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From the 11/12/2021 release of VAERS data:

Found 875,292 cases where Vaccine is COVID19 and Patient Did Not Die

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 169 out of 8,753

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VAERS ID: 1835606 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Hypokinesia, Immunisation, Lymph node pain, Lymphadenopathy, Musculoskeletal stiffness, Pain, Pain in extremity, Paraesthesia, Swelling, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101410285

Write-up: Still 7 days later, swelling; Still 7 days later tenderness; Still difficult to squeeze my arm against my chest wall; Realized in morning my left armpit/ lymph node area was extremely swollen, painful; Realized in morning my left armpit/ lymph node area was extremely swollen, painful.; Booster dose/dose 3 received; About 7 hours after dose 3 , I developed shoulder injection tightness.; Then middle of night, I woke with same arm, forearm pain; Deep throbbing into fingers; Tingling into fingers; This is a spontaneous report from a contactable consumer, the patient. A 65-year-old non-pregnant female patient received third dose (booster) of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: EW0191) via an unspecified route of administration on 15Oct2021 (at the age of 65-years-old), as a single dose for COVID-19 immunisation. Medical history and concomitant medication was not reported. The patient had no known allergies. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient previously received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: ER8732) via an unspecified route of administration on 29Mar2021(at the age of 64-years-old), as a single dose for COVID-19 immunisation and second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: EW0164) via an unspecified route of administration on 19Apr2021 (at the age of 64-years-old), as a single dose for COVID-19 immunisation. On 15Oct2021, about 7 hours after dose 3, the patient experienced shoulder injection tightness, then in the middle of night, patient woke with up pain in same arm, forearm pain, deep throbbing into fingers, tingling into fingers. On 16Oct2021, the patient realized in morning left armpit/ lymph node area was extremely swollen and painful. On 20Oct2021, 7 days later, the patient still experienced, swelling, tenderness and it was still difficult to squeeze arm against her chest wall. The events did not result in doctor or other healthcare professional office/clinic visit, and emergency room/department or urgent care. Therapeutic measures were not taken as a result of the reported events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events about 7 hours after dose 3, developed shoulder injection tightness, then middle of night, patient woke with same arm, forearm pain, deep throbbing into fingers, tingling into fingers, the patient realized in morning left armpit/ lymph node area was extremely swollen and painful were resolving and the patient still experienced 7 days later, swelling, tenderness and still difficult to squeeze arm against chest wall was not resolved at the time of this report.


VAERS ID: 1835816 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-14
Onset:2021-10-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anal incontinence, Asthenia, Choking, Diarrhoea, Diplegia, Fall, Guillain-Barre syndrome, Metabolic function test, Muscular weakness, Nausea, Pyrexia, Retching, Urinary incontinence
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril Atorvastatin Lispro
Current Illness: stroke 3 months prior
Preexisting Conditions: DM2
Allergies: none
Diagnostic Lab Data: comprehensive metabolic panel ordered by doctor, results not yet available
CDC Split Type:

Write-up: the following day after the vaccine patient developed paralysis of legs 2 days in row causing patient to fall, legs like wet noodle, very weak upper body strength (Guillame Barre syndrome), fever, profuse diarrhea for at least 2 days, urinary incontinence, bowel incontinence, fever for 2-3 days, extreme weakness, nausea, nonstop gagging and choking on saliva in throat for 2 weeks


VAERS ID: 1835910 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Arizona  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Accidental overdose
SMQs:, Drug abuse and dependence (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: 2 Patients received 0.5 mL third dose and were not immunocompromised/received the third dose about 10 days ago; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by an other health care professional and describes the occurrence of ACCIDENTAL OVERDOSE (2 Patients received 0.5 mL third dose and were not immunocompromised/received the third dose about 10 days ago) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 15-Oct-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) .5 milliliter. On 15-Oct-2021, the patient experienced ACCIDENTAL OVERDOSE (2 Patients received 0.5 mL third dose and were not immunocompromised/received the third dose about 10 days ago). On 15-Oct-2021, ACCIDENTAL OVERDOSE (2 Patients received 0.5 mL third dose and were not immunocompromised/received the third dose about 10 days ago) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No Concomitant product use was reported. No treatment information was provided. They patients who claimed being immunocompromised received a full dose of 0.5 mL dose, but then came back concerned because the approved dosage for booster was 0.25 mL and they were not actually immunocompromised. The reporter informed that the patients received the third dose about 10 days ago. The reporter followed up with patients and they said they were fine.


VAERS ID: 1835927 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-17
Onset:2021-10-15
   Days after vaccination:240
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Sore arm was the as first two/second one was little harder; This spontaneous case was reported by a consumer and describes the occurrence of MYALGIA (Sore arm was the as first two/second one was little harder) in a 68-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 006B21A and 031M20A) for COVID-19 vaccination. No Medical History information was reported. On 17-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 17-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 15-Oct-2021, the patient experienced MYALGIA (Sore arm was the as first two/second one was little harder). On 16-Oct-2021, MYALGIA (Sore arm was the as first two/second one was little harder) had resolved. Unknown No concomitant medications were provided. No treatment medications were provided. This case was linked to MOD-2021-363625, MOD-2021-362729 (Patient Link).


VAERS ID: 1836582 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-10-08
Onset:2021-10-15
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Bronchitis, Decreased appetite, Diarrhoea, Dizziness, Myalgia, Nasopharyngitis, Pain, Pain in extremity, Productive cough, Pyrexia, Respiratory tract congestion, SARS-CoV-2 RNA, Suspected COVID-19, Vaccination site pain
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amLODIPine (NORVASC) 10 mg tablet aspirin 81 mg chewable tablet atorvastatin (LIPITOR) 10 mg tablet blood pressure monitor (BLOOD PRESSURE KIT) kit fluticasone propionate (FLONASE) 50 mcg/actuation nasal spray omeprazole (PriLOSEC) 20
Current Illness:
Preexisting Conditions: Nervous Macula scar of posterior pole of left eye Cigarette nicotine dependence without complication Circulatory Essential hypertension Digestive Class 2 severe obesity due to excess calories with serious comorbidity and body mass index (BMI) of 39.0 to 39.9 in adult (CMS/HCC) Diverticulosis GERD without esophagitis Polypus, colon Musculoskeletal Osteoarthritis of knee Easy bruising Endocrine/Metabolic Hyperlipidemia Type 2 diabetes mellitus without complication, without long-term current use of insulin (CMS/HCC) Other Depression Male erectile disorder of organic origin Spinal stenosis of lumbosacral region
Allergies: IbuprofenIndigestion / GI upset Iodinated Contrast MediaItching PenicillinsItching
Diagnostic Lab Data: 10/19/2021 1634 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 10/19/21 1634 | Final result | Specimen: Swab from Nares COVID-19 SARS-CoV-2 Overall Result Detected Critical
CDC Split Type:

Write-up: Office Visit 10/19/2021 Internal Medicine Acute bronchitis, unspecified organism +1 more Dx Progress Notes Date of Service: 10/19/21 Diagnosis Plan 1. Acute bronchitis, unspecified organism azithromycin (ZITHROMAX) 250 mg tablet 2. Suspected COVID-19 virus infection COVID-19 PCR COVID-19 PCR Plan Patient Instructions I am sorry that the body aches cough, weakness, and low-grade fever have been a problem over the past several days. On examination today, I hear a fair amount of mucus in both lungs, so I would like to treat this like acute bronchitis. Please start the course of a azithromycin. Watch for diarrhea with this antibiotic. Patient is a 57 y.o. male who presents for ZONE PATIENT COLD, CONGESTION, MYALGIA. 3-4 days ago body aches. Productive cough. No appetite. Litle weak, dizzy. No loss of taste or smell. Phone call to the office yesterday morning described arm soreness. 10/8/2021 he received the first Pfizer COVID-19 dose in his left deltoid. In the call, he described pain at the vaccination site and joints in the left arm.


VAERS ID: 1836685 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Arthralgia, Blood immunoglobulin G, Blood immunoglobulin M, Chest discomfort, Chest pain, Chills, Defaecation urgency, Fatigue, Headache, Hypertension, Pruritus, Pyrexia, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna 1st dose
Other Medications: Benadryl due to reaction from first dose at the advice of pharmacist.
Current Illness: No, other than the slight tingling and numbness of lips and tongue after first dose vaccine. Ended approx. 3 hours after shot. Had antibodies checked 8/28 and tested positive for both IgG and IgM. Negative Antigen Covid-19. Also tested at home Covid on 10/14, which was also negative
Preexisting Conditions: None other than ptsd/anxiety due to trauma from previous abusive relationship.
Allergies: Severe reaction to Contrast Dye in my early teens. Macrolides & Ketolides. Sulfa Drugs. Z-Pak. Ciprofloxacin. Some Penicillins. Flu shot, feelings of general unwellness, not severe.
Diagnostic Lab Data: N/A
CDC Split Type: N/A

Write-up: Second Dose Moderna: much more severe (than 1st dose) serious reaction with the following: Reaction within 15-20 minutes of dose. Took benadryl on site due to previous reaction. Continued benadryl every four hours for 3 days. High fever, joint pain, chills, headache, extreme fatigue, stomach upset, high blood pressure evening of shot. Chest soreness and tightness day after. Evening of, face, chest and wrists itching. Stomach issues with urgent forceful bm''s for over a week, as of today less intence and frequency. Approx. 45 minutes after 1st shot had numbing and tingling of mouth and tongue. Immediate soreness and pain left arm after injection. Extremely sore arm. Approx. 3 hours post injection the numbness and tingling subsided. Took benadryl as a precaution at bedtime. Following days, low grade fever, chills, fatigue.


VAERS ID: 1837055 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-15
Onset:2021-10-15
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, COVID-19, Chest pain, Cough, Diarrhoea, Dizziness, Dyspnoea, Exposure to SARS-CoV-2, Musculoskeletal stiffness, Nausea, Rash, SARS-CoV-2 test positive, Upper respiratory tract infection, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: finasteride (PROSCAR) 5 mg tablet fluticasone propionate (FLONASE) 50 mcg/actuation nasal spray fluticasone propionate (FLONASE) 50 mcg/actuation nasal spray lisinopril (PRINIVIL,ZESTRIL) 2.5 mg tablet primidone (MYSOLINE) 50 mg tablet
Current Illness:
Preexisting Conditions: Digestive Tubular adenoma of colon
Allergies: NKA
Diagnostic Lab Data: 10/18/2021 1428 COVID-19 (SARS CoV-2 RNA, RT-PCR) Collected: 10/18/21 1428 | Final result | Specimen: Swab from Nares COVID-19 SARS CoV-2 RNA Detected Abnormal 10/18/2021 1428 COVID-19 PCR Collected: 10/18/21 1428 | Final result | Specimen: Swab from Nares
CDC Split Type:

Write-up: Office Visit 10/18/2021 Urgent Care PA-C Family Medicine Exposure to COVID-19 virus +1 more Dx Cough Reason for Visit 10/18/2021 Chief Complaint Patient presents with ? Cough mild , exposure to covid HPI Assessment/Plan Pt was seen today for cough. Diagnoses and all orders for this visit: Exposure to COVID-19 virus - COVID-19 PCR URI, acute Pt is a 82 y.o. male Presents with slight cough x 3 days. Symptoms are stable .Patient has tried cough suppressant with moderate relief. Patient denies fever/chills, ST, nausea/vomiting, diarrhea, abdominal pain, rash, neck stiffness, chest pain, shortness of breath, dizziness. +covid exposure


VAERS ID: 1837410 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-10-01
Onset:2021-10-15
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anger, Emotional distress, Interchange of vaccine products, No adverse event
SMQs:, Hostility/aggression (narrow), Depression (excl suicide and self injury) (broad), Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Stated he probably had COVID as he was symptomatic after wife contracted it. He did not get tested. This would have been about 2.5 weeks before he received the 2nd COVID vaccine.
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: NOne
CDC Split Type:

Write-up: I gave a Moderna for a second dose instead of a Pfizer. No adverse reactions after the shot. Patient was angry and upset. Sat in the parking lot for 1.5 hours. No adverse reactions.


VAERS ID: 1837426 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-01
Onset:2021-10-15
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C2119 / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Condition aggravated, Nausea, Tinnitus
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Enbrel 50mg 1xweek, Sureclick Injector pen 1x week, Gabapentin 300mg 1xday, Amitriptyline 25mg 1xday, Levothyroxine 100mcg 1xday, Lisinopril 10mg 1xday, Vit D 2000 IU 1xday, Folic Acid 800 Mcg 1xday, Fexofenadine 180 mg 1xday, Zinc 25mg 1x
Current Illness:
Preexisting Conditions: Fibromyalgia, Rheumatoid Arthritis, Osteoarthritis, Sjogren''s, high blood pressure, Tinnitus (2 out Of 10)
Allergies: Sulfa medication
Diagnostic Lab Data: Primary Doctor. Prescribed: Amoprazole 40mg 1 capsule per day- No change in nausea level.
CDC Split Type: vsafe

Write-up: Tinnitus continues 8 to 10 level from when received Dose 2. developed nausea


VAERS ID: 1837677 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-05-01
Onset:2021-10-15
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Gastrooesophageal reflux disease
SMQs:, Gastrointestinal nonspecific dysfunction (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: tylenol gabapentin zofran migranol lamictal zytrec montelukast probiotic
Current Illness: migraine
Preexisting Conditions: migraine epilepsy Von-Willebrand''s disease IG-g deficiency
Allergies: metformin reglan MSG
Diagnostic Lab Data:
CDC Split Type:

Write-up: GERD - being treated with Prilosec and famotidine


VAERS ID: 1837714 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-10-06
Onset:2021-10-15
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Atrial fibrillation, Chest discomfort, Electrocardiogram abnormal
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: I was diagnosed with A-fib in 2019. I had Cardio ablation in December 2019, and had been A-fib free until two weeks ago
Allergies: none
Diagnostic Lab Data: EKG test 2 November
CDC Split Type:

Write-up: With in a week of receiving the vaccine I begin feeling a tightness in my chess and could feel something wasn''t right with my heart. I was unable to find a heart monitor available in the local stores and ordered on online. The device indicated that I was likely in Afib. I made an appointment with the clinic and they gave me an EKG to confirm that was the case


VAERS ID: 1838814 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-01-27
Onset:2021-10-15
   Days after vaccination:261
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Overdose, Pain in extremity
SMQs:, Drug abuse and dependence (broad), Tendinopathies and ligament disorders (broad), Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Cancer
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: The sore arm was the same as the first two/arms were sore for a couple days; got a full dose (100 mcg shot) as opposed to a half dose; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (The sore arm was the same as the first two/arms were sore for a couple days) and OVERDOSE (got a full dose (100 mcg shot) as opposed to a half dose) in a 76-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 050E21A, 022M20H and 032L20A) for COVID-19 vaccination. The patient''s past medical history included Cancer. On 27-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 26-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 15-Oct-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 100 microgram. On 15-Oct-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced OVERDOSE (got a full dose (100 mcg shot) as opposed to a half dose). On an unknown date, the patient experienced PAIN IN EXTREMITY (The sore arm was the same as the first two/arms were sore for a couple days). On 15-Oct-2021, OVERDOSE (got a full dose (100 mcg shot) as opposed to a half dose) had resolved. At the time of the report, PAIN IN EXTREMITY (The sore arm was the same as the first two/arms were sore for a couple days) had resolved. Concomitant medications were not provided. Treatment information was not provided. This case was linked to MOD-2021-363645, MOD-2021-363625 (Patient Link).


VAERS ID: 1839136 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / -

Administered by: Work       Purchased by: ?
Symptoms: Fatigue, Immunisation, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101383460

Write-up: Tiredness; Swelling in left armpit.; Booster; This is a spontaneous report from a contactable consumer, the patient. A 56-year-old non-pregnant female patient received third booster dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the left arm on 15Oct2021 at 11:45 (at the age of-56-years-old) as a single dose for COVID-19 immunisation. Medical history was not reported. The patient had no known allergies. Prior to the vaccination, the patient was not diagnosed with COVID-19. Concomitant medications included first dose of influenza vaccine (FLU) on 11Oct2021 in the left arm and vitamins (unspecified) for unknown indications from an unknown date and unknown if ongoing. The patient previously received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: ENS318) via an unspecified route of administration in the left arm on 02Mar2021 (at the age of-56-years-old) and second dose BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the left arm on 23Mar2021 (at the age of-56-years-old); as a single dose for COVID-19 immunisation. On 16Oct2021 at 12:15, the patient experienced tiredness and swelling in left armpit. The events did not result in doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care. Therapeutic measures were not taken as a result of the events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events tiredness and swelling in left armpit were resolving at the time of this report. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.


VAERS ID: 1839145 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: New York  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Immunisation
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101401188

Write-up: Booster; Tightness in chest; Mild trouble breathing; This is a spontaneous report from a contactable consumer, the patient. A 48-year-old male patient received third booster dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the left arm on 15Oct2021 at 15:00 (at the age of 48-years-old) as a single dose for COVID-19 immunisation. Medical history was not reported. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccine within four weeks prior to the vaccination. Concomitant medications were not reported. The patient previously received the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration on an unknown date and second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration on an unknown date as a single dose for COVID-19 immunisation. On 15Oct2021, the patient experienced tightness in chest and mild trouble breathing. The events did not result in doctor or other healthcare professional office/clinic, emergency room/department or urgent care. Therapeutic measures were not taken as a result of the events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events tightness in chest and mild trouble breathing were unknown at the time of this report. The lot number for BNT162b2 was not provided and will be requested during follow up.


VAERS ID: 1839156 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Deafness, Dizziness, Feeling hot, Flushing, Heart rate, Heart rate increased, Pharyngeal paraesthesia, Pruritus, Tinnitus
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Clot blood; Low blood pressure.
Allergies:
Diagnostic Lab Data: Test Date: 2021; Test Name: heart beat; Result Unstructured Data: Test Result:80 beats per minute; Comments: next day her heart beat was still high; Test Date: 2021; Test Name: heart beat; Result Unstructured Data: Test Result:70 beats per minute; Comments: the next day about 70 beats per minute; Test Date: 2021; Test Name: heart beat; Result Unstructured Data: Test Result:60 beats per minute; Comments: now it is about 60 beats per minute; Test Date: 2021; Test Name: heart beat; Result Unstructured Data: Test Result:100 beats per minute; Test Date: 2021; Test Name: heart beat; Result Unstructured Data: Test Result:108 beats per minute; Test Date: 20211015; Test Name: heart beat; Result Unstructured Data: Test Result: increased to 108 beats per minute; Comments: She checked her pulse and realized it was really high, increased to over 100 beats per minute; probably about 110 beats per minute.
CDC Split Type: USPFIZER INC202101401968

Write-up: left ear felt like loss of hearing a few times then it cleared up; rapid heartbeat/increased to 108 beats per minute; ringing in the ear; facial warmth and flushing; facial warmth and flushing; scratchy tingling weird feeling in throat; itching of the skin (has sensitive skin); Lightheaded; This is a spontaneous report from a non-contactable consumer (patient). This 45-year-old female patient received 1st dose of BNT162B2 (COMIRNATY, Batch/lot number: 301308A, Expiry Date: 30Nov2021, 30mcg/0.3mL injection), at the age of 45 years old, on 15Oct2021 at around 16:00-16:30, in left arm deltoid, at single dose 0.3 ml for covid-19 immunization. Medical history was blood clots and low blood pressure. Concomitant drugs were not reported. Caller asking if her second Covid 19 Vaccine can be Johnson & Johnson. If you can mix the vaccine after taking the first one as Pfizer? Caller voiced she was trying to stay away from Johnson & Johnson because of the history of blood clots. After receiving her first Pfizer Covid 19 Vaccine she experienced rapid heartbeat increased to 108 beats per minute (after about one hour and lasted about 7 hours), facial warmth & Face flushed/flushing, lightheaded, Throat felt kind of weird, felt sensations in her throat/a little scratchy, tingly, weird feeling in her throat, itching of the skin (has sensitive skin), left ear felt like loss of hearing a few times then it cleared up, about 1-1.5 hours later she had ringing in the ear. She got flushed first, so felt warm and flushed right away, probably like within about 15 minutes of administration of the Pfizer Covid 19 Vaccine: Around 16:15-16:45. Then she felt a little bit, maybe just a little bit lightheaded, not too bad though, wasn''t bad or anything. When she got home her throat felt kind of weird, felt sensations in her throat, a little scratchy, tingly, weird feeling in her throat; not terrible or anything just felt a little weird and she felt a little itchy. Then it was a little bit later when the rapid heart beat started-that probably happened like an hour after getting vaccinated; it didn''t start right away or at least she didn''t notice that right away, until she was sitting down and felt her chest pounding really hard and she was like what the heck. She checked her pulse and realized it was really high, increased to over 100 beats per minute; probably about 110 beats per minute. That lasted for about 7 hours, or at least she fell asleep after 7 hours so she does not know if it lasted longer that day. The next day her heart beat was still high, around 80 beats per minute; and the next day about 70 beats per minute; now it is about 60 beats per minute. She normally has a lower heart rate because she has low blood pressure and normally her heart rate is about 60 beats per minute. Regarding treatment or interventions for these events she just rested, tried to limit activity to not stress her heart rate any more; she didn''t move around too much, took it easy. She verified that she has not required any visit to the physician''s office, emergency room or hospitalization relative to any of these adverse events. She probably should have gone to the doctors or emergency room but was scared. She didn''t want to go the emergency room and get COVID. Initially she thought she could go to urgent care, and thought she would just give it 20 minutes and she would probably be ok, then it was getting later in the day and she just thought urgent care was probably going to be closing soon so she left it as wait and see. By the time her rapid increased heart beat started the urgent care was closed and she didn''t want to go to the emergency room and thought she would be ok. The caller would like to know if it is still totally fine for her to get the second dose of Pfizer Covid-19 Vaccine. Outcome of the event for left ear felt like loss of hearing a few times then it cleared up, ringing in the ear and rapid heartbeat was recovered, for other events was unknown. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1839235 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-30
Onset:2021-10-15
   Days after vaccination:46
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Caesarean section, Epidural catheter placement, Exposure during pregnancy, Injury, Labour complication, Peripheral swelling, Platelet count decreased, Premature labour, Procedural haemorrhage, Swelling face, Transfusion, Volume blood decreased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), 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, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zoloft, Lamictal, prenatal, vitamin D, Magnesium
Current Illness: none
Preexisting Conditions: Pregnancy
Allergies: Gluten, Dairy
Diagnostic Lab Data: Platelet Count: 124 Quest 10/22/2021 Platelet Count: 109 regulatory authority 10/22/2021
CDC Split Type:

Write-up: My midwife ran labs for preeclampsia do to swelling in my legs, hands and face. The labs came back showing low platelet counts (124 L). I have no history of that ever being an issue, and it was not something I experienced with my first pregnancy. I was due to have the baby on November 8th 2021. On October 21, 2021 in the evening, I went into labor. I labored at home for 5 hours (with help from my doula to breathe through the pain). I was admitted to the hospital at around 3:00 am on October 22, 2021. I was dilated to 7 and begged for an epidural. They decided to do labs to check my platelet levels again. They were at 109, which was just above what was acceptable for giving me an epidural. After the epidural my Platelet levels dropped again. I pushed for 2 hours and then my baby''s heart rate started to drop. They rushed me in for an emergency c-section where I lost 4 1/2 liters of blood. During recovery, my blood volume continue to go down. The OB determined that I needed a blood transfusion. I do not know when my platelet levels begin to drop before I was first tested, but it affected my and my baby''s health. I was in the hospital for 4 days before we were released to go home. I am still recovering from the emergency c-section (the surgery itself and the trauma). Baby is healthy.


VAERS ID: 1839623 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Error: Improper Storage (temperature)-


VAERS ID: 1839637 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Error: Improper Storage (temperature)-


VAERS ID: 1839639 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Error: Improper Storage (temperature)-


VAERS ID: 1839640 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Error: Improper Storage (temperature)-


VAERS ID: 1839642 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Error: Improper Storage (temperature)-


VAERS ID: 1839881 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-03
Onset:2021-10-15
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Adenovirus test, Angiogram pulmonary abnormal, Aortic arteriosclerosis, Blood bicarbonate increased, Blood creatinine normal, Blood urea normal, Bordetella test negative, Brain natriuretic peptide increased, COVID-19, COVID-19 pneumonia, Cardiac failure congestive, Cardiomegaly, Chest X-ray abnormal, Chlamydia test negative, Computerised tomogram thorax abnormal, Condition aggravated, Coronavirus test negative, Cough, Dyspnoea, Dyspnoea exertional, Enterovirus test negative, Full blood count normal, Hepatic mass, Human metapneumovirus test, Human rhinovirus test, Hypochloraemia, Hypoxia, Influenza A virus test negative, Influenza B virus test, Influenza virus test negative, Liver function test normal, Lung consolidation, Lung opacity, Lymph node calcification, Mycoplasma test negative, Oedema, Pleural thickening, Polyuria, Productive cough, Pulmonary mass, Respiratory syncytial virus test negative, Respiratory viral panel, SARS-CoV-2 test positive, Spinal osteoarthritis, Viral test negative
SMQs:, Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (narrow), Tubulointerstitial diseases (broad), Respiratory failure (broad), Infective pneumonia (narrow), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 mg tablet colchicine (MITIGARE) 0.6 mg capsule metOLazone (ZAROXOLYN) 2.5 mg tablet miscellaneous medical supply misc miscellaneous medical supply misc miscellaneous medical supply misc oxygen (02) gas pot
Current Illness:
Preexisting Conditions: Nervous Lumbar radiculopathy Right leg weakness Greater trochanteric bursitis of left hip Respiratory Allergic rhinitis OSA (obstructive sleep apnea) Circulatory Ascending aortic aneurysm Paroxysmal atrial fibrillation Chronic diastolic CHF (congestive heart failure) Acute on chronic congestive heart failure, unspecified heart failure type Digestive Cholecystitis, chronic Fatty liver disease, nonalcoholic Class 3 severe obesity with serious comorbidity and body mass index (BMI) of 45.0 to 49.9 in adult Gastroesophageal reflux disease Body mass index 50.0-59.9, adult Genitourinary Benign prostatic hypertrophy Chronic renal insufficiency, unspecified stage Musculoskeletal Arthritis Disc degeneration, lumbar Presence of artificial hip joint, right Primary osteoarthritis of left knee Primary osteoarthritis of right knee Primary osteoarthritis of left hip Seborrheic keratosis Muscular deconditioning Endocrine/Metabolic Hypercholesterolemia Infectious/Inflammatory COVID-19 Other Edema Prostate cancer screening Hypertrophy of breast Umbilical hernia Advance care planning Chronic anticoagulation Non-smoker
Allergies: NKA
Diagnostic Lab Data: 10/18/2021 1144 Respiratory virus detection panel Collected: 10/18/21 1144 | Final result | Specimen: Swab from Nasopharynx Adenovirus Not Detected Mycoplasma pneumoniae Not Detected Chlamydophila pneumoniae Not Detected Parainfluenza Not Detected COVID-19 SARS-CoV-2 Overall Result Detected Critical Enterovirus/Rhinovirus Not Detected Coronavirus Not Detected Respiratory Syncytial Virus Not Detected Influenza A Not Detected Bordetella pertussis Not Detected Influenza B Not Detected Bordetella parapertussis Not Detected Metapneumovirus Not Detected Procedure Component Value Ref Range Date/Time X-ray chest 1 view, Portable Resulted: 10/18/21 1700 Order Status: Completed Updated: 10/18/21 1700 Narrative: XR CHEST 1 VW PORT IMPRESSION: 1. Left upper and left lower lobe opacities. Recommend enhanced CT correlation. 2. Cardiomegaly. 3. Underlying chronic interstitial disease and bilateral atelectasis. 4. Old granulomatous disease. END OF IMPRESSION: INDICATION: Pt states that he has been having coughing fits in the morning when he gets out of bed. SOB. TECHNIQUE: Frontal view of the chest was obtained. COMPARISON: X-ray of December 14, 2018 FINDINGS: A confluent left upper lobe and left lower lobe airspace opacities are seen. There are no consolidations, pulmonary edema or pleural effusions. The heart is enlarged..The mediastinum is widened.There is a stable calcified right upper lobe nodule. Overlying leads and wires are identified. Biapical pleural thickening is seen. Underlying chronic interstitial disease and bibasilar atelectasis are visualized. Arthritic change is noted in the right AC joint. There is spondylosis. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. CT chest without contrast Resulted: 10/18/21 1637 Order Status: Completed Updated: 10/18/21 1637 Narrative: PROCEDURE INFORMATION: Exam: CT Chest Without Contrast; Diagnostic Exam date and time: 10/18/2021 3:11 PM Age: 67 years old Clinical indication: Shortness of breath; Additional info: Covid-pos. Increasing SOB. Dyspnea TECHNIQUE: Imaging protocol: Diagnostic computed tomography of the chest without contrast. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT CHEST WO CONTRAST 2/26/2021 8:02 AM FINDINGS: Lungs: Calcified granuloma right upper lobe. Patchy alveolar airspace consolidation within the apicoposterior segment of the left upper lobe. Likely pneumonic process although recommend follow-up to ensure resolution. Subtle airspace disease left lung base. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: No pericardial effusion. Small amount of fluid within the superior pericardial recess. Aorta: Calcification of the aorta. Lymph nodes: Calcified lymph nodes right hilum Liver: Mild nodularity of the liver is present. Correlate regarding risk factors for hepatocellular disease. Bones/joints: thoracic inlet is unremarkable. Degenerative changes are present within the spine. Soft tissues: Soft tissues of the mediastinum appear unremarkable. IMPRESSION: Patchy alveolar airspace consolidation within the apicoposterior segment of the left upper lobe. Likely pneumonic process although recommend follow-up to ensure resolution. Subtle airspace disease left lung base. Findings consistent with the given history.
CDC Split Type:

Write-up: ED to Hosp-Admission Discharged 10/18/2021 - 10/22/2021 (4 days) Hospital MD Last attending ? Treatment team Acute on chronic congestive heart failure, unspecified heart failure type Hospital Problems POA * (Principal) Acute on chronic congestive heart failure, unspecified heart failure type Yes Covid pneumonia, Paroxysmal A. Fib, Morbid obesity, Nocturnal hypoxia Presenting Problem/History of Present Illness/Reason for Admission Hypoxia [R09.02] Acute on chronic congestive heart failure, unspecified heart failure type [I50.9] Acute COVID-19 [U07.1] Hospital Course Symptoms started approximately October 15 or 14 with cough with white sputum and exertional shortness of breath as well as shortness of breath lying flat. BNP was a little higher than usual and he was started on IV diuretics but his Covid was also positive. His lungs sounded like Covid in the CT look like Covid. Therefore we diuresed him but on the second day in the hospital I did start him on remdesivir he had been started on steroids upon admission. He certainly improved on a daily basis. On the day of discharge he is feeling well really denying any shortness of breath his edema is better his lungs are clear he is back to his normal diuretic dose and he is not hypoxic with exertion. He got 4 days of remdesivir because he is doing so well we can discharge him before the fifth day but he will complete 10 days of Decadron. LFTs remain normal as always is got a little bit of a hypochloremia with 91 bicarb is mildly elevated at 35 but his BUN and creatinine are stable CBC unremarkable. Rest and exercise oximetry revealed no hypoxia Operative Procedures Performed Treatments: IV Decadron IV diuretics remdesivir Procedures: None Consults: PT OT Pertinent Test Results: CTA of chest consistent with Covid pneumonia


VAERS ID: 1839997 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2020-12-31
Onset:2021-10-15
   Days after vaccination:288
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: drospirenone-ethinyl estradioL (YAZ) 3-0.02 mg per tablet lidocaine/hydrocortisone ac (lidocaine HCl-hydrocortison ac) 3 %-1 % (7 gram) cream multiple vitamins (HEXAVITAMIN) tablet tablet senna (SENOKOT) 8.6 mg tablet
Current Illness:
Preexisting Conditions: Other Contraception
Allergies: Bee Venom Protein (Honey Bee)Swelling PenicillinsRash
Diagnostic Lab Data: 10/18/2021 1056 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 10/18/21 1056 | Final result | Specimen: Swab from Nares COVID-19 SARS-CoV-2 Overall Result Detected Critical
CDC Split Type:

Write-up: Fever or Chills Fatigue Muscle or body aches Sore throat Congestion or running nose Nausea or vomiting


VAERS ID: 1840032 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-10-14
Onset:2021-10-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Hot flush, Palpitations, Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D, Trimterene/ HTCZ 37.5-25mg 1x daily
Current Illness: None
Preexisting Conditions: Pre-diabetes, Obesity
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Heart pounding, anxiety, hot flashes, vaginal bleeding w/ clots. Bleding lasted a week. Still having heart pounding and hot flashes. Not sexual active prior to incident.


VAERS ID: 1840297 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-03
Onset:2021-10-15
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Bordetella test negative, COVID-19, Chills, Computerised tomogram head, Cough, Fall, Fatigue, Feeling hot, Human metapneumovirus test, Influenza A virus test negative, Influenza B virus test, Respiratory syncytial virus test, SARS-CoV-2 test positive, Skin abrasion, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: aspirin (ASPIR-81) 81 mg tablet betamethasone, augmented, (DIPROLENE) 0.05 % lotion blood sugar diagnostic (ONETOUCH ULTRA TEST) strip calcipotriene (DOVONEX) 0.005 % cream clopidogreL (PLAVIX) 75 mg tablet dutasteride (AVODART) 0.5 mg
Current Illness:
Preexisting Conditions: Respiratory Obstructive sleep apnea syndrome Circulatory Atherosclerosis of coronary artery Essential hypertension Digestive Gastroesophageal reflux disease Copper deficiency Severe obesity (BMI 35.0-39.9) with comorbidity (CMS/HCC) Genitourinary Recurrent cystitis Benign prostatic hyperplasia with urinary obstruction Endocrine/Metabolic Type 2 diabetes mellitus without complication, without long-term current use of insulin (CMS/HCC) Hypercholesterolemia Hematologic Thrombocytopenia (CMS/HCC) Microcytosis Immune Plaque psoriasis Other Encounter for screening for malignant neoplasm of prostate
Allergies: Canagliflozin CefadroxilOther (document details in comments)
Diagnostic Lab Data: 10/18/2021 1656 Respiratory virus detection panel Collected: 10/18/21 1656 | Final result | Specimen: Swab from Nasopharynx Adenovirus Not Detected Mycoplasma pneumoniae Not Detected Chlamydophila pneumoniae Not Detected Parainfluenza Not Detected COVID-19 SARS-CoV-2 Overall Result Detected Critical Enterovirus/Rhinovirus Not Detected Coronavirus Not Detected Respiratory Syncytial Virus Not Detected Influenza A Not Detected Bordetella pertussis Not Detected Influenza B Not Detected Bordetella parapertussis Not Detected Metapneumovirus Not Detected CT head without contrast [3309635324] Resulted: 10/18/21 1804 Order Status: Completed Updated: 10/18/21 1804 Narrative: CT HEAD WO CONTRAST IMPRESSION: Senile atrophy is evident with probable minimal chronic periventricular white matter microvascular ischemic disease. There are no findings for acute territorial infarction or intracranial hemorrhage. The paranasal sinuses demonstrate basal left maxillary, partial bilateral ethmoid and left sphenoid sinus disease. END OF IMPRESSION: INDICATION: Recurrent falls in this 71-year-old male with confusion. TECHNIQUE: Computed axial tomograms of the brain were obtained with routine unenhanced protocol. Sagittal and coronal reconstructions were performed. COMPARISON: None available. FINDINGS: The ventricular system, sulci and cisterns demonstrate minor increase in caliber, consistent with senile atrophy. There is minor, subtle diminution of attenuation within the periventricular white matter, consistent with small vessel ischemic disease. There are no findings for intracranial hemorrhage or other abnormal fluid collection. The corticomedullary differentiation is maintained, and there is no evidence of acute infarction, mass effect or mass lesion. Protocol limited evaluation of the orbits, sella turcica and mastoid air cells is unremarkable. The paranasal sinuses demonstrate basal left maxillary, partial bilateral ethmoid and left sphenoid sinus disease. If there is high clinical suspicion for acute infarction, CT re-evaluation in approximately 24 hours'' time or, alternatively, MRI examination utilizing diffusion-weighted gradient sequences would prove more sensitive. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. X-ray chest 1 view, Portable [3309635318] Resulted: 10/18/21 1705 Order Status: Completed Updated: 10/18/21 1705 Narrative: XR CHEST 1 VW PORT IMPRESSION: There are areas of minor bibasilar increased density, right greater than left, consistent with areas of dependent subsegmental atelectasis versus minimal infiltrate. Clinical correlation is required. END OF IMPRESSION: INDICATION: pt c/o weakness and SOB fatigue, cough. TECHNIQUE: Portable, AP, erect projection of the chest was obtained at 1637 hours. COMPARISON: Chest x-ray dated April 11, 2014 FINDINGS: Limitations: None. Medical Devices: None noted. The trachea is midline. The mediastinum is not widened or shifted. The heart is normal. The thoracic aorta is unremarkable. There are areas of minor bibasilar increased density consistent with areas of dependent subsegmental atelectasis versus minimal infiltrate. Clinical correlation is required. No pulmonary parenchymal mass. No pulmonary edema. No pleural effusion. No pneumothorax. Bones and soft tissues of the chest wall demonstrate no acute abnormality.
CDC Split Type:

Write-up: ED Discharged 10/18/2021 (3 hours) ER Patient presents with ? Weakness - Generalized HPI 71-year-old male with history of diabetes who presents ED for evaluation of recurrent falling. Over the last couple days he has felt more fatigued with cough and warmth and chills. He fell multiple times most recent being this morning, fell off the commode landed on his knees and his back. Has an abrasion to his right posterior shoulder. Did not strike his head. No loss of conscious. No neck pain. No chest pain. No abdominal pain. No vomiting. No diarrhea. 10/21/2021 COVID-19 virus infection Dx Medication Infusion Reason for Visit


VAERS ID: 1840441 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-02-19
Onset:2021-10-15
   Days after vaccination:238
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anion gap decreased, Anticoagulant therapy, Asymptomatic COVID-19, Blood albumin decreased, Blood bilirubin increased, Blood chloride increased, Blood glucose increased, Blood urea nitrogen/creatinine ratio increased, Brain natriuretic peptide normal, COVID-19, Chest X-ray abnormal, Computerised tomogram thorax normal, Cough, Dyspnoea, Full blood count abnormal, Lung infiltration, Metabolic function test, Neutrophil count increased, SARS-CoV-2 test positive, Troponin normal, White blood cell count increased
SMQs:, Acute renal failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haematopoietic leukopenia (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Biliary system related investigations, signs and symptoms (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine, carvedilol, docusate, doxazosin, pravastatin, vitamin D
Current Illness:
Preexisting Conditions: Abdominal aortic aneurysm in 2017, arthritis, hx of cardiac murmur, lumbar radiculopathy, malignant hypertensive heart disease without CHF, mixed hyperlipedemia, obesity
Allergies: None
Diagnostic Lab Data: 10/15/21 COVID 19: positive
CDC Split Type:

Write-up: On 10/23/21 patient presented to ER. Patient is an 80-year-old male presents emergency department for further evaluation treatment of increasing shortness of breath. Patient was diagnosed with COVID-19 8 days prior on 10/15/21. Patient states that over the last 4-5 days he has noticed increasing shortness of breath as well as increasing cough. Patient denies any headache, vision changes, fever, chills, sore throat, difficulty swallowing, chest pain, heart palpitations, nausea vomiting diarrhea, abdominal pain, constipation, difficulty urinating, painful urination, increased urinary frequency, blood in his urine, patient denies any new numbness or tingling in his extremities. Patient denies any new edema in his extremities. Patient denies any recent travel. Patient states that when he tested positive for the virus he did not have any symptoms. Patient is completely fully vaccinated with Moderna back in Feburary-March. Patient has a significant medical history of hypertension. Hyperlipidemia. Obesity. Abdominal aortic aneurysm. ED course-single-view portable chest x-ray shows bilateral infiltrates. CMP significant for chloride elevated 109. Anion gap decreased 9.5. BUN creatinine ratio elevated 21. Albumin decreased 3.2. Total bilirubin elevated 1.8. Glucose elevated 209. Troponin within normal limits. BNP within normal limits. CBC significant for white blood cells elevated at 14.16. Absolute neutrophils elevated 11.8. During admission he received oxygen, remdesivir, dexamethasone, ceftriaxone and doxycycline. CT negative for pulmonary embolism. Hospital course was prolonged due to type of the disease but overall progressed and improved. He has finished 5 days course of remdesivir. He is still on a Decadron for total 10 days duration. On the day of discharge he is feeling very comfortable at rest. On 2 L nasal cannula On exertion he does require 7 L but does not show any signs of any distress. He is feeling functional and will be able to manage at home Exam on the day of discharge Skin turgor good Lungs no rales rhonchi crepitation Heart regular rhythm Extremity no edema. Due to slightly increase hypercoagulability risk: COVID, he is given Lovenox for next 10 days at home as his activity will increase He is instructed to come to emergency for any acute sudden major changes. Discharged on 10/29/21


VAERS ID: 1840490 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-09-01
Onset:2021-10-15
   Days after vaccination:44
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2539 / 3 RA / -

Administered by: Private       Purchased by: ?
Symptoms: Pericardial excision
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: Sulfa drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pericardial window 10/15/2021


VAERS ID: 1840663 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, X-ray limb normal
SMQs:, Arthritis (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: ASA, Levothyroxine, Calcium, Spironolactone, Vitamin B
Current Illness: none
Preexisting Conditions: Hypothyroidism
Allergies: None
Diagnostic Lab Data: shoulder xray
CDC Split Type:

Write-up: persistent pain in left shoulder


VAERS ID: 1840738 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-03
Onset:2021-10-15
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Cough, Headache, Nasopharyngitis, Pyrexia, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pfizer dose 1 -04/08/2021- I had pain at the injection site for about 3 days, and fatigue my left arm.
Other Medications: Bustirone 15mg 3 times daily; farxiga 10 mg once daily; fluoxetine 60 mg once daily; gemfibrozil 600mg twice daily; glipizide 5mg twice daily; lisinopril 5mg one daily; metformin 1000mg twice daily; pantoprazole 20mg once daily; atorvastati
Current Illness: none
Preexisting Conditions: diabetes; depression; anxiety disorder; bipolar disorder
Allergies: none
Diagnostic Lab Data: COVID test 10/2021- negative
CDC Split Type: vsafe

Write-up: In mid October 2021, I had cold symptoms. I had headache, runny nose, fever, congestion, fatigue and a slight cough. I did a virtual visit with my doctor. I did over the counter cold medicine and it lasted about 2 weeks. I did a COVID test that was negative.


VAERS ID: 1842464 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E21A / 2 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Patient was administered a dose from an expired vial. This spontaneous case was reported by a nurse and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Patient was administered a dose from an expired vial.) in a 42-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 049E21A) for COVID-19 vaccination. No Medical History information was reported. On 15-Oct-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 15-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Patient was administered a dose from an expired vial.). On 15-Oct-2021, EXPIRED PRODUCT ADMINISTERED (Patient was administered a dose from an expired vial.) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No relevant concomitant medications were provided. No treatment information was provided. Expiration date of vial was 11 Oct 2021. This case was linked to MOD-2021-365891, MOD-2021-366043, MOD-2021-366595, MOD-2021-365742, MOD-2021-365543, MOD-2021-366925, MOD-2021-366226, MOD-2021-365600, MOD-2021-365692 (Patient Link).


VAERS ID: 1842569 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E21A / 2 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Patient was administered a dose from an expired vial; This spontaneous case was reported by a nurse and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Patient was administered a dose from an expired vial) in a 57-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 049E21A) for COVID-19 vaccination. No Medical History information was reported. On 15-Oct-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 15-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Patient was administered a dose from an expired vial). On 15-Oct-2021, EXPIRED PRODUCT ADMINISTERED (Patient was administered a dose from an expired vial) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were reported. No treatment information was provided. This case was linked to MOD-2021-366918, MOD-2021-365600, MOD-2021-365692, MOD-2021-365742, MOD-2021-365891, MOD-2021-366043, MOD-2021-366226, MOD-2021-366595, MOD-2021-366925 (Patient Link).


VAERS ID: 1842621 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E21A / 2 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Patient was administered a dose from an expired vial; This spontaneous case was reported by a nurse and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Patient was administered a dose from an expired vial) in a 43-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 049E21A) for COVID-19 vaccination. No Medical History information was reported. On 15-Oct-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 15-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Patient was administered a dose from an expired vial). On 15-Oct-2021, EXPIRED PRODUCT ADMINISTERED (Patient was administered a dose from an expired vial) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No relevant concomitant medications were provided. No treatment information was provided. Expiration date was 11 Oct 2021. This case was linked to MOD-2021-366918, MOD-2021-365543, MOD-2021-365600, MOD-2021-365692, MOD-2021-365742, MOD-2021-365891, MOD-2021-366043, MOD-2021-366226, MOD-2021-366595 (Patient Link).


VAERS ID: 1842801 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-10-14
Onset:2021-10-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Deafness, Meniere's disease
SMQs:, Hearing impairment (narrow), Vestibular disorders (narrow)

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

Write-up: Meniere''s disease (hearing loss and vertigo) occurring one day after the vaccine. Hearing loss present 3 weeks later.


VAERS ID: 1843358 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Error: Improper Storage (temperature)-


VAERS ID: 1843361 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-21
Onset:2021-10-15
   Days after vaccination:55
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Menstruation delayed
SMQs:, Fertility disorders (broad)

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

Write-up: Delayed period.


VAERS ID: 1843403 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / IM

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

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1843406 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Error: Improper Storage (temperature)-


VAERS ID: 1843430 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Error: Improper Storage (temperature)-


VAERS ID: 1843435 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / IM

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

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1843439 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / IM

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

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1843444 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Error: Improper Storage (temperature)-


VAERS ID: 1843446 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Error: Improper Storage (temperature)-


VAERS ID: 1843464 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Error: Improper Storage (temperature)-


VAERS ID: 1843478 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Error: Improper Storage (temperature)-


VAERS ID: 1843484 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / IM

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

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1843489 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Error: Improper Storage (temperature)-


VAERS ID: 1843496 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Error: Improper Storage (temperature)-


VAERS ID: 1843524 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / IM

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

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

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1843532 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-14
Onset:2021-10-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Fatigue, Musculoskeletal pain, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine
Other Medications: Euflexa Synthroid low dose hormones Also went straight from vaccine to MRI that evening.
Current Illness: shoulder injury. FELT FANTASTIC PRIOR TO VACCINE....NEVER HAD COVID.
Preexisting Conditions:
Allergies: Vicadine
Diagnostic Lab Data: None yet, calling physcian today. Had hoped it woudl be gone by now.
CDC Split Type:

Write-up: muscular skeletal pain still on November 4 exhausted, with no relief from sleep Nausea Weakness


VAERS ID: 1843694 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test normal, Computerised tomogram thorax normal, Dyspnoea, Heart rate increased, Palpitations, Pruritus, Rash, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none, just birth control as prescribed - taken at 9pm every night.
Current Illness: none
Preexisting Conditions: endometriosis
Allergies: penicillin allergy
Diagnostic Lab Data: None. Bloodwork and Chest CT scan came back fine for heart issues.
CDC Split Type:

Write-up: after 2 hours of receiving the shot, I developed hives all over my body, itching on the inside of my body it felt like...including my mouth, and rashes. I immediately called the pharmacist and he said to take 2 Benadryl which helped to subside the symptoms. 3 days later I was also sent to the ER for rapid heart rate in the 140s, shortness of breath, and palpitations, irregular to my health.


VAERS ID: 1844072 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-14
Onset:2021-10-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Atrial fibrillation, Headache, Hypoaesthesia, Magnetic resonance imaging abnormal, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Supraventricular tachyarrhythmias (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Na
Current Illness: RA
Preexisting Conditions:
Allergies: Zpack
Diagnostic Lab Data: MRI, showed few white folic
CDC Split Type:

Write-up: AFib followed by numbness in face, leg, and foot. HeadAches, Muscle aches,


VAERS ID: 1844346 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-08
Onset:2021-10-15
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH F18841 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amenorrhoea, Intermenstrual bleeding, Menstrual disorder
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Fertility disorders (broad)

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

Write-up: My Menstrual cycle comes every month on the 15th, In October I never got a menstrual cycle so I took a pregnancy test and it is negative now we are going into November and my period Still hasn?t arrived I?ve been spotty randomly here and there but no actual blood, this is Very rare for me because I receive my menstrual cycle every month and it?s very heavy last about a week so this is definitely new


VAERS ID: 1845286 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Delaware  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: 5 patients received an expired vaccine dose; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (5 patients received an expired vaccine dose) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 033C21A) for COVID-19 vaccination. No Medical History information was reported. On 15-Oct-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 15-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (5 patients received an expired vaccine dose). On 15-Oct-2021, EXPIRED PRODUCT ADMINISTERED (5 patients received an expired vaccine dose) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications was reported. No treatment drug details was reported. The vial was placed in refrigerator from freezer on 9 Sep 2021 and health care profession stated that the patients will revaccinate on 29 10 2021.


VAERS ID: 1845319 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-01
Onset:2021-10-15
   Days after vaccination:197
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: VITAMIN 15; MULTIVITAMIN 6; CENTRUM SILVER +50.
Current Illness: Prolapsed mitral valve (Patient was reported to feel some of the flutters due to this condition.)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20211005; Test Name: SARS-CoV-2 test; Test Result: Negative; Result Unstructured Data: Tested negative for COVID-19; Test Date: 20211019; Test Name: SARS-CoV-2 test; Test Result: Positive; Result Unstructured Data: Tested positive for COVID-19
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: tested positive for covid-19; Lack of Efficacy; started feeling bad; This spontaneous case was reported by a consumer and describes the occurrence of FEELING ABNORMAL (started feeling bad), COVID-19 (tested positive for covid-19) and DRUG INEFFECTIVE (Lack of Efficacy) in a 70-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included Prolapsed mitral valve (Patient was reported to feel some of the flutters due to this condition.). Concomitant products included VITAMIN 15, ASCORBIC ACID, ERGOCALCIFEROL, NICOTINAMIDE, RETINOL PALMITATE, RIBOFLAVIN, THIAMINE MONONITRATE (MULTIVITAMIN 6) and CENTRUM SILVER +50 for an unknown indication. On 01-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 01-May-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 15-Oct-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced FEELING ABNORMAL (started feeling bad). On 16-Oct-2021, the patient experienced COVID-19 (tested positive for covid-19) and DRUG INEFFECTIVE (Lack of Efficacy). The patient was treated with MONOCLONAL ANTIBODY 17-1A on 19-Oct-2021 for Adverse event, at an unspecified dose and frequency. At the time of the report, FEELING ABNORMAL (started feeling bad) and DRUG INEFFECTIVE (Lack of Efficacy) had resolved and COVID-19 (tested positive for covid-19) was resolving. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 05-Oct-2021, SARS-CoV-2 test: negative (Negative) Tested negative for COVID-19. On 19-Oct-2021, SARS-CoV-2 test: positive (Positive) Tested positive for COVID-19. Concomitant medications include something for eyes. for uveitis This is a case of drug ineffective in this 70-year-old, female patient, with medical history of prolapsed mitral valve, who experienced the non-serious, unexpected events of Covid-19 (AESI) and feeling abnormal. The events occurred 5 months after second dose of Moderna vaccine. The rechallenge is not applicable as patient received treatment of monoclonal antibody. The patient''s age and history of prolapsed mitral valve may have increased her risk of getting Covid-19 infection. The event Covid-19 remains as a confounder to the event feeling abnormal. The benefit-risk relationship of Moderna vaccine is not affected by this report. This case was linked to MOD-2021-366602 (Patient Link).; Sender''s Comments: This is a case of drug ineffective in this 70-year-old, female patient, with medical history of prolapsed mitral valve, who experienced the non-serious, unexpected events of Covid-19 (AESI) and feeling abnormal. The events occurred 5 months after second dose of Moderna vaccine. The rechallenge is not applicable as patient received treatment of monoclonal antibody. The patient''s age and history of prolapsed mitral valve may have increased her risk of getting Covid-19 infection. The event Covid-19 remains as a confounder to the event feeling abnormal. The benefit-risk relationship of Moderna vaccine is not affected by this report.


VAERS ID: 1845356 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-14
Onset:2021-10-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 2 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Facial paralysis, Limb injury, Peripheral swelling, Speech disorder
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hearing impairment (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101417298

Write-up: right eye lower than left; Arm swollen; could not close hand; confusion; Problem/difficulty speaking; This is a spontaneous report from a contactable consumer (patient). A 40-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE; Lot Number: fh8020), via an unspecified route of administration, administered in right arm on 14Oct2021 (at the age of 40-years-old) as dose 2, single for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. The patient was not pregnant at the time of vaccination. The patient previously took ibuprofen and experienced allergy. Historical vaccine included BNT162B2 (Lot number: fe3592), via an unspecified route of administration, administered in right arm on 23Sep2021 (at the age of 40-years-old) at dose 1, single for COVID-19 immunization. Prior to vaccination, the patient did not have COVID-19 infection and did not receive any other vaccine in four weeks. The patient reported that next day at 6 pm, her arm was swollen, could not close hand, had confusion, problem/difficulty speaking, and right eye was lower than left. No treatment was received for the events. The patient was not COVID tested post-vaccination. Outcome of the events was unknown. Follow-up attempts are completed. No further information is expected.


VAERS ID: 1845383 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-10-14
Onset:2021-10-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Myalgia, Pain in extremity, Peripheral swelling
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19 (if covid prior vaccination: Yes)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101433759

Write-up: Quadriceps on both legs are in a lot of pain/generalize muscle soleness in arms and legs; Both thighs feel swollen and tender; Both thighs feel swollen and tender; This is a spontaneous report from a contactable consumer. A 25-years-old female patient received bnt162b2 (BNT162B2), dose 1 via an unspecified route of administration, administered in Arm Left on 14Oct2021 17:00 (Batch/Lot Number: Ff2590) as single dose for covid-19 immunisation . Medical history included covid-19. There were no concomitant medications. The patient experienced quadriceps on both legs are in a lot of pain/generalize muscle soleness in arms and legs (disability, medically significant) on 15Oct2021 15:00 with outcome of not recovered , both thighs feel swollen and tender (disability, medically significant) on 15Oct2021 15:00 with outcome of not recovered. Follow-Up (27Oct2021): Follow-up attempts are completed. No further information is expected.


VAERS ID: 1846795 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-10-13
Onset:2021-10-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Blood test, Chest discomfort, Chest pain, Electrocardiogram, Inflammation, Tenderness
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Smallpox inoculation in 2003. Patient broke out in body rash on day 15, prompting an ER visit on day 16 and public health notif
Other Medications: Vitamin D 5000IU 1 per 3 days
Current Illness:
Preexisting Conditions: Low blood pressure and orthostatic hypotension since 2002
Allergies:
Diagnostic Lab Data: EKG good. Patient has history of strong/good heart metrics and EKG was consistent with these. Blood pressure high (130/70 based on a norm of 115/70 with chronic condition causing drops to 90/50). Blood work normal. All taken on 20 October with lab reporting later.
CDC Split Type:

Write-up: Pain and tightness in center of chest, sensitive to touch/pressure. Pain built over succeeding days, but varied in intensity over the course of individual days. Diagnosed by civilian health care provider as potential inflammation of structures in breastbone area on 20 October. Prescribed 500mg Naproxin 2/daily for six weeks as treatment. As of 5 November, prescription alleviates discomfort but sense of pressure persists with dull pain appearing near time of next does. This sense is gradually diminishing over time. Provider cleared patient to receive second vaccine dose.


VAERS ID: 1846952 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pancreatitis
SMQs:, Acute pancreatitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: PER PT 11:33AM 11/5/21 - PT SAID HE HAD PANCREATITIS AFTER A FEW HOURS (about 8pm) AFTER THE 1ST DOSE.


VAERS ID: 1848454 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-27
Onset:2021-10-15
   Days after vaccination:230
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Inappropriate schedule of product administration, Malaise, Vaccination site pain
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: under the weather; had a sore left injection site/sore left arm; tired; The patient received his third Moderna Covid-19 booster dose on 15OCT2021; This spontaneous case was reported by a consumer and describes the occurrence of MALAISE (under the weather), VACCINATION SITE PAIN (had a sore left injection site/sore left arm), FATIGUE (tired) and INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (The patient received his third Moderna Covid-19 booster dose on 15OCT2021) in an 18-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 039D21A and 045A21A) for COVID-19 vaccination. No Medical History information was reported. On 27-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 25-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 15-Oct-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 15-Oct-2021, the patient experienced MALAISE (under the weather), VACCINATION SITE PAIN (had a sore left injection site/sore left arm), FATIGUE (tired) and INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (The patient received his third Moderna Covid-19 booster dose on 15OCT2021). On 15-Oct-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (The patient received his third Moderna Covid-19 booster dose on 15OCT2021) had resolved. At the time of the report, MALAISE (under the weather), VACCINATION SITE PAIN (had a sore left injection site/sore left arm) and FATIGUE (tired) outcome was unknown. No Concomitant medications were reported. No Treatment information was reported. It was reported that Symptoms were more pronounced than the first two vaccinations on 15-OCT-2021 This case was linked to MOD-2021-369380, MOD-2021-369381 (Patient Link).


VAERS ID: 1848550 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-10-15
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / OT
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Antibody test, Nephrolithiasis, Ultrasound kidney
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adalimubab (Humira)
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Crohn''s disease
Allergies:
Diagnostic Lab Data: Test Name: Antibody test; Result Unstructured Data: Test Result:No antibodies for covid vaccine; Test Date: 202110; Test Name: Ultrasound kidney; Result Unstructured Data: Test Result:Kidney stone
CDC Split Type: USPFIZER INC202101441172

Write-up: Kidney stone; This is a solicited report based on the information received by Pfizer (MFR Control No. #21K-163-4122796-00). The male contactable consumer (patient) reported for himself. A 67-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), intramuscular on an unspecified date (Batch/Lot number was not reported; information was not available in the patient''s file) as dose 1, single (at the age of 67 years old) for COVID-19 immunization;. Medical history included moderate to severe adult Crohn''s Disease from an unknown date. The patient''s concomitant medications were not reported. The patient previously took vancomycin and experienced vancomycin allergy, and sulfa drugs and experienced sulfa drugs allergy. On unknown dates, the patient experienced no antibodies for COVID vaccine and COVID vaccine did not work; assessed as non-serious by reporter. On 15Oct2021, the patient experienced kidney stone. It was unknown if patient was enrolled in a COVID-19 Vaccine Trial. The patient underwent lab tests and procedures which included antibody test: No antibodies for covid vaccine on unspecified date, ultrasound kidney: Kidney stone on Oct2021. The action taken in response to the event for adalimumab was dose not changed. The outcome of the event was not recovered. Causality for HUMIRA (ADALIMUMAB): The reporter''s causality for the event(s) of NO ANTIBODIES FOR COVID VACCINE, COVID VACCINE DID NOT WORK and KIDNEY STONE with HUMIRA(ADALIMUMAB) was no reasonable possibility. The reporter''s assessment of the causal relationship of the events with the suspect product was not provided at the time of this report. Since no determination has been received, the case is managed based on the company causality assessment. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Sender''s Comments: Based on the description given in the narrative, there is reasonable possibility of causal association between the event Nephrolithiasis and the suspect BNT162B2 cannot be excluded. The impact of this report on the benefit/risk profile of the Pfizer drug is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.


VAERS ID: 1848556 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-22
Onset:2021-10-15
   Days after vaccination:207
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Eye pruritus, Ocular hyperaemia, SARS-CoV-2 test, Uveitis, Vision blurred
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Ocular infections (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Immune disorder (NOS); Latex allergy; Shellfish allergy
Allergies:
Diagnostic Lab Data: Test Date: 20211017; Test Name: covid test; Test Result: Negative ; Comments: Nasal Swab
CDC Split Type: USPFIZER INC202101449015

Write-up: uveitis; a lot of itchy eyes; Had a lot of itchy eyes redness for last several months; Blurry vision; This is a spontaneous report from a Contactable HCP (patient). A 44-year-old female (not pregnant) patient received the second dose of BNT162B2 via an unspecified route of administration on the left arm on 22Mar2021 at the age of 43-year-old as single dose for COVID-19 immunization. Medical history included auto immune. The patient didn''t received other vaccine in four weeks. Known allergies included cupronickel, latex and shellfish. The patient performed COVID tested (Nasal Swab) post vaccination on 17Oct2021 and result was negative. The patient was not COVID prior vaccination. Concomitant medication was none. The patient previously received cupronickel and levaquin, both experienced allergy. The patient previously received the first dose of BNT162B2 via an unspecified route of administration on an unspecified date as single dose for COVID-19 immunization. On 15Oct2021, the patient had a lot of itchy eyes redness for last several months thought it was allergies but now have blurry vision and uveitis and going on 9 days. The events resulted in doctor or other healthcare professional office/clinic visit and emergency room/department or urgent care. Treatment was received and not specified. The outcome of events was recovering. The Lot number for the vaccine, [BNT162B2] was not provided and will be requested during Follow-up.; Sender''s Comments: Based on available information, a possible contributory role of BNT162B2 vaccine can not be excluded for the reported event Uveitis. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.


VAERS ID: 1849473 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -
FLUA4: INFLUENZA (SEASONAL) (FLUAD QUADRIVALENT) / SEQIRUS, INC. - / UNK - / -

Administered by: Unknown       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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient broke out in hives and had to go to hospital for treatment. Ended up needing oral steroid treatment


VAERS ID: 1850389 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-10-14
Onset:2021-10-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 3 RA / IM
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 4L97X / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Arthralgia, Blood creatine phosphokinase, Full blood count, Joint swelling, Myalgia, Red blood cell sedimentation rate
SMQs:, Rhabdomyolysis/myopathy (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Mulitvitamin, L-lysyne, Lexapro, Wellbutrin
Current Illness: No
Preexisting Conditions: No
Allergies: NKA
Diagnostic Lab Data: C-Kinase, Sed rate, CBC 11/2/2021
CDC Split Type:

Write-up: Extreme muscle pain, under arms, thighs especially. Right knee and ankle swelling and pain on week 2 after vaccination. Prednisone and antibiotic prescribed. Can still feel vague muscle aches and thinks pain will return at conclusion of prednisone.


VAERS ID: 1850851 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-21
Onset:2021-10-15
   Days after vaccination:208
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Alanine aminotransferase normal, Anion gap, Aspartate aminotransferase normal, Basophil percentage decreased, Blood alkaline phosphatase normal, Blood bilirubin decreased, Blood chloride normal, Blood creatinine normal, Blood culture, Blood glucose increased, Blood lactate dehydrogenase increased, Blood lactic acid, Blood magnesium normal, Blood potassium normal, Blood sodium decreased, Blood urea increased, Brain natriuretic peptide normal, C-reactive protein increased, COVID-19, COVID-19 pneumonia, Carbon dioxide normal, Chest X-ray, Cough, Differential white blood cell count, Dyspnoea, Electrocardiogram, Eosinophil percentage decreased, Fibrin D dimer, Glomerular filtration rate decreased, Haematocrit normal, Haemoglobin normal, Hyponatraemia, Immature granulocyte count, Lymphocyte percentage decreased, Mean cell volume normal, Monocyte percentage increased, Neutrophil count, Neutrophil percentage increased, Oxygen saturation decreased, Platelet count normal, Productive cough, Red blood cell count normal, Red blood cell nucleated morphology, Red cell distribution width normal, SARS-CoV-2 test positive, Serum ferritin increased, Sputum discoloured, Troponin I normal, Urine osmolarity normal, Urine sodium decreased, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (broad), Haematopoietic leukopenia (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prior to Admission Medications Outpatient Home Medications Taking? Aspirin (ECOTRIN LOW STRENGTH) 81 mg Oral TBEC DR Tab Sig: TAKE 1 TABLET ORALLY DAILY Patient taking differently: takes 325mg PO daily CALCIUM ORAL Sig: None Entered Not
Current Illness:
Preexisting Conditions: PMHx of CAD (s/p PCI to RCA in 2019 and 2007), HTN, HLD, diet controlled DMII (last A1c 6.8 in 9/2021
Allergies: Lipitor - Foot pain Lovastatin - Muscle pain Penicillins Class - rash Simvastatin - Tingling in feet
Diagnostic Lab Data: Results as of 11/8/2021 11:07 10/15/2021 15:50 NA: 134 (L) K: 4.1 CL: 98 (L) CO2: 29 BUN: 25 CREAT: 1.04 ANION GAP4 SERPL: 7 GLUC: 103 TROPONIN I: <0.02 BNP: 45 ALT: 33 AST: 26 ALKP: 73 TBILI: 0.2 GFR-AFRAM: $g60 GFR NONAFR AMER: 53 (L) COMMENT, GLOMERULAR FILTRATION RATE: SEE NOTE CRP, SER QL: 1.0 (H) LACTATE: 0.9 WBC: 6.7 RBC''S: 4.68 HGB: 13.7 HCT: 42.7 MCV: 91 RDW, RBC: 13.4 PLT: 330 IMMAT GRANULO % AUTO: 0 NRBC: 0 NEUTROPHILS % AUTO: 60 ANC: 4.1 LYMPHS % AUTO: 24 MONOS % AUTO: 11 EOS % AUTO: 3 BASO''S % AUTO: 0 DIFF PANEL: AUTO DIF BLD CULT RSLT: Final Report... 10/15/2021 16:25 BLD CULT RSLT: Final Report... 10/15/2021 17:01 EKG 12 OR MORE LEADS W INT & RPT: Rpt HEART RATE: 66 PR: 144 QRS: 92 QT: 403 QT CORRECTED: 423 10/15/2021 17:31 XR CHEST: Rpt 10/15/2021 21:20 D-DIMER: 0.88 (H) 10/15/2021 22:17 GLUC BLD GLUCOMETER: 304 (H) 10/16/2021 06:05 LDH: 205 CRP, SER QL: 0.9 WBC: 6.9 RBC''S: 4.26 HGB: 12.1 HCT: 38.9 MCV: 91 RDW, RBC: 13.2 PLT: 299 IMMAT GRANULO % AUTO: 0 NRBC: 0 NEUTROPHILS % AUTO: 82 (H) ANC: 5.7 LYMPHS % AUTO: 13 (L) MONOS % AUTO: 5 EOS % AUTO: 0 BASO''S % AUTO: 0 D-DIMER: 0.90 (H) 10/16/2021 06:05 NA: 132 (L) K: 4.6 CL: 99 (L) CO2: 25 BUN: 20 CREAT: 0.66 ANION GAP4 SERPL: 8 MG: 1.8 GLUC: 199 (H) LDH: 231 ALT: 28 AST: 22 ALKP: 66 TBILI: 0.2 COMMENT, GLOMERULAR FILTRATION RATE: SEE NOTE FERRITIN: 240 10/16/2021 11:27 GLUC BLD GLUCOMETER: 94 10/16/2021 16:01 OSMO UR: 356 NA UR: 28 10/16/2021 17:36 GLUC BLD GLUCOMETER: 281 (H) 10/16/2021 21:55 GLUC BLD GLUCOMETER: 109 10/17/2021 05:54 NA: 136 K: 4.6 CL: 101 CO2: 30 BUN: 21 CREAT: 0.64 ANION GAP4 SERPL: 5 MG: 2.0 GLUC: 102 ALT: 26 AST: 18 ALKP: 62 TBILI: 0.2 COMMENT, GLOMERULAR FILTRATION RATE: SEE NOTE OSMO: 297 WBC: 10.8 RBC''S: 4.29 HGB: 12.4 HCT: 38.7 MCV: 90 RDW, RBC: 13.3 PLT: 344 IMMAT GRANULO % AUTO: 1 NRBC: 0 NEUTROPHILS % AUTO: 77 (H) ANC: 8.3 (H) LYMPHS % AUTO: 14 (L) MONOS % AUTO: 8 EOS % AUTO: 0 BASO''S % AUTO: 0 10/17/2021 18:50 GLUC BLD GLUCOMETER: 146 10/17/2021 21:51 GLUC BLD GLUCOMETER: 225 (H) 10/18/2021 05:54 NA: 135 K: 4.5 CL: 100 CO2: 29 BUN: 23 CREAT: 0.68 ANION GAP4 SERPL: 6 MG: 2.0 GLUC: 81 LDH: 200 ALT: 27 AST: 18 ALKP: 60 TBILI: 0.2 COMMENT, GLOMERULAR FILTRATION RATE: SEE NOTE CRP, SER QL: 0.2 FERRITIN: 263 WBC: 10.2 RBC''S: 4.41 HGB: 12.7 HCT: 39.6 MCV: 90 RDW, RBC: 13.4 PLT: 374 IMMAT GRANULO % AUTO: 1 NRBC: 0 NEUTROPHILS % AUTO: 69 ANC: 7.0 LYMPHS % AUTO: 22 MONOS % AUTO: 9 EOS % AUTO: 0 BASO''S % AUTO: 0 D-DIMER: 0.73 (H) 10/18/2021 07:52 GLUC BLD GLUCOMETER: 77
CDC Split Type:

Write-up: 73 Y female with a past medical history of CAD with stents, DM2 with hyperlipidemia, HTN, osteopenia, atherosclerosis of aorta, PAD presents with progressive shortness of breath and cough with sputum production and declining O2 sats, admitted for acute hypoxemic respiratory failure 2/2 likely COVID Pneumonia COVID PNEUMONIA // ACUTE HYPOXEMIC RESPIRATORY FAILURE Patient fully vaccinated with two doses Pfizer. Patient attended wedding 10/2 and noticed mild symptoms shortly after. Developed a cough 10/6 managed by Robitussin. Tested positive at home 10/8, and tested positive again 10/9. 10/14, symptoms worsened considerably with productive cough with green sputum, and home pulse ox showed SpO2 in high 80s. Used supplemental O2 at home which mildly relieved symptoms and was told to present to ED by PCP. In ED, patient comfortably speaking on 2LNC. 6mg Decadron x 3, Remdesivir 200mg in ED, and Remdesivir 100mg x1. Patient oxygen requirements improved from 2L NC to 1L NC to RA. HYPONATREMIA On presentation, patient with Na of 134 10/15, decreased to 132 10/16 and improved to 136 10/17. Stable at time of discharge Reason for Hospital Admission (Admitting Diagnosis): COVID Pneumonia


VAERS ID: 1850967 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-27
Onset:2021-10-15
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / ID

Administered by: Unknown       Purchased by: ?
Symptoms: Sciatica
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aleve
Current Illness: 0
Preexisting Conditions:
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sciatica


VAERS ID: 1851012 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-14
Onset:2021-10-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Haemoptysis, Pulmonary pain
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no known
Preexisting Conditions:
Allergies: nkda
Diagnostic Lab Data: None yet, advised to follow up with PCP for examination and testing.
CDC Split Type:

Write-up: Patient stated that on the day after the second dose, she experienced pain on the right upper side of her chest aroud her lung. She coughed up what she described as a blood clot about the size of a half dollar. As of Friday, November 5th, se was still experiencing pain/tightness in the upper right chest area.


VAERS ID: 1851366 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-13
Onset:2021-10-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac flutter, Dyspnoea, Heart rate increased, Immunodeficiency, Palpitations
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow), 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: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: short of breath, feeling like heart beating faster, and sometimes fluttering, or pounding heart


VAERS ID: 1853598 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, C-reactive protein increased, Computerised tomogram thorax, Dyspnoea, Echocardiogram, Fibrin D dimer, Laboratory test, Neck pain, Palpitations, Pericarditis, Red blood cell sedimentation rate increased
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Arthritis (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? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: hctz, allopurinol, gabapentin, mulga, Eliquis
Current Illness: none
Preexisting Conditions: afib, ckd3, htn, hld,
Allergies: Shellfish
Diagnostic Lab Data: CT of chest and echo labs etc
CDC Split Type:

Write-up: SOB, heart racing, neck and shoulder pain starting with 24 hours of Pfizer "Booster" She was found to have d-Dimer $g4000, elevated sed rate and CRP. Sent to emergency room. Found to have significant pericarditis and transfered to higher level care hospital for emergency care.


VAERS ID: 1853659 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CT at Health System - 10/15/2021
CDC Split Type:

Write-up: Pt states approximately 2 hours after receiving the vaccine she developed right facial numbness without drooping. She was taken by Ambulance to a hospital. All tests were normal, per patient.


VAERS ID: 1853753 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-22
Onset:2021-10-15
   Days after vaccination:207
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Hypotension, Renal failure
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: presenting to the emergency department from primary care clinic where he was noted to be hypotensive in have some new onset renal failure


VAERS ID: 1853922 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-01
Onset:2021-10-15
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Mobility decreased, Pain
SMQs:, Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (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: asthma
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: injection site still sore after 5 weeks; sometimes cannot lift arm above shoulder; if I do lift my arm above shoulder there is pain in the arm at the injection site.


VAERS ID: 1854046 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 RA / IM

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

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

Write-up: Vaccine was expired upon administration.


VAERS ID: 1854050 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 RA / IM

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

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

Write-up: Vaccine was expired upon administration.


VAERS ID: 1854057 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 LA / IM

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

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

Write-up: Vaccine was expired upon administration.


VAERS ID: 1854063 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 RA / IM

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

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

Write-up: Vaccine was expired upon administration.


VAERS ID: 1854067 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 RA / IM

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

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

Write-up: Vaccine was expired upon administration.


VAERS ID: 1854080 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 LA / IM

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

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

Write-up: Vaccine was expired upon administration.


VAERS ID: 1854084 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 RA / IM

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

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

Write-up: Vaccine was expired upon administration.


VAERS ID: 1854088 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 LA / IM

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

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

Write-up: Vaccine was expired upon administration.


VAERS ID: 1854093 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 RA / IM

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

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

Write-up: Vaccine was expired upon administration.


VAERS ID: 1854098 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 LA / IM

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

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

Write-up: Vaccine was expired upon administration.


VAERS ID: 1854107 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 LA / IM

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

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

Write-up: Vaccine was expired upon administration.


VAERS ID: 1854112 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 LA / IM

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

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

Write-up: Vaccine was expired upon administration.


VAERS ID: 1854117 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 LA / IM

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

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

Write-up: Vaccine was expired upon administration.


VAERS ID: 1854122 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 RA / IM

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

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

Write-up: Vaccine was expired upon administration.


VAERS ID: 1854396 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Hypoaesthesia, Pain in extremity, Paraesthesia, Vertigo
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (narrow), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Unknown timeline, per patient tetanus shot given at a different location caused tingling in administration arm; possibly 1 year
Other Medications: Unknown
Current Illness: None other than seasonal allergies and migraine symptoms including nausea
Preexisting Conditions: Chronic migraines, anxiety, asthma, depression, insomnia
Allergies: Latex
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Patient received immunization. A few minutes after, had lightheadedness and arm soreness/tingling. She stayed for the full thirty minutes and had no further problems. Blood pressure was within normal limits. When patient returned with boyfriend for his second COVID-19 shot 3 weeks later on 11/5/2021, she said she had lingering effects starting the day after administration including severe vertigo, occasional shortness of breath and intermittent numbness of extremities. When reported, patient said she went to the ER on 10/16/2021 for the vertigo but decided against it because of the wait. ''Rest was the only thing that would help anyway.'' When patient was called 11/9/2021, she confirmed no chance of pregnancy and continued episodes of shortness of breath but unknown if due to asthma (patient has no primary care provider).


VAERS ID: 1854446 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-23
Onset:2021-10-15
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breast discharge, Gait disturbance, Injection site pain, Laboratory test, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Paroxetine 20mg Pravastatin 80 mg
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: I went to see physician today advised her of what was going on I''m going to have some lab work done to see if it shows anything she''s also going to be talking to that a few other doctors and get back with me on what they think I should do she''s going to also put me on some steroids
CDC Split Type:

Write-up: On September 23rd 2021 I got my second dose in my left arm. It hurt from the time of injection continuing on to today which is November the 9th 2021 I have had problems with pain in my left arm and in my left leg that actually hurt so bad sometimes I cannot walk when I get up from sitting. Also my left breast has been leaking a clear liquid for probably a month or so


VAERS ID: 1855331 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-10-14
Onset:2021-10-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: EKG -11/2/2021 Echocardiogram- 11/2/2021
CDC Split Type:

Write-up: Heart racing, chest pains, shortness of breath


VAERS ID: 1855903 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Influenza like illness
SMQs:

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

Write-up: Onset of headache going on 4 weeks. 24 hrs flu like ache


VAERS ID: 1856668 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 2 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: administered dose past the manufacture expiry date; This spontaneous case was reported by a health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (administered dose past the manufacture expiry date) in a 26-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 050E21A) for COVID-19 vaccination. No Medical History information was reported. On 15-Oct-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 15-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (administered dose past the manufacture expiry date). On 15-Oct-2021, EXPIRED PRODUCT ADMINISTERED (administered dose past the manufacture expiry date) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant medications was not reported. Treatment medications was not reported


VAERS ID: 1856669 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 2 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: administered dose past the manufacture expiry date (2nd dose that was expired when administered on 15Oct2021 Lot#050E21A Exp 13Oct2021); This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (administered dose past the manufacture expiry date (2nd dose that was expired when administered on 15Oct2021 Lot#050E21A Exp 13Oct2021)) in a 50-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 050E21A) for COVID-19 vaccination. No Medical History information was reported. On 15-Oct-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 15-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (administered dose past the manufacture expiry date (2nd dose that was expired when administered on 15Oct2021 Lot#050E21A Exp 13Oct2021)). On 15-Oct-2021, EXPIRED PRODUCT ADMINISTERED (administered dose past the manufacture expiry date (2nd dose that was expired when administered on 15Oct2021 Lot#050E21A Exp 13Oct2021)) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medication was reported. No treatment information was provided. 9 patients were administered dose past the manufacture expiry date along with patient. 3 doses administered on 15-Oct-2021 and 6 doses administered on 22-Oct-2021.


VAERS ID: 1856771 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 RA / -

Administered by: Public       Purchased by: ?
Symptoms: Dysstasia, Immunisation, Loss of control of legs, Muscular weakness, Neuralgia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: ATORVASTATIN
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Arthritis
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101457614

Write-up: lots of nerve pain in my upper legs; I lost control of my legs; could not stand; could not even turn and put my feet down on the floor; they are very weak for like a week or more; Booster; This is a spontaneous report from a contactable consumer (patient). This 77-year-old female patient received boost dose of BNT162B2 (Batch/lot number: FE3590, expiration date: Nov2021) on 15Oct2021, at the age of 77 years old, administrated in Right Arm at single dose for COVID-19 immunization. Relevant medical history and concurrent conditions was Arthritis. Concomitant drug was atorvastatin. Prior vaccination within 4 weeks was No. Historical vaccine was 1st and 2nd dose of BNT162B2. Patient stated, "I got my booster "the third" Pfizer shot on 15Oct2021 and the next evening I lost control of my legs. I could not stand. I could not even turn and put my feet down on the floor right so I like I made it to bed that night. It is got better in the morning but had lots of nerve pain in my upper legs but I could not even stand night before." Patient stated, "No I did not treatment. I got up to next morning and I could walk down and move my legs but they are very weak for like a week or more and I still have some nerve pain from that." Outcome of the event nerve pain and booster was unknown, for other events was recovering. Follow-up attempts are completed. No further information is expected.


VAERS ID: 1857051 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 2 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: administered dose past the manufacture expiry date; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (administered dose past the manufacture expiry date) in a 51-year-old patient of an unknown gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 050E21A) for COVID-19 vaccination. No Medical History information was reported. On 15-Oct-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 15-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (administered dose past the manufacture expiry date). On 15-Oct-2021, EXPIRED PRODUCT ADMINISTERED (administered dose past the manufacture expiry date) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications provided. No treatment medications provided.


VAERS ID: 1857380 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-05
Onset:2021-10-15
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspnoea, Heart rate increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Dehydration (broad)

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

Write-up: Persistent shortness of breath and rapid heart rate from onset of symptoms


VAERS ID: 1857507 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Dyspepsia, Gait disturbance, Injection site pain, Myalgia, Pain, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Chicken Pox vaccine. I was required to take the chicken pox vaccine. I was in my late 30''s or about 40 at the time. I suffere
Other Medications: None
Current Illness: None.
Preexisting Conditions: I have asthma. I broke my back playing hockey when I was 15 years old. I also damaged my shoulders playing hockey as well as my left knee.
Allergies: I had allergies to milk, eggs, wheat, flour, and some no longer used medications. I grew out of most of these in my teens, but had a very bad reaction to the chicken pox vaccine in my late 30''s. This was most likely due to the egg allergy. Eating too many eggs still gives me indigestion.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I started vomiting about 20 minutes after I received the vaccination. That continued on and off for the next 24 hours. The indigestion has continued since then and has not stopped. I also still have pain in my arm where the injection was given and general muscle soreness throughout my body.. This includes my back and the site of my old back injury. This has made walking painful at times.


VAERS ID: 1858015 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-15
Onset:2021-10-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Headache
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: allegra, flonase
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Neurology consult ordered; not assessed at this time.
CDC Split Type:

Write-up: Recurring headache (daily)


VAERS ID: 1858324 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-10-08
Onset:2021-10-15
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 80777-273-10 / 2 LA / IM

Administered by: Private       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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Rash of face, hands, and arms starting 1 week after the vaccine


VAERS ID: 1858781 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-02
Onset:2021-10-15
   Days after vaccination:196
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Influenza like illness, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Arthritis (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: Atorvastatin 20mg, B Complex, Multivitamins, Zinc+C, CoQ10,
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Was a little sore at injection site. Some mild flu-like symptoms for 48 hours after BOTH injectionsvaccinations (March 5, 2021, 2nd shot on April 2, 2021). All was well until about 4-6 weeks ago, I started noticing soreness in elbows and knees. This is general soreness that did not immediately cause concern. I''m fairly active and assumed it was due to over exertion beyond normal activity. Soreness has persisted for las 4-6 weeks.


VAERS ID: 1860774 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-10-05
Onset:2021-10-15
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood test, Blood urine present, Chromaturia, Infection, Urine analysis
SMQs:, Rhabdomyolysis/myopathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I was taking Omeprazole 20mg once daily, Atorvastatin 5mg once daily, Allopurinol 100mg once daily, Tamsulosin .4mg once daily, Pregabalin 100mg morn/night, Occuvite (supplement for my eyes 2 daily), a multivitamin and Turmeric 2 capsules d
Current Illness: I was not ill at the time I received my vaccine.
Preexisting Conditions: I have had blood in my urine in the past and I''ve had bladder cancer (three years ago and beat it with BCG). I now have chronic back pain.
Allergies: I am allergic to Percocet and oxycodone.
Diagnostic Lab Data: I had a urinalysis performed and blood drawn. There was blood in my urine and it was noticed that I had an infection in my blood.
CDC Split Type: vsafe

Write-up: About 1-2 weeks after receiving my third dose, my urine was darker and I passed blood at a point in time. I knew there was a problem, so I contacted my Urologist. I went in and we went into a procedure where I was on an antibiotic. It seemed to clear it up, but then I noticed that it came back. I called him again. While getting ready for my back surgery, they drew blood to check my panels and noticed that there was an infection in my blood. I am now on two antibiotics. When I went to my appointment yesterday 11/10, everything looked better. I''m going back today for another check up and hopefully I am able to have my back surgery on 11/23.


VAERS ID: 1860960 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-12
Onset:2021-10-15
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Burning sensation, Chills, Condition aggravated, Gingival discomfort, Gingival pain, Headache, Hyperaesthesia teeth, Impaired work ability, Inflammatory pain, Neuropathy peripheral, Oral discomfort, Pain, Pain in extremity, Pyrexia, Speech disorder, Toothache
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Gingival disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Arthritis (broad), Tendinopathies and ligament disorders (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? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: lyrica 100mg, candesartan 16mg, tamoxifen 20mg, Motegrity 2mg; terbinafine 250mg, multivitamin, vit D 2000IU, Vit C 500mg, zinc 50mg, flaxseed oil 1400mg
Current Illness: none
Preexisting Conditions: oral viral neuropathy/complex regional pain syndrome, HTN, small intestine bacterial overgrowth (SIBO)
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Evening post vaccine - Fever & chills (x 2 days), HA (x 5 days) & joint pain (x 3 weeks). Tylenol prn. Flare up of oral neuropathy & inflammatory pain peaked at 3 days post vaccine: - extreme sensitivity and burning, pulsing pain to teeth and gums, unable to talk due to pain - burning pain to arms, neck, and back (increased Lyrica, 50% relief) - joint pain (hips & legs) - continued for 3 weeks until 1 week after prednisone started 10/25/21 - started prednisone pulse/taper therapy. Mouth/teeth burning, pulsing pain is continuous, unresponsive to prednisone, topical lidocaine and topical benzocaine. Unable to talk or work since vaccine. Disability filing 11/8/21.


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