausea, strong chills (cold feet, cold hands). 5 hours after - insomnia, fatigue, chills. 10 hours after - vomiting. Sleep 2-3 hours. 15 hours after - chills, fatigue. Sleep more 6 hours. 24 hours - fatigue. (no chills, no temperature) Headache. 30 hours - headache, slight insomnia, fatigue 40 hours - no headache, fatigue.


VAERS ID: 1291531 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: RASH


VAERS ID: 1291537 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NDC# 59267-1000 / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Immediate post-injection reaction, Stridor, Tremor
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: The patient is a 53yo F with history of asthma, non-epileptic seizures who on 5/4/21 received the 1st Pfizer vaccine of her vaccination series. Immediately afterward, she developed full-body shaking and SOB. She was immediately sent to the ER where she was found to have stridor but without angioedema, hypoxia, urticaria, vomiting, hypotension, or other signs of anaphylaxis. During her stay in the ER, I oversaw her care and her symptoms completely resolved after IM Epi, benadryl, famotidine, albuterol/iptratropium, steroids, and magnesium. After an observation period in the ED, she had no recurrence of symptoms and was ultimately discharged.


VAERS ID: 1291543 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048821A / 1 LA / SYR

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

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

Write-up: The day after getting the shot I had soreness in left arm, severe body aches and pain, no fever, chills. Felt really cold to the bones and my teeth would chatter.


VAERS ID: 1291641 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Confusional state, Dizziness, Hypotension, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Confusion-Mild, Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Hypotension-Medium, Systemic: Weakness-Mild


VAERS ID: 1291806 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-13
Onset:2021-05-04
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Headache, Hyperhidrosis, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Fever chills sweating nausea headache body aches


VAERS ID: 1291807 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Injection site swelling, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Colestid
Current Illness: Bronchitis
Preexisting Conditions: IBS/IBD, PCOS, Hidradenitis Supprativa
Allergies: Clindamyacin, Versed
Diagnostic Lab Data:
CDC Split Type:

Write-up: Itchy rash and large painful swelling at injection site


VAERS ID: 1291821 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018B21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: LIPS FELT NUMB-Mild.


VAERS ID: 1291824 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018B21A / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Flushing, Hyperhidrosis, Pruritus
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Allergic: Itch Generalized-Mild, Systemic: Flushed / Sweating-Mild.


VAERS ID: 1291835 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

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

Write-up: Sore arm. Fever 101 Body aches


VAERS ID: 1291839 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Dizziness, Fatigue, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Moderate to severe muscle and joint pain from 12-36 hours after vaccination. Weakness and exhaustion from 12-48 hours after injection. Mild dizziness and nausea at 48 hours.


VAERS ID: 1291840 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction, Dysphagia, Dyspnoea, Eye swelling, Lip swelling, Mouth swelling, Muscle spasms, Paraesthesia, Pharyngeal paraesthesia, Pruritus, Rash, Swelling face, Swollen tongue, Throat tightness, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Dystonia (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Systemic: Allergic: Anaphylaxis-Severe, Systemic: Allergic: Difficulty Breathing-Severe, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Severe, Systemic: Allergic: Itch (specify: facial area, extremities)-Severe, Systemic: Allergic: Itch Generalized-Severe, Systemic: Allergic: Rash (specify: facial area, extremities)-Severe, Systemic: Allergic: Rash Generalized-Severe, Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Severe, Additional Details: symptoms started 2 hours after the 2nd Covid a injection. Lower lip was protruding and severely swollen, spasms in left ear, itching and tingling of the face and throat, hived around eyes and on back. Pt tried Benadryl at home but did not help and was rushed to emergency room where was started immediately on an IV. Was also given epinephrine, Benadryl and Pepcid. Pt stayed at emergency room for 5 hours.


VAERS ID: 1291842 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-30
Onset:2021-05-04
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain lower
SMQs:, Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: LLQ ABDOMINAL PAIN


VAERS ID: 1291847 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Migraines from egg yolk based vaccines.
Other Medications: 1. Buspirone (Buspar); 2. Wellbutrin (Bupropion HCL); 3. OXCARBAZEPINE (Trileptal); 4. Metformin HCL; 5. FAMOTIDINE (Pepcid); 6. Levothyroxine.
Current Illness: Allergy to laundry detergent
Preexisting Conditions: 1. Vasomotor Rhinitis; 2. Borderline Personality Disorder; 3. Bipolar Disorder (or Manic Depressive disorder) with Mixed Episodes; 4. Generalized Anxiety Disorder; 5. Pre-diabetes 6. Anemia; 7. Migraines; 8. Insulin Resistance; 9. Poly-cystic Ovarian Syndrome; 10. Acid Reflux 11. Allergies; 12. Hypothyroidism
Allergies: 1. Penicillin (a) hives; 2. Amoxicillin (a) hives; 3. Methicillin (a) hives; 4. Cloxacillin (a) hives; 5. Lamictal (a) hives; 6. Septra (a) hives 7. Bacitracin (antibiotic ointment) (a) localized hives; 8. Benadryl (a) nausea/vomiting 9. Sudafed (a) false hypo-manic episode; 10. Poppy derivatives (OPIATES) (a) sneezing/runny nose; 11. Saffron (a) sneezing/runny nose; 12. Novocaine (a) hypersensitivity; 13. Lidocaine (a) hypersensitivity; 14. Latex (a) hives; 15. EGG YOLKS (vaccines incubated in eggs) (a) migraine headache trigger and nausea/vomiting
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Migraine and ringing in ears.


VAERS ID: 1291848 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-04-29
Onset:2021-05-04
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site urticaria, Injection site warmth
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor, Lyrica, Synthroid, Alopurinol, Folic Acid Vit C, Vit D, Zinc, Magnesium, Quenticin, Elderbery
Current Illness: none
Preexisting Conditions: psoriatic arthritis, sarcoid, psoriasis
Allergies: none
Diagnostic Lab Data: Called my doctor - he told me this is a common reaction to vaccines but because it is so significant I should report it to vears. So I am
CDC Split Type:

Write-up: 5 days after receiving my 2nd vaccine I have a LARGE HOT welt on my arm where I received the vaccine. After 2 days it is slowly getting larger and it is still hot.


VAERS ID: 1291862 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Flushing, Heart rate increased, Hypertension, Hypoaesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Hypersensitivity (broad), Dehydration (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: Cephalexin; Medium Nausea and Vomiting; Ciprofloxacin Medium; Other - See Comments Severe dizziness, sick to stomach; Metformin Medium; Diarrhea Lisinopril; Cough.
Diagnostic Lab Data: Per Med Rec " Patients vitals were taken at 0904 and were as follows - BP 198/106, Pulse - 112, O2 =- 97%. Patient stated she felt flushed, and "numb in the head." Patient informed us that she had not ate or drank anything prior to her appointment. She had also just had labs drawn. Patient was prescribed two blood pressure medications but she had only been taking one. Vitals checked again at 0910 and were as follows - BP 197/97, Pulse - 92, O2 - 96%. Patient was given water, a snack and had a cold rag placed on her head. Dr. had evaluated patient and advised that the patient sit for a while longer and as long as there were no signs of anaphylaxis patient was ok to leave. Vitals checked at 0919 and were as follows - BP 187/99, Pulse 88, O2 98%. Vitals checked a final time at 0930 - BP 185/102, Pulse - 87, O2 - 97%. Patient was instructed by Dr. to start taking her second blood pressure medication daily and call the office with any concerns. Patient was also advised that she can have the 2nd dose of Moderna on 06/01/21 as scheduled but she should eat, drink and take all medications prior to that appointment. Patient had a family member pick her up from the office and she left the office at 0943."
CDC Split Type:

Write-up: Per hospital reporting system "Within 5 mins of patient getting Vaccine patient told nurse she was feeling numbness and tingling in her face. Nurse propped patient''s feet up on chair got CTL to come to the room where the event was happening. Vitals was checked (BP was high and Pulse was high) cool rag was placed on patient''s forehead and Provider came to access patient. Patient was kept for an hour with vitals being accessed and then released to go home with son."


VAERS ID: 1291880 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flucelvax
Other Medications: Estrace, Progest, magnesium, fish oil, vitamin b12 & b6
Current Illness: None
Preexisting Conditions: Mild tinnitus in one ear
Allergies: Quinolones and anti nausea drugs Reaction to flucelvax, but receive fluzone no problem
Diagnostic Lab Data: None as of yet. Was hoping the effect was short lived. And there is no cure for tinnitus.
CDC Split Type:

Write-up: Experienced excessive fatigue 6 hrs post vaccination. Not concerned. Following morning noticed an increase in tinnitus symptoms. I had longstanding, mild tinnitus, in one ear, however, this was whistling in both ears and an order of magnitude worse.


VAERS ID: 1291883 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0189 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ZYRTEC, DAPSONE 50 MG, VIT D
Current Illness: NONE REPORTED
Preexisting Conditions: ANAPHYLAXIS
Allergies: COD, NSAIDS
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: HIVES ON FEET


VAERS ID: 1291900 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad)

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

Write-up: Shaking at night, headache in the morning


VAERS ID: 1291942 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Fainting / Unresponsive-Mild, Additional Details: The patient just fainted after recieving covid shot briefly. She stated that she usually faints after receiving shots or needles.


VAERS ID: 1291961 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 2 LA / IM

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

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

Write-up: Fever 101, Chills, sweats starting about 11:30PM, lasting until 7:00am, Tylenol.


VAERS ID: 1291982 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Chills, Paraesthesia, Paraesthesia oral
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Systemic: Chest Tightness / Heaviness / Pain-Medium, Systemic: Chills-Medium, Systemic: Tingling of Lips and Tongue-Medium, Systemic: Tingling (specify: facial area, extemities)-Medium


VAERS ID: 1291993 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: Fever persisting 36 hours with a peak temperature of 102.6 degrees, body aches and fatigue


VAERS ID: 1292000 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Injection site pain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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? 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: Pain at injection site, fever, chills, body aches, headache, fatigue Treatment: NSAIDs for 24 hours, fluids


VAERS ID: 1292002 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexapro, Lyrica, Prilosec, Flexeril
Current Illness:
Preexisting Conditions: Gastroperesis, fibromyalgia, hyper mobility, chronic fatigue syndrome
Allergies: Cymbalta, witch hazel, adhesive, thimerisol
Diagnostic Lab Data:
CDC Split Type:

Write-up: Left arm pain and immobility, fatigue, headache, neck and shoulder pain, nauseated


VAERS ID: 1292008 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Headache, Musculoskeletal stiffness, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Covid-19 pfizer, aches, pains, low-grade fever
Other Medications: Premarin 0.9mg
Current Illness: No
Preexisting Conditions: No
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nausea and diarrhea within 2 hours of shot - resolved Headache and stiff neck within 2 hours of shot - persists Fever reaching 102.9 - 5/5 4am Fever persists 99-100 with advil / tylenol


VAERS ID: 1292009 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Although patient stated that "his seizures were under control," due to the medication he takes, no specific medications were disclosed at the time of his visit. Patient is does not get any of his prescriptions filled at clinic. He only sche
Current Illness: A history of seizures/epilepsy per the Patient Vaccine Consent Form
Preexisting Conditions: A history of seizures/epilepsy per the Patient Vaccine Consent Form
Allergies: None per the Patient Vaccine Consent Form
Diagnostic Lab Data: The paramedics assessed his vitals when they arrived. Patient stated that he "felt fine" and he chose not to leave with the paramedics. I have not been made aware of any specific laboratory results or any other medical tests that may have been performed at this date and time.
CDC Split Type:

Write-up: Patient experienced a seizure episode immediately after I administered his COVID-19 vaccine. I administered the vaccine at 10:22 AM and a few seconds later Patient started to shake and toss his head back. I immediately called 911/paramedics after his wife and I helped him to lay to his side. His seizure episode lasted about 2 or 3 minutes. He quickly regained consciousness and became fully responsive before the paramedics arrived.


VAERS ID: 1292032 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

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

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

Write-up: Nausea


VAERS ID: 1292042 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Fatigue, body aches, headache, fever, chills


VAERS ID: 1292050 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 2 LA / IM

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

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

Write-up: Redness and pain at injection site lasting 36+ hours, headache moderate lasting 36 hours


VAERS ID: 1292109 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 2 RA / UN

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Chills, Diarrhoea, Headache, Hyperhidrosis, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin, about half an hour before the vaccine (I later learned I shouldn''t have taken it)
Current Illness: none
Preexisting Conditions: none
Allergies: latex, sulfa drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, chills, sweats, diarrhea, muscle pain, joint pain


VAERS ID: 1292116 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Pallor
SMQs:, Hypotonic-hyporesponsive episode (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: Unknown
Current Illness: No known health conditions
Preexisting Conditions: None
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: 10 to 12 minutes after the vaccine administration Observing pharmacist reported that patient was turning pale and continued to be pale after few minutes. Patients mother reported that it does happen to him often. Called paramedics as precautionary and paramedics suggested to take him to the hospital. Patient was transported in the ambulance for further evaluation. Could not reach the patient or the Mother to follow up


VAERS ID: 1292129 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chills, Headache, Injection site erythema, Injection site pain, Nausea, Neck pain, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac, multi-vitamin, vitamin d, fish oil, blood pressure meds
Current Illness:
Preexisting Conditions: High blood pressure
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within first 24 hours, I experienced: fever, chills, headache, neck ache, body aches, nausea, injection site redness and pain.


VAERS ID: 1292205 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Delaware  
Vaccinated:2021-04-24
Onset:2021-05-04
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lipoma
SMQs:, Lipodystrophy (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: diabetes high cholesterol
Preexisting Conditions: diabetes high cholesterol
Allergies: n/a
Diagnostic Lab Data: the patient said he was seen in hospital
CDC Split Type:

Write-up: The patient said he developed a lipoma in his right arm


VAERS ID: 1292297 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Headache, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Headache within 30 minutes, body aches, fever, confusion within 12 hours.


VAERS ID: 1292312 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / N/A - / IM

Administered by: Public       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Immunization error occurred at a Bi-monthly vaccine clinic inside . is currently residing at this and he filled out a pre-vaccination checklist per protocol and checked NO to all questions on checklist including "have you had a previous dose of COVID-19 vaccine." We administered 0.5 mL Johnson and Johnson COID-19 vaccine IM in right arm 05-04-21. He was monitored for 15 minutes and left without incident. When I went back to pharmacy to document vaccine I then discovered record of J & J previous given on 03-09-21. I filled out occurrence report and notified clinical super visor at .


VAERS ID: 1292366 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 LA / IM

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

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

Write-up: Patient was not 16 years of age.


VAERS ID: 1292368 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / N/A LA / IM

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

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

Write-up: Immunization error occurred at a Bi-monthly vaccine clinic at homeless shelter. Patient said he was from country and had never been seen at Health services. Pt filled out pre vaccination checklist and answered NO to all questions including , "have you had a previous dose of COVID-19 vaccine." On 05-04-21 pt received a single dose of Johnson and Johnson COVID-19 vaccine in his left arm. He was monitored for 15 minutes and left without incident. He was very interested in obtaining COVID-19 vaccine card because he wanted to go to public event. Clinical supervisor alerted us that he previous dose on 04-01-21.


VAERS ID: 1292377 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / UNK LA / IM

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

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

Write-up: Pt reported feeling dizzy as she approached monitoring table. Pt was assisted by EMS fire & M.A. Agee. Vitals taken x4 and water /snacks given. Pt reported improvement in condition and was released by fire/EMS to leave with family. Pt. self ambulated with family to exit of building. 3:48PM BP82/36, HR 60, OxSat 99%, BS 105. At 3:50PM bp 80/41, HR 80, OxSat 98%. @ 3:52PM BP 98/59, HR 77, OxSat 97%, @3:57PM BP 116/61, HR 92.


VAERS ID: 1292469 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abortion spontaneous, Exposure during pregnancy
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow)

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

Write-up: Was 5.5 weeks pregnant. Had the shot, felt strange that night, miscarried the next day.


VAERS ID: 1292798 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-28
Onset:2021-05-04
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA MODERNA / 2 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Anion gap, Anticoagulant therapy, Basophil count decreased, Basophil count increased, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood potassium normal, Blood sodium normal, Blood urea normal, Carbon dioxide normal, Coagulation time normal, Eosinophil count normal, Glomerular filtration rate increased, Haematocrit normal, Haemoglobin normal, Haemoptysis, Immature granulocyte count, Increased viscosity of upper respiratory secretion, Lipase normal, Lymphocyte count decreased, Lymphocyte count normal, Mean cell haemoglobin concentration normal, Mean cell haemoglobin normal, Mean cell volume normal, Mean platelet volume normal, Metabolic function test, Monocyte count, Monocyte count normal, Neutrophil count increased, Neutrophil percentage decreased, Platelet count normal, Pulmonary embolism, Pulmonary mass, Red blood cell count normal, Red cell distribution width normal, Tachycardia, White blood cell count normal
SMQs:, Agranulocytosis (broad), Haematopoietic leukopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, venous (narrow), Pulmonary hypertension (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: cholecalciferol 120mcg PO daily urea 20% cream thin film to affected daily for skin dryness
Current Illness: No acute illness
Preexisting Conditions: Intrathoracic desmoid tumor s/p resection with radiation and chemotherapy Vitamin D deficiency Chronic pain Hyperlipidemia
Allergies: NKDA
Diagnostic Lab Data: Provider: Specimen: BLOOD. HE 0504 425 Specimen Collection Date: May 04, 2021@20:00 Test name Result units Ref. range Site Code WBC 6.22 10x3cumm 4.0 - 11.0 [600] RBC 5.19 MIL/cmm 4.33 - 5.63 [600] HEMOGLOBIN 15.4 g/dL 13.5 - 17 [600] HEMATOCRIT 46.1 % 39 - 50 [600] MCV 88.8 fL 82.0 - 98.0 [600] MCH 29.7 pg 27.9 - 32.5 [600] MCHC 33.4 g/dL 31.0 - 36.0 [600] RDW-CV 12.8 % 11.7 - 15.2 [600] RDW-SD 41.5 fL 36.8 - 49.6 [600] PLATELET 182 K/cumm 150 - 400 [600] MPV 10.1 fL 9.2 - 12.5 [600] NEUTROPHIL % 53.4 % 46.5 - 74.0 [600] NEUTROPHIL # 3.33 K/mcL 1.70 - 7.60 [600] LYMPHOCYTE % 35.9 % 16.0 - 45.0 [600] LYMPHOCYTE # 2.23 K/mcL 1.00 - 3.60 [600] MONOCYTE % 6.9 % 4.0 - 12.0 [600] MONOCYTE # 0.43 K/mcL 0.2 - 1.0 [600] EOSINOPHIL % 2.3 % 0 - 6.4 [600] EOSINOPHIL # 0.14 K/mcL 0.02 - 0.56 [600] BASOPHIL % 1.3 % 0.2 - 1.6 [600] BASOPHIL # 0.08 K/mcL 0.00 - 0.13 [600] IMMATURE GRANULOCYTE % 0.2 % 0.0 - 0.7 [600] IMMATURE GRANULOCYTE # <0.03 K/mcL 0.00 - 0.06 [600] NUCLEATED RBC % 0.0 /100WBC 0.0 - 0.2 [600] NUCLEATED RBC # <0.01 K/mcL 0.000 - 0.012 [600] Specimen Collection Date: May 04, 2021@20:00 Test name Result units Ref. range Site Code LIPASE (LX) 25 unit/L 22 - 51 [600] SODIUM 140 mEq/L 135 - 145 [600] POTASSIUM 3.7 mEq/L 3.5 - 5.0 [600] CHLORIDE 100 mEq/L 95 - 105 [600] ANION GAP 11 mmol/L 7 - 16 [600] CO2 29 mEq/L 24 - 32 [600] GLUCOSE 86 mg/dL 60 - 100 [600] Eval: This reference range is for FASTING specimens only. Eval: Effective 6/23/08, the reference range is 60-100 mg/dL. Eval: Previous reference range was 60-110 mg/dL. UREA NITROGEN 12 mg/dL 5 - 25 [600] CREA 0.76 mg/dL 0.70 - 1.40 [600] EGFR 141.2 mL/min Ref: $g=60 [600] BMP: NA: 140 mEq/L (05/04/21 20:00) SERUM K+: 3.7 mEq/L (05/04/21 20:00) SERUM CO2: 29 mEq/L (05/04/21 20:00) SERUM CL: 100 mEq/L (05/04/21 20:00) SERUM BUN: 12 mg/dL (05/04/21 20:00) SERUM CREA: 0.76 mg/dL (05/04/21 20:00) SERUM GLU: 86 mg/dL (05/04/21 20:00) SERUM CA: 10.0 mg/dL (05/04/21 20:00) SERUM
CDC Split Type:

Write-up: Patient is a 35 y/o MALE with a pmh Desmoid tumor of T spine dx 2007 s/p resection and XRT, last chemo 2017, followed by HEME/ONC last seen 3/22/21. Presenting for bloody cough x1 day. States was in usual state of health. Around midnight of day of presentation, pt. was awoken from sleep by hard cough. He noticed that he was coughing bright red blood, small volume but could not quantify. He was concerned however did not immediately worry because he otherwise felt fine. Later that afternoon, he had another episode of cough, this time darker in color and "thicker". This being new and the second time, prompted pt. to present to ED. While on his way here, he said he cont. to have cough with blood, small volume but frequent, states "training blood all the way here". Denies any prior similar event, no trauma, no recent illness, no sick contact, lives alone, no recent travels, no prolonged immobility, no recent surgeries, no leg pain/swelling. Of note, pt. received Moderna COVID-19 vaccine #2 on Wed of last week (4/28/21). ED Course: Pt was afebrile, initially tachycardic to 106, otherwise hemodynamically stable. Labs: BMP wnl, no elevated wbc, h/h-15.4/46.1, coags normal on admission. CTA w/ acute pulmonary emboli and left main extending into the lingulae and left lower lobe segmental branches, in addition to Nonspecific sub-5 mm pulmonary nodules; largest 5 mm nodule in right upper lobe. Pt started on hep drip.


VAERS ID: 1292850 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-10
Onset:2021-05-04
   Days after vaccination:83
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: COVID-19, Exposure during pregnancy, Oropharyngeal pain, SARS-CoV-2 test positive
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, B6, Unisom, Prenatal Vitamins
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: PCR covid test
CDC Split Type:

Write-up: 1/20/2021 1st Pfizer Covid Vaccine 6pm EL3302 Left arm 18 weeks preg 2/10/2021 2nd Pfizer Covid Vaccine 1pm EL3302 Left arm 5/4 Covid POC PCR test Positive- asymptomatic 5/5 sore throat 34 weeks preg 5/15 tentative


VAERS ID: 1293008 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-04-09
Onset:2021-05-04
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Fibrin D dimer increased
SMQs:, Haemorrhage laboratory terms (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: Elevated D dimer


VAERS ID: 1293018 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Blood creatine phosphokinase increased, Gait inability, Urinary incontinence
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: tylenol, tylenol with codeine, lipitor, vitamin d, restasis, trulicity, diflucan, lasix, gabapentin, synthroid, metformin, toprol xl, prilosec, potasium, zanaflex
Current Illness: Diabetes, hyperlipidemia, GERD, hypothyroidism
Preexisting Conditions: see above
Allergies: Iodine, Sulfa
Diagnostic Lab Data: CK of 3-4000 improved with IV fluids
CDC Split Type:

Write-up: Pt had dose 1 Moderna on 5/3 within 24 hours had back pain and urinary incontinence unable to ambulate. Hospitalized overnight.


VAERS ID: 1293031 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-15
Onset:2021-05-04
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Pericarditis Medication Treatment ongoing


VAERS ID: 1293034 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Fainting / Unresponsive-Mild


VAERS ID: 1293088 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / UNK LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Erythema, Needle issue, Pain of skin, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Medication errors (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient states, topical adverse reaction, redness, stinging on arm where medication leaked onto skin. Patient also reported itching at the wrist of left arm. No treatment was given other than wiping off the medication and cleaning the area. Patient states reaction was day of and morning next day, all symptoms have now resolved.


VAERS ID: 1293316 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Myocarditis
SMQs:, Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ethinyl estradiol 0.02mg and Drospirenone 3mg (Yaz) take one tablet by mouth once daily at the same time for abnormal uterine bleeding
Current Illness: None
Preexisting Conditions: Allergic rhinitis Anemia, iron deficiency - previously resolved Abnormal uterine bleeding - Improved on Yaz Headaches
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Myopericarditis


VAERS ID: 1293459 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Diabetic ketoacidosis
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: DM
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: DKA


VAERS ID: 1293472 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 3 LA / IM

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

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

Write-up: PT CAME IN REPORTING THAT SHE WAS GETTING HER 2ND VACCINE BUT WHEN ENTERING DATA INTO REGISTRY, IT SHOWS THAT PT HAS RECIEVED 2 DOSES PRIOR. PT RECIEVED 3 DOSES OF MODERNA. THE FIRST DOSE WAS IN JANUARY, THEN 4/2, THEN 5/4. ATTEMPTED TO CONTACT PT TO CONFIRM BUT HAVE NOT HEARD BACK.


VAERS ID: 1293537 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-04-30
Onset:2021-05-04
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / UNK LA / IM

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

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: diabetes, hypertension, asthma, CAD
Allergies: statins
Diagnostic Lab Data: Treated for pulmonary embolism. Will need to contact Hospital
CDC Split Type:

Write-up: Hospitalized at Hospital.


VAERS ID: 1293609 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood pressure systolic increased, Haemorrhage intracranial, Hemiparesis, Platelet count decreased, Unresponsive to stimuli
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Hypertension
Preexisting Conditions: Hypertension
Allergies:
Diagnostic Lab Data: see above
CDC Split Type:

Write-up: 65 year old man with HTN received second shot of Pfizer COVID 19 vaccine on 5/3/2021. He was found unresponsive on 5/4/2021. He was diagnosed with left intracranial hemorrhage with resulting right hemiparesis. His admission platelets was 46. His admission systolic blood pressure was 220. He only responds to touch and pain. He does not track movement. He is currently comfort care and on hospice


VAERS ID: 1293627 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall, Head injury, Headache, Loss of consciousness, Neck injury, Oropharyngeal pain, Scratch, Streptococcus test negative, Syncope
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), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Vestibular disorders (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Daily gummy multivitamin for adults
Current Illness: None
Preexisting Conditions: None
Allergies: None known
Diagnostic Lab Data: Evaluated for concussion - walk-in clinic on 5/4 Strep test - pediatrician''s office - negative rapid test; still awaiting 24-hour culture Re-evaluated for concussion by pediatrician - confirmed
CDC Split Type:

Write-up: At approximately 9 AM on the morning after receiving the second dose, the patient became dizzy at school. As she was walking to the teacher''s desk, she lost consciousness and fainted, hitting her head on a desk, scraping her neck on a desk, and suffering several other minor injuries from the fall. She was immediately seen by school nurse and released to my care for the rest of the day. She rested at home and then was seen in at Walk-In Clinic to be evaluated for a concussion. On Day 2 after receiving the vaccine, the patient reported a sore throat, but no other symptoms. She was seen on the third day post-vaccine by our pediatrician''s office for possible strep. She tested negative for strep and a concussion from her fainting episode was confirmed due to the lingering headache.


VAERS ID: 1294060 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-05-04
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Contusion, Headache, Pain in extremity, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210508333

Write-up: TINGLING SENSATION; PAIN IN ONE LEG; HEADACHE ON AND OFF; BRUISING; This spontaneous report received from a patient concerned a patient of unspecified age and sex. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: Unk) dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. Per procedure no follow up will be requested. No concomitant medications were reported. On 04-MAY-2021, the subject experienced bruising. On an unspecified date, the subject experienced tingling sensation, pain in one leg, and headache on and off. The action taken with covid-19 vaccine was not applicable. The outcome of the headache on and off, pain in one leg, tingling sensation and bruising was not reported. This report was non-serious.


VAERS ID: 1294066 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Florida  
Vaccinated:0000-00-00
Onset:2021-05-04
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: patient had no known allergies.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210509357

Write-up: RIGHT SHOULDER BLADE PAIN WHICH SPREAD TO NECK; This spontaneous report received from a patient concerned a 61 year old female. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included patient had no known allergies. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 205a21a, expiry: 23-JUN-2021) dose was not reported, administered on 03-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 04-MAY-2021, the subject experienced right shoulder blade pain which spread to neck. The action taken with covid-19 vaccine was not applicable. The patient recovered from right shoulder blade pain which spread to neck on 05-MAY-2021. This report was non-serious.


VAERS ID: 1294133 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046A21A / 2 LA / IM

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

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

Write-up: The person received the first Moderna vaccine by accident. Per the CDC guidance, the second Moderna was provided as off-label use.


VAERS ID: 1294177 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046A21A / 2 RA / IM

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

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

Write-up: Person is under the age 18 years of age for Moderna, but they were provided the first dose by accident. Second dose was provided as an using the CDC guidance as an off-label.


VAERS ID: 1294291 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / UNK - / IM

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

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

Write-up: About 15 minutes after administration patient complained of right front leg pain


VAERS ID: 1294292 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Computerised tomogram, Fatigue, Gait inability, Muscular weakness, Urine analysis, X-ray
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (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: Sirolimus (Rapamune) Mycophenolate mofetil (Cellcept) Prednisone Amlodipine Insulin glargine (Lantus) Insulin lispro (Humalog) Omeprazole Cholecalciferol (Vit D) Sertraline (Zoloft) Aspirin 81mg tablet Multivitamin tablet Tylenol Extra St
Current Illness: in recovery from liver transplant received 9/30/20 .
Preexisting Conditions: Liver transplant recipient
Allergies: Lipitor, Simvastatin
Diagnostic Lab Data: CT scan and X-ray were done in Emergency room, as well as blood test and uranalysis. Other tests were done after admission to the hospital; refer to Hospital for more information.
CDC Split Type:

Write-up: Vaccine was given at Hospital at bout 12:15 PM on 5/4. Weakness of muscles and inability to walk; tired feelings began at about 8:55 PM. Got up to walk to bathroom and could not complete the walk; only walked about 20 feet then need to be supported by husband and eventually lowered to sit on the floor. Fire department was called to help load the patient in to a car for transport to Emergency Room at 1:00 AM on 5/5/21; patient was admitted to this hospital at about 5:00 AM for further testing and observation. Patient is currently still hospitalized at that location.


VAERS ID: 1294319 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-04-30
Onset:2021-05-04
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Constipation
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Periactin CoQ10
Current Illness: None
Preexisting Conditions: Cyclic vomiting syndrome
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Constipation


VAERS ID: 1294512 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Tachycardia, dizziness, sweating, flushing, vitals wnl Given 4 ounces of juice.


VAERS ID: 1294531 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-27
Onset:2021-05-04
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Limb discomfort, Mobility decreased, Muscular weakness, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: I continue to feel pain in my right arm. On about day 6 after getting the first dose my arm felt heavy and weak. I have not been able to use my right arm as much due to pain and weakness. I also have been getting sharp pains going down my arm, this happens randomly throughout the day.


VAERS ID: 1294557 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Cough, Ear discomfort, Fatigue, Headache, Nausea, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D 1200 IU
Current Illness: Non
Preexisting Conditions: Sleep apnea diagnosed OSA, and Unilateral Hemi-diaphragm paralyses right side more then 12 years.
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: I had the 2nd shot of Moderna vaccine Monday 5/3 at noon by 3 AM the next morning I had a fever measured 104.5 chills, headache, weak. I tool Tylenol as directed it would only reduce temps to 101 after 2 hours the fever 104 would return. This lasted until late morning the next day my temps started to fall off to 99. Tiredness and headaches still a problem been 3 days since the Moderna 2nd vaccine shot. I also feel some inner ear pressure like some inflammation in there. The headaches seem to be getting somewhat worse causing me to feel nauseated I took 500 MG of Ibuprofen seems to reduce the headaches. I also developed a cough dry but almost like a flu cough which seems to be resolving.


VAERS ID: 1294577 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-24
Onset:2021-05-04
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extremely heavy period


VAERS ID: 1294656 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Florida  
Vaccinated:0000-00-00
Onset:2021-05-04
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Lymphadenopathy, Rash erythematous, Urticaria, Vital signs measurement
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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Non-smoker
Preexisting Conditions: Comments: The patient had no known drug allergies.
Allergies:
Diagnostic Lab Data: Test Date: 20210504; Test Name: Vital signs measurement; Result Unstructured Data: not reported
CDC Split Type: USJNJFOC20210507890

Write-up: ITCHY HIVES; SWOLLEN LYMPH NODES NEAR THROAT; RED RASH ON LEG; This spontaneous report received from a patient concerned a 38 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included non-alcohol user, and non-smoker, and other pre-existing medical conditions included the patient had no known drug allergies.The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 204A21A, and batch number: 204A21A expiry: 23-JUN-2021) dose was not reported, administered on 04-MAY-2021 13:00 for prophylactic vaccination. No concomitant medications were reported. On 04-MAY-2021, the subject experienced swollen lymph nodes near throat. On 04-MAY-2021, the subject experienced red rash on leg. Laboratory data included: Vital signs measurement (NR: not provided) not reported. On 04-MAY-2021 17:00, the subject experienced itchy hives. The action taken with covid-19 vaccine was not applicable. The patient recovered from itchy hives on 04-MAY-2021, was recovering from red rash on leg, and had not recovered from swollen lymph nodes near throat. This report was non-serious.


VAERS ID: 1294759 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-23
Onset:2021-05-04
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 1 LA / IM

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

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

Write-up: Pfizer Covid vaccine administered to 15 year old. Patient and/or mom falsified information on consent and release form stating patient''s DOB was 1 year before pt''s real DOB and age was 1 year older than patient''s real age. * * * NO adverse reaction reported. * * *


VAERS ID: 1294823 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-05-04
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Feeling abnormal, Headache, Pain, Pyrexia, Rhinorrhoea
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 20210504; Test Name: Body temperature; Result Unstructured Data: 100.2 F
CDC Split Type: USJNJFOC20210508236

Write-up: WOKE UP FEELING terrible; SNIFFLES; BODY ACHES; POUNDING HEADACHE; 100.2 FEVER; This spontaneous report received from a patient concerned a female of unspecified age. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) dose was not reported, administered on 03-MAY-2021 for prophylactic vaccination. Batch number was not reported. Per procedure, no follow up will be requested for this case. No concomitant medications were reported. On 04-MAY-2021, the subject experienced woke up feeling terrible. On 04-MAY-2021, the subject experienced sniffles. On 04-MAY-2021, the subject experienced body aches. On 04-MAY-2021, the subject experienced pounding headache. On 04-MAY-2021, the subject experienced 100.2 fever. Laboratory data included: Body temperature (NR: not provided) 100.2 F. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the woke up feeling terrible, pounding headache, sniffles, body aches and 100.2 fever was not reported. This report was non-serious.


VAERS ID: 1294844 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Injection site warmth, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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: Sulfasalazine, Omeprazole, Folic Acid, Propranolol
Current Illness: Infected tooth
Preexisting Conditions: Crohn''s Disease
Allergies: Remicad, Humana
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Fever after 12 hours, 101 degrees, ending after 36 hours, at 60 hours below injection upper arm red, hot to touch, sore. Doctor prescribed cephalexin 500 mg, 3x daily. 90 hours tender still, less red and less hot, other than are feeling much better.


VAERS ID: 1294851 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness, Syncope, Unresponsive to stimuli, Urinary incontinence
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), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (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? 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: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Additional Details: Patient slumped on chair at observation area within 5 minutes of vaccination but quickly regained consciousness when rph attempted to assist patient. Patient did not hit the ground and was unconscious for less than 30 seconds. patient urinated on self. blood pressure reading was 107/75mmhg and temperature was 97. Patient was monitored for more than 30 minutes afterward and left with a family member.


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