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

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



Case Details (Reverse Sorted by Onset Date)

This is page 170 out of 3,232

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VAERS ID: 1295075 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-02
Onset:2021-05-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / SYR

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

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: Penicillin and sulfa
Diagnostic Lab Data: provider examination 5/6/2021. no lab tests.
CDC Split Type:

Write-up: I had COVID-19 vaccine Sunday morning. I noticed fecal impaction Tuesday morning when I tried to use the bathroom . It did not respond to stool softener (Docusate sodium 100mg) 4 pills a day that I self administered Tuesday and Wednesday. I sought medical treatment with gastroenterologist Thursday morning. The NP told me to administer fleet enemas at home . I self-administered two enemas Thursday morning and evening. Now, I am having normal bowel function Friday morning. I believe this event is related to the COVID-19 vaccine because nothing else in my habits or diet was different at this time. For years prior to this event I had no constipation. I have regular bowel movements every morning after I drink some caffeine. I am physically active and eat lots of fiber. I never use laxatives prior to this event. On Sunday after I got the vaccine I worked in the garden for several hours. I felt good while I was working. But it was in the high 80s and I was in the sun. This could have caused some dehydration, but I felt fine Sunday night. Monday I was fatigued which I attributed to the vaccine and I took two advil. I know advil can be constipating but I only took 2 pills Monday and I commonly take more around my period and have normal bowel function. Tuesday, I felt fine except for the fecal impaction. I ate normally Sunday and Monday including lots of vegetables.


VAERS ID: 1295102 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product preparation error, Underdose
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: Diluent Administered Instead of Vaccine


VAERS ID: 1295215 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Eye pruritus, Eye swelling, Ocular hyperaemia
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Glaucoma (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: Levothyroxine 100 mg, Losartan 50mg
Current Illness: NO
Preexisting Conditions: NO
Allergies: Sulfa
Diagnostic Lab Data: NO
CDC Split Type:

Write-up: 05/04/2021-$g MY BOTH EYE STARTED EACHY LITTLE BIT ON SAME DAY OF 1ST DOSE COVID19 VACCINATION . 05/05/2021-$g FEEL BETTER TILL AFTER NOON THEN SLOWLY BECAME MORE RED, MORE EACHY AND I NOTICE MY RIGT EYE HAS SWELLING UNDER EYE BY THE TIME OF 9.30 PM, I TOOK BENADRY FOR RELIVE 05/06/2021-$g CONSULT MY PRIMARY DR, SHE HAS PRISCRIBED ME ORAL MEDICINES AND EYE DROP: PREDNISONE 20 MG-TWICE A DAY LORTADINE 10 MG- ONCE A DAY NEOMYCIN-POLYMYXIN-HC DROP-TWICE A DAY


VAERS ID: 1295221 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-01
Onset:2021-05-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Carditis, Electrocardiogram ST segment elevation, Electrocardiogram abnormal, Immunoglobulin therapy, Magnetic resonance imaging heart, Myocardial fibrosis, Myocarditis, Troponin increased
SMQs:, Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Myopericarditis -diffuse ST elevations on EKG with elevated troponin. Cardiac MRI shows inflammation and area of fibrosis in septum. Started on motrin 600mg QID. S/p 1x IVIG, 2x IV solumedrol, transitioned to PO prednisone course for 3.5wks, ASA 81mg daily.


VAERS ID: 1295241 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER 205A21A / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Dizziness postural, Gait disturbance, Nausea, Night sweats
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Crestor,Inderal,Multivitamin,Calcium,CoQ10,ASA,VitaminD3,
Current Illness:
Preexisting Conditions:
Allergies: Erythromycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Janssen COVID-19 Vaccine EUA (Injected IM in Lt Arm on May 4, 2021 at 10:10 am) May 4, 2021 at 6 pm I experienced chills (no fever). During the nights I experienced chills alternating with sweats (no fever). When I awoke at 6 am on May 5 and stood I was very dizzy - enough that I had to brace myself with the wall to walk to the bathroom. Dizziness persisted all day on May 5. I had no further chills nor sweats and continued to be afebrile. On May 6 I was still dizzy but it was not as severe. On May 7 (today) I continue to have dizziness and some nausea but, again, it is not as severe as on May 5.


VAERS ID: 1295268 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Hypersomnia, Injection site bruising, Injection site erythema, Injection site swelling, Pain, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: none
Preexisting Conditions: I have only 1 kidney
Allergies: injectable dye
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fever of 101.7 for 17 hours. Aspirin did not reduce fever. Injection site had a 5 inch band of purple all around it then it turned red like a sunburn. The whole left shoulder swelled up. Strong pain in all muscles and joints of the body. Multiple hours of sleep for two days.


VAERS ID: 1295283 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205 A21 A / N/A LA / SYR

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

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

Write-up: Body turned red. Itching was extremely bad and started at 3:30 on May 4th. Got prescribed Vistaril and a steroid. Back at the ER on the 6th blotchy and red streaks and itching EVERYWHERE. Changed steroid and gave me cream


VAERS ID: 1295429 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Confusional state, Fatigue, Feeling abnormal, Impaired work ability, Mobility decreased, Pain
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: The first dose on April 13..I had same reaction as day 1 this time...but no subsequent reaction like I am having now
Other Medications: amlodipine 5mg
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Day of Vax: At about 2pm....I had a severe reaction forcing me to lay down for several hours....body aches and pains, mental confusion, really weird feelings throughout my body. I had to take sick time from work. I felt better in the evening. Day 2(wed): woke up with moderate/extreme fatigue....body did not feel good...could not work took more sick time...spent most of day in bed. Day 3(thurs): Was going to try to get back to regular schedule.....worked in the morning...did my usual lunch time hike.....in the afternoon suffered from another bout of moderate/extreme fatigue...could not work..took more time off....in the evening had chest pain in my back between my shoulder blades. Day 4(fri): I am filling out this form...woke up with pain in between my shoulder blades....that seems to be feeling a little better now....I am trying to get back to my regular routine and have been working this morning. I believe that I will continue to get fatigued for a few more days....and I''m very sensitive between my shoulder blades.


VAERS ID: 1295444 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-04-27
Onset:2021-05-04
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Corneal reflex decreased, Eye movement disorder, Facial pain, Lip blister, Movement disorder, Muscle twitching
SMQs:, Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Glaucoma (broad), Corneal disorders (narrow), Ocular motility 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: HPI Pt is a 17yo female, otherwise healthy, who presents with right side of her face with decreased movement, some pain, and eyebrow twitching x 5 hours. Symptoms started out of the blue. No trauma. No hx of similar symptoms in the past. No fevers, upper respiratory infection symptoms, cough, sore throat, nausea, vomiting, diarrhea, rash, dysuria. Does have a blister on her lip x 2-3 days. No weakness to her muscles. No slurred speech. No headache, dizziness, vision changes. She is having trouble blinking her right eye and closing her right eye. Normal oral intake, urine output and activity level. No sick contacts. No known COVID exposures. Got the Pfizer vaccine #1 on 4/27/21.


VAERS ID: 1295586 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 2 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Chills, Headache, Pain, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: 48 hours of chills, fever, body and head aches, Tremors


VAERS ID: 1295606 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Pain
SMQs:

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

Write-up: BODY ACHES


VAERS ID: 1295613 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 1 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Hyperhidrosis, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: VACCINATION GIVEN @ 08:20. PATIENT C/O DIZZINESS @ 08:23. SKIN APPEARED PALE AND DIAPHORETIC. PATIENT STATED SHE HAD NOT HAD ANY FOOD OR FLUIDS YET. PLACED IN SUPINE POSTION WITH FEET ELEVATED. 08:30 HR 68, RR 16, BP 100/40. PATIENT GIVEN A LOLLIPOP AND WATER. 08:40 VS HR 72, RR 16, BP 120/50. PATIENT REPORTS FEELING LESS DIZZY. VSS. 08:55 PATIENT SAT UP IN CHAIR. TOLERATED WELL. SKIN PINK , WARM, AND DRY. 09:00 HR 70, RR16, BP 100/60. VSS. PATIENT DISCHARGED @ 9:05 SYMPTOMS RESOLVED.


VAERS ID: 1295677 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chest discomfort, Immediate post-injection reaction, Palpitations, Somnolence, Throat clearing, Throat irritation
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Xyzal
Current Illness: None
Preexisting Conditions: Hx of PVCs
Allergies: Sunscreen, Insect Repellant
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient reports acute onset of "wave in chest", palpitations, and progressive chest tightness immediate after vaccination as well as feeling sleepy. Symptoms slightly improved over course of 15 mins and patient was going to leave vaccination site. Patient returned to vaccination site for assessment at 45 mins post vaccination with complaints of heaviness in chest without complaints of dermatological changes, shortness of breath, dizziness, nausea. VITALS at 19:25: HR 81 regular, Temp 97.5F, RR 18, BP 130/82, O2 99% RA Patient reported sensation of "scratchy throat" and constantly clearing throat. and was given water , symptoms with weight on chest and throat scratchiness resolved with belching. Throat clearing resolved with water. VITALS at 19:45:HR 66 regular, RR 16, O2 98% RA, BP 122/84. Patient reporting c/o chest heaviness relieving but still would come and go. Patient vocalizing desire to leave site under supervision of family member that was present. Patient A&O x 4 at time of departure from site at 19:50.


VAERS ID: 1295691 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac arrest, Myocardial infarction, Percutaneous coronary intervention, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Respiratory failure (broad)

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

Write-up: 5/4/21 presenting to the emergency department for evaluation of cardiac arrest. Prior to arrival, the patient received his second COVID shot. While there, he went into v-fib arrest. Acute inferior posterior myocardial infarction with out-of-hospital cardiac arrest


VAERS ID: 1295834 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-30
Onset:2021-05-04
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspepsia, Haematocrit decreased, Haemoglobin decreased, Nausea, Platelet count decreased, Vomiting, White blood cell count increased
SMQs:, Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Famotidine
Current Illness: None
Preexisting Conditions: Hyperlipidemia, prediabetes, cataract
Allergies: Sulfa
Diagnostic Lab Data: H & H 7.1/21.2, Platelet 76, WBC 12.2
CDC Split Type:

Write-up: Patient received 2nd dose Moderna on 4/30. Went to UC on 5/2 with dx of dyspepsia, nausea and vomiting. Seen in Hospital on 5/4 altered with GIB. Dx DIC


VAERS ID: 1295839 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Cerebrovascular accident, Dysarthria, Dysphagia, Facial paralysis, Laboratory test, Magnetic resonance imaging head abnormal
SMQs:, Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hearing impairment (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin 81, Trelegy, albuterol
Current Illness: none
Preexisting Conditions: CAD, secondary polycythemia, COPD, HTN
Allergies: sertraline
Diagnostic Lab Data: MRI, full labs, stroke workup
CDC Split Type:

Write-up: 12h after administration, patient developed dysphagia and dysarthria with RL facial droop. Diagnosed with acute ischemic CVA of left corona radiata.


VAERS ID: 1295912 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Axillary pain
SMQs:

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

Write-up: Patient having left arm pain into axilla without enlarged lymph nodes


VAERS ID: 1295972 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Body temperature increased, Chills, Decreased appetite, Dizziness, Fatigue, Hot flush, Hyperhidrosis, Hypoaesthesia, Migraine, Nausea, Piloerection, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Meloxicam 15mg, bupropion hcl sr 100mg, montelukast sodium 10mg, buprenorphine/nalox 8-2mg sl film, multi vitamin. Benadryl
Current Illness: Allergies
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extream fatigue/inability to stay awake, nausea/throwing up even trinng to drink water, fever 104+ then dropping to 95 degrees an back up, extreme hot and cold flashes(sweating while having goose bumps), migraines an knub feeling doing anything about past out, above lasted 36 hours, afterwards still extreme fatigue even walking up stairs loose energy/breath like im going to pass out, numb feeling, loss of appetite etc which has continued to today.


VAERS ID: 1296055 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Dysgeusia, Feeling hot, Flushing, Vision blurred
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypersensitivity (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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: none
Diagnostic Lab Data: blood pressure check 135/85
CDC Split Type:

Write-up: Patient approached pharmacy staff during 15 minute observation to report feeling of overheating and anxiousness. He was brought into the consultation room where blood pressure was taken which was normal. Patient was given water and a dose of Benadryl as well as provided direct cooling with table fan. He mentioned getting a taste in his mouth prior to the flushing and anxiety as well as blurred vision. He was observed for an additional 45 minutes with symptoms subsiding and was advised to seek medical attention if symptoms reappear as he refused any further medical intervention. Patient was called several hours after vaccine at home where he said he was feeling improvement but was resting.


VAERS ID: 1296125 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-19
Onset:2021-05-04
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 1 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Medical marijuana dextroamphetamine-amphetamine 25mg Prenatal vitamins famotidine 20mg Sertaline 100mg
Current Illness: Nausea due to pregnancy
Preexisting Conditions: Anxiety & depression
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Two weeks after the first vaccine was administered the patient experience fetal death intrauterine. Pt was 18 weeks and 5 days. G4P3 EDD 10/3/21


VAERS ID: 1296148 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Dizziness, Nausea, Pallor
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)

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

Write-up: Shortly after receiving his COVID shot, patient began to feel nauseated and lightheaded. He was standing up near the bleachers and an assistant initially brought a trash can over to him. He was extremely pale and started to nod off as if he was going to pass out. Chair placed so could sit down and instructed to breathe slowly and VSS obtained. BP=122/70-98% spot oximeter-78 pulse. He was able to drink some water and part of a cookie. He fully recovered and was able to return to class after 25 minutes.


VAERS ID: 1296218 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 LA / IM

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

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

Write-up: Shortly after receiving his first COVID shot, he became faint. Nurse alerted by another parent who had accompanied her son that the patient was dropping his cookie. 0935, as nurse came up behind patient, accompanied by principal, patient slumped to the left and was holding him in place to prevent him from falling to the floor. Color was pale and dusky as moved hair out of his face. Stimulated patient and assisted to cot to get blood flow to brain. BP 120/84, pulse 52 and 97% pulse ox reading. At 9:43: sitting up in chair and drinking water, 99% pulse oximeter and pulse 61. Patient recovered after 30 minutes and went back to class. Principal notified his mother and wanted him to return to class.


VAERS ID: 1296470 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-01
Onset:2021-05-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Dyskinesia, Dysstasia, Extraocular muscle paresis, Feeling abnormal, Gait disturbance, Hemiparesis, Jaw disorder, Scan normal, Speech disorder
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dyskinesia (narrow), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Calcibon D Calcitrion Rivotril 0.5 mg (am) Lamictal 400 mg Wellbutrin 300 mg Brintellix 30mg Rivotril 0.5 (pm)
Current Illness: Hypothyroidism Depression Hyperparathiroidism Osteoporosis
Preexisting Conditions: Controlled Depression
Allergies: Allergy to plasil (for vomit)
Diagnostic Lab Data: I was at the hospital. They did a TAC scan and everything was perfect. Saturation OK Heart OK Presi?n OK
CDC Split Type:

Write-up: 1. Dizzy 30 mins later 2. As if I was drugged 1 hour later 3. Not speaking coherent 1:40 hour later 4. Walking supported/leaning by a wall 2:00 hours later 5. Could not walk alone and had involuntary movements 6. Dislodged jaw 7. Not standing by my self 9. Winking eyes and not able to open them 10. The left side was weaker than my right side


VAERS ID: 1296644 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-04-07
Onset:2021-05-04
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Bell's palsy, Blood test, Computerised tomogram
SMQs:, Hearing impairment (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: Metformin ,levoxyl ,simvastatin, Januvia, amlodipine, omeprazole, losartan
Current Illness: none
Preexisting Conditions: diabetic
Allergies: levaquin
Diagnostic Lab Data: CT scan 5/6/21 Blood Work 5/6/21 Blood Work 5/7/21
CDC Split Type:

Write-up: Bell Palsey


VAERS ID: 1297333 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Axillary pain, Lymphadenopathy
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: I developed a soreness/swollen feeling in my lymph node in my left arm pit (same arm as shot) that lasted about 14 hours.


VAERS ID: 1298841 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Washington  
Vaccinated:0000-00-00
Onset:2021-05-04
Submitted: 0000-00-00
Entered: 2021-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Non-smoker
Preexisting Conditions: Comments: The patient had no health conditions, The patient has no known drug allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210509194

Write-up: LEFT AND RIGHT LEG PAIN; FEVER MAXIMUM OF 100 DEGREE F; HEADACHE; SORE BODY; This spontaneous report received from a patient concerned a 38 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included non-alcoholic, and non smoker, and other pre-existing medical conditions included the patient had no health conditions, the patient has no known drug allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown exp 23-JUN-2021) dose was not reported, administered on 04-MAY-2021 14:00 for prophylactic vaccination.The batch number was not reported and has been requested. No concomitant medications were reported. On 04-MAY-2021, the subject experienced sore body. On 04-MAY-2021, the subject experienced fever maximum of 100 degree f. On 04-MAY-2021, the subject experienced headache. On 05-MAY-2021, the subject experienced left and right leg pain. Treatment medications (dates unspecified) included: paracetamol. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from fever maximum of 100 degree f, sore body, and headache, and had not recovered from left and right leg pain. This report was non-serious.


VAERS ID: 1298852 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Florida  
Vaccinated:0000-00-00
Onset:2021-05-04
Submitted: 0000-00-00
Entered: 2021-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Non-smoker
Preexisting Conditions: Comments: The patient had no known allergies. The patient did not have any history of drug abuse or illicit drug use.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210509665

Write-up: SWEATING; BODY ACHES; STOMACH ACHES; CHILLS; HEADACHE; FEVER; This spontaneous report received from a patient concerned a 48 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included non alcoholic, and non smoker, and other pre-existing medical conditions included the patient had no known allergies. the patient did not have any history of drug abuse or illicit drug use. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: Unknown) dose was not reported, administered on 04-MAY-2021 17:00 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 04-MAY-2021, the subject experienced stomach aches. On 04-MAY-2021 23:00:00, the subject experienced sweating. On 04-MAY-2021 23:00:00, the subject experienced body aches. On 04-MAY-2021 23:00:00, the subject experienced chills. On 04-MAY-2021 23:00:00, the subject experienced headache. On 04-MAY-2021 23:00:00, the subject experienced fever. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from headache, chills, sweating, fever, body aches, and stomach aches. This report was non-serious.


VAERS ID: 1299494 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-29
Onset:2021-05-04
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Injected limb mobility decreased, Myalgia, Pyrexia, Tenderness
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (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? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Daily I take: Hydrochlorothiazide, Lisinopril, Amlodipine About 15 hours after vaccine, I took Tylenol
Current Illness: None
Preexisting Conditions: High Blood pressure
Allergies: None
Diagnostic Lab Data: I have not seen a Dr about this yet.
CDC Split Type:

Write-up: My initial reaction, roughly 15 hours after shot was fever, chills, muscle aches/pain for 15-16 hours The main adverse reaction now that started 4-5 days later is left wrist (same arm as shot) pain in the joint.. any movement, twisting, lifting/carrying is noticeably uncomfortable or not possible due to the pain. Painful to the touch as well and at the time of this submission it has not improved at all. Prior to vaccine shot, I have never had joint pain or issues with my wrists/arms.


VAERS ID: 1299634 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-11
Onset:2021-05-04
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

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

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

Write-up: on or about 5/4/21 noticed a rash on both legs they had been itchy prior to that, the rest of my body is itchy w a few rash spots present. 5/8/21 noticed my left thumb twitching. As far as Item 20 rash is still still present and the thumb twitching is still present


VAERS ID: 1299821 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-04-27
Onset:2021-05-04
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN EW0171 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blister, Diarrhoea, Fatigue, Headache, Herpes zoster, Pain, Photophobia, Rash
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

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

Write-up: Shingles - zoster Headache , rush , severe pain , blisters in right side of torax, fatigue, diarrhea, sensitivity to light


VAERS ID: 1299984 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Injection site pain, Pyrexia, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Swollen shoulder, pain in shoulder in line with the injection site. Tiredness, fever for two nights.


VAERS ID: 1300354 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Urticaria, Vaccination site rash
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: large, welt-like rash around vaccine site, mild pain and burning sensation


VAERS ID: 1300942 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Blood pressure increased, Blood test, Chest X-ray, Chills, Computerised tomogram, Dysphemia, Electrocardiogram, Electroencephalogram, Feeling jittery, Injection site pain, Magnetic resonance imaging, Muscle spasms, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Fluoxetine 40MG, Concerta 54MG
Current Illness:
Preexisting Conditions: Chronic Migraines
Allergies:
Diagnostic Lab Data: On May 5: EKG (elevated B/P of 137, then 141 at time of hospital admission), CAT Scan, MRI, EEG, Chest X-Ray, Blood Work. (All done at the Hospital). Suspected cause of symptoms was collaboration of Concerta medication with the Moderna Vaccine.
CDC Split Type:

Write-up: At approximately 6:00PM Tuesday May 4 (approx 8 hours after second dose): Fever up to 101.6 F, severe chills, muscle pain at injection site, profuse vomiting ( at least 7 times between 10:00PM and 4:00AM 05/05), muscle spasms in upper legs. Severe stutter On Wednesday May 5, starting around 3:00PM: Persistent stutter, full body jitters that progressed to upper body muscle spasms (primarily in the neck and shoulder region) that worsened throughout the evening. Checked into the ER approximately 4:30PM and was administered a muscle relaxant (I believe) through an IV to lessen the spasms around 7:00PM. Muscle spasms and stutter persisted until approximately 4:00PM on Thursday, May 6 at time of discharge from hospital.


VAERS ID: 1301125 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Hyperhidrosis, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: About 2 minutes after vaccination patient was feeling light headed, pale, sweaty, clampy. It lasted about a minute or 2 then he stated that he was starting to feel better. He stayed in the store about 30 minutes ( or until he was comfortable leaving on his own).


VAERS ID: 1301189 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

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

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

Write-up: Rash all over


VAERS ID: 1301625 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-01
Onset:2021-05-04
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Atrial tachycardia, Blood thyroid stimulating hormone normal, Electrocardiogram abnormal, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vascepa, allopurinol, levothyroxine
Current Illness:
Preexisting Conditions: Hyperlipidemia, hypothyroidism, gout, obesity
Allergies: Bactrim
Diagnostic Lab Data: TSH was normal. No anemia. Electrolytes were within normal imits.
CDC Split Type:

Write-up: Patient describes palpitations 2 weeks after receiving 2nd dose of Moderna vaccine for COVID 19. ECG in hospital demonstrates multifocal atrial tachycardia.


VAERS ID: 1301655 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Blood pressure increased
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (narrow)

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

Write-up: Blood pressure of 190 5 mins after injection of second dose. Blood pressure of 220 the following day. Blood pressure over 180 since injection everyday


VAERS ID: 1301656 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Limb injury, Seizure, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: fainting, eyewitness reported seizure (patient also had scrapped left shoulder)


VAERS ID: 1301806 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003 C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal discomfort, Asthenia, Dizziness, Fatigue, Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine 50mcg
Current Illness: N/a
Preexisting Conditions: N/a
Allergies: Almonds
Diagnostic Lab Data:
CDC Split Type:

Write-up: Starting from midnight, i experienced fever and body aches. In am i had extreme dizziness and vomited. I also experienced extreme weakness. Fever continued past following midnight. Stomach upset was noted. Following day i still experienced extreme fatigue and weakness.


VAERS ID: 1301972 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:2021-05-04
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Headache, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Penicillin allergy
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210508256

Write-up: BLURRED VISION; HEADACHE; This spontaneous report received from a consumer concerned a 23 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included penicillin allergy. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 204A21A expiry: 23-JUN-2021) dose was not reported, administered on 28-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On 04-MAY-2021, the subject experienced blurred vision. On 04-MAY-2021, the subject experienced headache. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from blurred vision, and headache on 05-MAY-2021. This report was non-serious.; Sender''s Comments: V0: Medical Assessment comment not required per standard procedure as the case is assessed as non-serious.


VAERS ID: 1301994 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Immediate post-injection reaction, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Pt. fainted right after getting vaccinated. B/P 110/70, HR 74, R 19. Pt stated, "I faint most of the time when I see needles." At 3:10 pm pt. stated, "I feel better now." Pt. is alert and oriented x4. 3:26 pm pt stated , "I''m ok now I want to go home." Pt. went home at 3:25 pm.


VAERS ID: 1302036 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 2 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Asthenia, Chills, Decreased appetite, Diarrhoea, Fatigue, Frequent bowel movements, Headache, Hypersomnia, Impaired work ability, Injection site pain, Joint range of motion decreased, Night sweats, Toothache, Weight decreased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BCP, Claritin, weekly allergy shots, B12, D3, Zinc, Omega 3.
Current Illness: None
Preexisting Conditions: None
Allergies: Lactose intolerant
Diagnostic Lab Data:
CDC Split Type:

Write-up: "Moderna COVID-19 Vaccine EUA" Left arm was extremely sore soon after injection on Tuesday morning, couldn''t reach behind back or lift above head without a lot of pain (4 days); felt tired that evening; woke up 4 times (!) during first night to empty bowels; chills and sweating during night (2 nights); headache in the morning (decided to take Tylenol); teeth hurting (dull pain off and on for 6 days); loss of appetite (3 days); diarrhea (second day); weight loss (4 lbs). Continued to take Tylenol and took time off from work, slept for most of the time and started feeling weak but better Thursday evening. Feel back to normal on Monday.


VAERS ID: 1302088 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

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

Write-up: Pt. developed a reaction to 1st dose COVID-19 vaccine. Pt. has symptoms of tingling and bilater arms, no nausea. Pt. has history of Ischemic stroke 9 yrs. ago. No Rx of current medication. No hospital care provided. Pt verbalizes feeling better and recovered. Pt. VS: 107/74, 80 P, 99% O2Sat, Standing BP 117/73, 86 P, 97% O2Sat.


VAERS ID: 1302105 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

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

Write-up: Moderate arm pain, moderate nausea and mild lightheadedness


VAERS ID: 1302119 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Fatigue, Night sweats, Pain in extremity
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (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: non3
Current Illness: non3
Preexisting Conditions: none
Allergies: non3
Diagnostic Lab Data: none
CDC Split Type:

Write-up: severe fatigue, mild lightheadedness, nighttime chills followed by sweats, unknown if fever present the day/night following the vaccine nighttime symptoms resolved after one night ,daytime fatigue with lightheadedness continued into third day mild arm pain for three days


VAERS ID: 1302174 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-28
Onset:2021-05-04
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Computerised tomogram, Electrocardiogram, Hypoaesthesia, Injection site reaction, Magnetic resonance imaging, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: About 30 years ago she had a flu shot that caused guerre barre syndrome. these symptoms lasted several months. she had the pa
Other Medications: levoxyl 150 mcg. amlodipine 2.5, oxycodone 5mg qhs,
Current Illness:
Preexisting Conditions: asthma, chronic pain,
Allergies: Bactrim, Flagel,
Diagnostic Lab Data: blood work Chest X-ray CT MRI EKG
CDC Split Type:

Write-up: pt says about 6 days later her left arm felt like it pins and needles in it the day after taking the vax that felt like paresthesia . On 5/4/2021 she went to the ER. She had multiple test and everything came back negative and everything was ruled out. She was prescribed steroids. On 5/8/2021 the numbness and tingling started on all 10 of her toes and right finger tips and she still has a numb arm. She will FU w/ her PCP on 5/10/2021 via tele visit.


VAERS ID: 1302222 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / UNK - / -

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

Life Threatening? 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:
Current Illness:
Preexisting Conditions: EMR NOTED HISOTRY OF VASOVAGAL SYNCOPE IN THE PAST PER CHART
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presents via EMS for altered mental status after a syncopal episode. Per EMS, coworkers heard a loud noise and found him face down on the floor unresponsive shortly after receiving 1st Moderna vaccine (history of vasovagal syncope in the past per chart). Per bystanders pt HR in the 30s, but 60s upon EMS arrival. Upon arrival, pt answering yes/no questions appropriately, but limited history given.


VAERS ID: 1302238 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-02-04
Onset:2021-05-04
   Days after vaccination:89
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 2 LA / IM

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

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

Write-up: Patient presented to the Hospital Emergency Department with symptoms consistent with COVID-19 and had a positive COVID-19 PCR test. The patient was admitted the hospital Med/Surg unit for treatment of COVID-19 pneumonia. The patient was fully vaccinated at the time of his positive COVID-19 test.


VAERS ID: 1302253 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood glucose normal, Fatigue
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: Low Platelets, Diverticulitis, Arthritis
Allergies: ASA
Diagnostic Lab Data: B/P 120/60, HR 81, 96% O2, Glucose 124.
CDC Split Type:

Write-up: Client stated she began to feel fatigued following administration of the vaccine. Fire Rescue at scene to evaluate the client. All vitals within normal limits. Client began to feel better. Per Fire Rescue no further evaluation needed. Client exited the site at 3:27pm.


VAERS ID: 1302271 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-04-30
Onset:2021-05-04
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Biochemical pregnancy, Body temperature increased, Exposure during pregnancy, Human chorionic gonadotropin
SMQs:, Neuroleptic malignant syndrome (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (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: Probiotic, progesterone in oil, estrace, Prenatal vitamin
Current Illness: no
Preexisting Conditions: infertility, anovulation
Allergies: no
Diagnostic Lab Data: BHCG
CDC Split Type:

Write-up: Embryo transfer 4/22/21, vaccine with temp 101 4/30/21, biochemical pregnancy diagnosed 5/4/21


VAERS ID: 1302310 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-04-30
Onset:2021-05-04
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bell's palsy
SMQs:, Hearing impairment (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: atorvastatin 40 mg tablet, doxazosin 4 mg tablet, levothyroxine 88 mcg tablet, valsartan 80 mg tablet, atenoloL 25 mg tablet
Current Illness: No
Preexisting Conditions: High blood pressure, Hyperthyroid
Allergies: No
Diagnostic Lab Data: Diagnosed as Bell''s Palsy by NP at on May 6
CDC Split Type:

Write-up: Bell''s Palsy


VAERS ID: 1302351 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-15
Onset:2021-05-04
   Days after vaccination:50
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Computerised tomogram abdomen abnormal, Computerised tomogram pelvis abnormal, Hypotension, Lung opacity, Pelvic fluid collection, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: apixaban (ELIQUIS) 2.5 MG PO Tab take 1 Tab by mouth twice daily for 90 days. Unknown Unknown time atorvastatin (LIPITOR) 20 MG PO Tab take 20 mg by mouth once every night at bedtime. Unknown Unknown time digoxin (LANOXIN) 125 MCG PO Tab ta
Current Illness: CAD (coronary artery disease) ? CKD (chronic kidney disease) ? Dementia (CMS/HCC) ? Mitral valve insufficiency
Preexisting Conditions: CAD (coronary artery disease) ? CKD (chronic kidney disease) ? Dementia (CMS/HCC) ? Mitral valve insufficiency
Allergies: Allergies reviewed. Amoxicillin, Clarithromycin, and Lansoprazole
Diagnostic Lab Data:
CDC Split Type:

Write-up: History of Present Illness: This is a 84y.o. male with a medical history of endocarditis secondary to staph aureus on chronic doxycycline suppression, bioprosthetic valve, coronary artery disease, COPD, atrial fibrillation on Eliquis, dementia, and thrombocytopenia who presented to the hospital secondary to hypotension. The patient resides at a facility and was sent in for low BP. Patient is overall a poor historian. Presentation, his min blood pressure was 95/61. CT of the abdomen and pelvis showed intrapelvic fluid collection with concerns for possible abscess, long segment of sigmoid colitis, and right lower lobe groundglass attenuation concerning for acute infectious process. ROS: Constitutional: Denies fever or chills Eyes: Denies change in visual acuity, eye pain HENT: Denies nasal congestion or sore throat Respiratory: Denies cough or shortness of breath Cardiovascular: Denies chest pain or edema GI: Denies abdominal pain, nausea, vomiting, bloody stools or diarrhea GU: Denies dysuria, hematuria Musculoskeletal: Denies back pain or joint pain Integument: Denies rash, papules Neurologic: Denies headache, focal weakness or sensory changes Endocrine: Denies polyuria or polydipsia Lymphatic: Denies tender or enlarged lymph nodes Psychiatric: Denies depression or anxiety Tested + for Covid 5/4/2021 with admission CT abd with ground glass RLL


VAERS ID: 1302440 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-04-07
Onset:2021-05-04
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / N/A LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Angiogram cerebral abnormal, Arteriogram carotid, Asthenia, Blood glucose increased, Blood pressure increased, Computerised tomogram, Dysarthria, Hemiplegia, Magnetic resonance imaging head abnormal, Scan with contrast abnormal, Thalamic infarction
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hypertension (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril
Current Illness: None
Preexisting Conditions: High Blood Pressure
Allergies: Sulfa Drugs-hives
Diagnostic Lab Data: 5/4/21. Hospital protocol was used for treatment including CT without contrast, CTA of head and neck with contrast, MRI of the brain with and without contrast, medications.
CDC Split Type:

Write-up: Approximately one month after receiving vaccine, he had a left thalamic infact acute (CMS-HCC). The was taken to Hospital immediately and was treated there. Symptoms included right sided paralysis and weakness and slurred speech. Blood pressure was also elevated(184/97). Glucose(286). Hospital stay was three days.


VAERS ID: 1302523 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ataxia, Back pain, Blindness, Blood test abnormal, Chest pain, Computerised tomogram normal, Diplopia, Dyspnoea, Headache, Hypoaesthesia, Magnetic resonance imaging normal, Muscle tightness, Pain, Pain in extremity, Poor peripheral circulation, Ultrasound Doppler, Ultrasound Doppler normal, Vision blurred
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Ocular motility disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Benadryl, Zyrtec, naproxen
Current Illness: None
Preexisting Conditions: Asthma, endometriosis, IBS, complex migraine with aura
Allergies: Tramadol
Diagnostic Lab Data: CTs, MRIs, Echo, and venous ultrasound were clear. Blood work had a couple abnormalities but nothing they were concerned about.
CDC Split Type:

Write-up: Night of vaccine had severe body aches, back pain, leg pain severe until legs went numb, then arm pain severe until also numb, chest pains/ trouble breathing. Following days had pains in arms and legs as if a tourniquet was left on and I cycled through severe pain and being numb. 5 days in I lost my vision (super blurry and seeing double) and lost complete control of arms and legs on top of headache and chest pains. Vision came back a couple hours later but the leg pains/ numbness continued even now. It feels as if my circulation has been cut off.


VAERS ID: 1302541 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / IM

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

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

Write-up: Johnson and Johnson vaccine. I have been experiencing ringing in the ears .. coming and going .. sometimes mild , sometimes more intense . I still have the ringing as of today , one week after . I am certain it is due to the vaccine as I have never experienced this before


VAERS ID: 1302685 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-27
Onset:2021-05-04
   Days after vaccination:66
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Acute myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

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

Write-up: Hospital admission STEMI 5/4/21


VAERS ID: 1302689 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-16
Onset:2021-05-04
   Days after vaccination:77
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 LA / IM

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

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

Write-up: This 87 year old male hospice received the Covid shot on 2/16/21 and died on 5/4/21.


VAERS ID: 1302697 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-09
Onset:2021-05-04
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Diabetic ketoacidosis
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Hospital admission 05/04/21


VAERS ID: 1302723 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-04-08
Onset:2021-05-04
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Retinal vein occlusion
SMQs:, Embolic and thrombotic events, venous (narrow), Retinal 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: none
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: CRV (central retinal vein) occlusion.


VAERS ID: 1303635 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / SYR

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

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

Write-up: Right arm & hand numb & tingly, pins & needles. 2 days later it moved to my left arm & hand & now also my calves.


VAERS ID: 1303649 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-28
Onset:2021-05-04
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Bronchiectasis, Computerised tomogram thorax abnormal, Haemoptysis, Platelet count normal, Pulmonary embolism, Pulmonary mass, Ultrasound scan normal, White blood cell count normal
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, venous (narrow), Cardiomyopathy (broad), Infective pneumonia (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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin D
Current Illness: none
Preexisting Conditions: Desmoid tumor of spine and chest wall, surgically removed 2007 with XRT, second resection 2011, chemo as recently as 2017. Still with residual tumor. Archictecture of lung is damaged due to surgery/XRT with small lung cavity and bullous disease in upper lobes.
Allergies: none
Diagnostic Lab Data: Hb 15.4 on admission, now 13.5 after 5 days hemoptysis, WBC 6.22 plts 182 on admission, BMP nl. CT shows Acute pulmonary emboli and left main extending into the lingular and left lower lobe segmental branches. No evidence of right heart strain RV:LV ratio of 0.67. 2. Groundglass and consolidative opacities left lower lobe favored to represent pulmonary infarcts although superimposed aspiration pneumonia possible. 3. Posttreatment changes to the left chest with masslike pleural/paraspinal soft tissue thickening along the left medial pleural margin, residual tumor a possibility. 4. Nonspecific sub-5 mm pulmonary nodules; largest 5 mm nodule in right upper lobe.
CDC Split Type:

Write-up: Pt was admitted for hemoptysis and a PE 6 days following the event. The PE was in the lung previously damaged by the tumor. The PE was small, the hemoptysis is due to likely a small arterial bleed. He''s been bronched twice and as of 5/10 continues to bleed. The PE is small but we are unable ot anticoagulate due to ongoing hemoptysis. The CT shows ground glass opacities/bronchiectasis in the area where there is bleeding. It''s mostly likely this is due to previous tumor resection and damage from his surgery and XRT and shrunken lung. However, the PE and hemoptysis DID occur within a week of the second covid vaccine so we felt it necessary to report. Pt has no history of DVT/PE. His LE u/s for DVT were negative.


VAERS ID: 1304827 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-26
Onset:2021-05-04
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal discomfort, Arthralgia, Burning sensation, Fatigue, Herpes zoster, Hypoaesthesia, Neuralgia, Rash
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin with Collagen, Vitamin D3, Glucosamine and Condroitin, Zyrtec PRN, Omeprazole, Vitamin C, Fish Oil
Current Illness: NONE
Preexisting Conditions: Back Pain from Herniated Disc
Allergies: Shrimp
Diagnostic Lab Data:
CDC Split Type:

Write-up: Had severe joint pain and fatigue from 04/26/21-05/02/21, then woke up in the middle of the night with a burning sensation to left side of abdomen and flank. Severe numbness and burning from (05/02-05/07), diagnosed with Neuralgia 05/07 /21, then developed rash the night of 05/07/21. Went to urgent care the morning of 05/08 and diagnosed with Shingles. Prescribed Neurontin and Lyrica for Shingles. I do not have any auto-immmune disorders diagnosed currently but have been tested in the past, not immunocompromised, not under stress, and I have not been exposed to anyone with Shingles or chickenpox.


VAERS ID: 1304957 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-05-04
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210513227

Write-up: ITCHING ON WRISTS, FOREARMS AND ANKLES; RASH ALL OVER BODY; This spontaneous report received from a patient concerned a 23 year old female. The patient''s weight was 152 pounds, and height was 61 inches. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 205A21A and expiry: UNKNOWN) dose was not reported, administered on 03-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 04-MAY-2021, the subject experienced itching on wrists, forearms and ankles. On 04-MAY-2021, the subject experienced rash all over body. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from rash all over body, and itching on wrists, forearms and ankles. This report was non-serious.; Sender''s Comments: V0:Medical assessment comment not required as per standard procedure as case assessed as non serious.


VAERS ID: 1305030 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-03-08
Onset:2021-05-04
   Days after vaccination:57
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Blood pressure increased, Blood pressure measurement, Epistaxis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Hypertension (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: CRESTOR; VITAMINS NOS
Current Illness:
Preexisting Conditions: Comments: No medical history was provided by the reporter.
Allergies:
Diagnostic Lab Data: Test Name: blood pressure; Test Result: Inconclusive ; Result Unstructured Data: 144/70; Test Date: 20210504; Test Name: blood pressure; Result Unstructured Data: 175/85
CDC Split Type: USMODERNATX, INC.MOD20211

Write-up: Nose was bleeding like a faucet/large amount of blood (estimates about 1/4 cup); Blood pressure was 175/85; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of EPISTAXIS (Nose was bleeding like a faucet/large amount of blood (estimates about 1/4 cup)) and BLOOD PRESSURE INCREASED (Blood pressure was 175/85) in a 71-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 028A21A and 036A21A) for COVID-19 vaccination. No medical history was provided by the reporter. Concomitant products included ROSUVASTATIN CALCIUM (CRESTOR) and VITAMINS NOS for an unknown indication. On 08-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 05-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 04-May-2021, the patient experienced EPISTAXIS (Nose was bleeding like a faucet/large amount of blood (estimates about 1/4 cup)) (seriousness criterion medically significant) and BLOOD PRESSURE INCREASED (Blood pressure was 175/85) (seriousness criterion medically significant). At the time of the report, EPISTAXIS (Nose was bleeding like a faucet/large amount of blood (estimates about 1/4 cup)) and BLOOD PRESSURE INCREASED (Blood pressure was 175/85) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 04-May-2021, Blood pressure measurement: 175/85 (High) 175/85. On an unknown date, Blood pressure measurement: 144/70 (Inconclusive) 144/70. The reporter had she noticed a large amount of blood (estimates about 1/4 cup) around her computer tray and that her nose was bleeding like a faucet. Her husband took her to the ER, where her blood pressure was 175/85. Caller does not normally have high blood pressure, and is not on blood pressure medication. When she left the ER, her blood pressure was 144/70 and they clamped her nose and gave her some oxymetazoline nose spray for any break-through bleeding. Her husband maintains that the nose bleed was caused by the vaccine. Treatment procedure in the Emergency Room (ER) included nose clamped and medication included oxymetazoline. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) was not applicable. Company Comment: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.


VAERS ID: 1306354 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Disorganised speech, Fall, Hallucination
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (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: USMODERNATX, INC.MOD20211

Write-up: started to hallucinate very badly; fell down the stairs; is not making any sense at all when she tries to talk; This spontaneous case was reported by a consumer and describes the occurrence of HALLUCINATION (started to hallucinate very badly) in a 58-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 04-May-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 04-May-2021, the patient experienced HALLUCINATION (started to hallucinate very badly) (seriousness criterion medically significant), FALL (fell down the stairs) and DISORGANISED SPEECH (is not making any sense at all when she tries to talk). At the time of the report, HALLUCINATION (started to hallucinate very badly), FALL (fell down the stairs) and DISORGANISED SPEECH (is not making any sense at all when she tries to talk) outcome was unknown. No concomitant medication provided. No treatment information provided. Action taken with mRNA-1273 in response to the drug was not applicable. Company Comment: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.


VAERS ID: 1306562 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Herpes zoster, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Opportunistic infections (broad)

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

Write-up: Pain at Injection Site-Mild, Systemic: Shingles-Severe.


VAERS ID: 1306585 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Muscle twitching
SMQs:, Anaphylactic reaction (broad), Dyskinesia (broad), Dystonia (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: Tylenol, Turmeric
Current Illness:
Preexisting Conditions: SLE, GPA
Allergies: Reglan, Medrol
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Chest discomfort intermittent for 3 hours after vaccine admin, and then again later that evening. muscle twitching lasting for 4 to 5 days post injection moderate


VAERS ID: 1306710 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Fatigue, Headache, Muscle fatigue, Myalgia, Pyrexia, Somnolence
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: No known allergies to Medication, food or other.
Diagnostic Lab Data: None Yet
CDC Split Type:

Write-up: Janssen Covid-19 Vaccine EUA. Symptoms started about 4-5 hours after injection. Headache and overall tiredness started on the first day. By the next morning 5/5/21, I was experiencing Muscle soreness, Joint pain, Headache. By the next evening, 24 hours after injection I was experiencing Extreme Muscle soreness and Joint pain, Piercing headaches, Fever, overall weakness and exhaustion. These symptoms continued on 5/6. By 5/7 the severity of the symptoms had lessened, But I continue to experience headaches, Muscle fatigue and weakness, and overall tiredness and an inability to feel well rested after sleep.


VAERS ID: 1306775 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-04-27
Onset:2021-05-04
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ear discomfort, Ear pain, Tinnitus
SMQs:, Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: I will forward any information that I receive from the ear specialist.
CDC Split Type:

Write-up: Five days after receiving the vaccine I developed a ringing in the ears. The ringing has been getting worse each day that passes. I have seen by GP and he is referring me to a specialist. In the past, when I have had the flue, I have experienced such ringing in the ears. After recovering from such an infection, the ringing has stopped. This episode is more severe with additional pressure pain that is a new symptom. I am extremely hesitant to take the second shot of the Moderna vaccine. If your have a recommendation , such as taking a different vaccine at a later date, please let me know.


VAERS ID: 1306786 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-08
Onset:2021-05-04
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Hypoaesthesia, Injection site hypoaesthesia, Injection site paraesthesia, Mobility decreased, Pain in extremity, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: 5/4/21 woke up with L arm pain and numbness and tingling; unable to lift arm above head


VAERS ID: 1306825 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-26
Onset:2021-05-04
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, trazodone, Fluoxetine, Invokana, Atorvastatin, Dorzolamide, women''s multivitamin
Current Illness: NA
Preexisting Conditions: diabetes, glaucoma
Allergies: NA
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Area on upper right arm just below the injection site became red and itchy about 1 week after receiving vaccine. The area at the bottom is slightly raised.


VAERS ID: 1306938 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Fibrin D dimer increased, Hypopnoea, Musculoskeletal chest pain, Pain in extremity, Pleuritic pain, Pulmonary embolism, Scan with contrast abnormal
SMQs:, Haemorrhage laboratory terms (broad), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine, lisinopril, metoprolol, nitroglycerin, albuterol, atorvastatin, Imdur - daily medication
Current Illness:
Preexisting Conditions: Hypertension, coronary artery disease s/p CABG, asthma, back pain, history of right breast cancer s/p mastectomy
Allergies:
Diagnostic Lab Data: D-dimer 3666, CT angiogram chest with and without contrast: acute bilateral nonobstructive pulmonary emboli
CDC Split Type:

Write-up: Patient started to experience left arm pain hours after the vaccination on 05/04/2021, and the pain gradually moved to the patient''s left chest wall, anterior chest and right chest wall, patient was having shallow breathing limited by pleuritic pain, presented to the ED on 5/10/2021 and was diagnosed with acute bilateral nonobstructive pulmonary emboli based on CT angiogram chest.


VAERS ID: 1307128 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: Headache that lasted several days. Treated with aspirin


VAERS ID: 1307188 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-30
Onset:2021-05-04
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Headache, Influenza like illness, Muscle spasms, Pyrexia, Tinnitus
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Hearing impairment (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: ringing in ears, dizzy, scattered headaches, muscle cramps in arms. Classic flu like symptoms 24 hours after injection. 99.9 fever for 10 hours, headache, fatigue. They resolved 24 hours later.


VAERS ID: 1307258 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 1 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Presyncope
SMQs:, Anticholinergic syndrome (broad), Hypotonic-hyporesponsive episode (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:

Write-up: vasovagal reACTION


VAERS ID: 1307279 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Feeling abnormal, Pulse abnormal
SMQs:, Dementia (broad)

Life Threatening? Yes
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: Flu very young 9??
Other Medications: Prozac Just came off 1 week prednisone for inflammatory issues, did not work Furosimide Amlodipine Clonazapam 2pm, TMJ at night. Woman centrum silver Wellbutrin Vit. D Potassium Hydrochloride Levothyoxine Omaprezol
Current Illness: Endometriosis Surgery oct 2020 Drop in thyroid, potassium, fixed Need HRT Inflammatory issues all joints Unexplained weight gain. Irregular periods as prior to the surgery. In the middle of figuring it out. See Dr. Tomorrow. Cardiologist/primary May 19th OBGYN.
Preexisting Conditions: Endometriosis Inflammation Tmj Myalgia
Allergies: Reactions to lisinipril Epinephrine Violin Reactions
Diagnostic Lab Data: None yet
CDC Split Type:

Write-up: 8 min in I completely dropped to 40 bpm.pulse. was there an extra half hour, I haven''t felt good since


VAERS ID: 1307329 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-30
Onset:2021-05-04
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anaphylactic reaction, Dyspnoea, Mouth swelling, Paraesthesia oral
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow)

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

Write-up: Presented to the emergency room 5/3/21 after the development of multiple symptoms after her second COVID vaccine on Friday. Symptoms consisted of perioral tingling, some possible oral swelling, and then subsequent shortness of breath with labored breathing. Initial treatments in the emergency room did result in some symptomatic benefit, however, the patient continued to have an oxygen requirement and demonstrated persistent symptoms of anaphylaxis. She was then admitted to the intensive care unit for higher level intervention.


VAERS ID: 1307365 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-04-30
Onset:2021-05-04
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cardiac monitoring, Chest X-ray, Chest pain, Echocardiogram, Electrocardiogram, Full blood count, Hypokalaemia, Pericarditis, Troponin I increased, Ultrasound scan
SMQs:, Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: None
Diagnostic Lab Data: EKG, CBC, electrolytes, cardiac biomarkers, CXR, cardiac monitoring, cont pulse oximetry, 02, PIV placement Bedside ultrasound, ECHO
CDC Split Type:

Write-up: Pt developed chest pain on 5-1-2021, then went to the ER 5-4-2021, was hospitalized for pericarditis , elevated troponin 1 level, and hypokalemia. DC 5-5-2021 after 1 night in the hospital. Outcome: remains alive. TX management is colchicineo.6mg BID x 3 months and prn ibuprofen


VAERS ID: 1307500 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO170 / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Immediate post-injection reaction, Muscular weakness, Pain, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypersensitivity (narrow)

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

Write-up: Pain and tingling immediately and thereafter. Weakness in arm. Doctor thinks a nerve was hit with the vaccination needle.


VAERS ID: 1307502 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-04-13
Onset:2021-05-04
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Back pain, C-reactive protein increased, Cardiac telemetry normal, Chest discomfort, Chest pain, Echocardiogram abnormal, Electrocardiogram ST segment depression, Electrocardiogram abnormal, Fibrin D dimer normal, Myocarditis, Pain, Pain in extremity, Pericardial effusion, Pericarditis, SARS-CoV-2 test negative, Sleep disorder, Speech disorder, Troponin increased
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Other ischaemic heart disease (broad), Chronic kidney disease (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NO
Current Illness: NO
Preexisting Conditions: NO
Allergies: NO
Diagnostic Lab Data:
CDC Split Type:

Write-up: 18M with no PMH s/p pfizer vaccination dose 2 on 5/4/21 who presented with chest pain. He initially had chest pain the day prior to admission with pain in his back and down his left arm. This improved with Tylenol and resolved prior to bed. On the morning of 5/6 the chest pain returned and was so severe it woke him from sleep. He was difficult for him to characterize, but he said it was all over his chest, sometimes sharp and pressure-like, most severe in mid substernal region and was so substantial that he had difficulty speaking properly. He feels that the pain is most severe when lying flat and is best managed when he is resting at a 45 degree angle. Patient was at ED he was found to have an initial ECG with ST depressions in aVR and elevations in II, aVF, and V2 through V6 raising suspicion for pericarditis/myocarditis. Initial troponin was elevated at 4.35 as well. Cardiology Dr. was contacted by ED physician, case discussed, and EKGs reviewed and felt this was more likely pericarditis, but not STEMI. Of note, he reports a family history significant for his mother having a?hole in her heart.?He was given Toradol with improvement in his pain and upon arrival to hospital his chest pain was markedly improved. He was noted to have troponins peaking at 39.415 that down trended and an elevated CRP of 4.8 on admission. D-dimer was 0.26. Covid PCR was negative. He was evaluated by cardiology again here who upon review of his ECG and cardiac enzymes as well as presentation was consistent with pericarditis. Echocardiogram showed normal LV systolic function with trace posterior pericardial effusion and telemetry was monitored without any arrhythmias. He was started on low-dose beta-blockers, aspirin 650 mg 3 times a day, and colchicine 0.6 mg every 12 hours for 2 doses followed by 0.6 mg daily. He is planned to continue this for approximately 3 months and will need to follow-up with cardiology in 1 to 2 weeks for repeat monitoring and management with plan to taper off aspirin once his CRP normalizes. Later that night, he even had a similar episode of sudden onset chest pain for which she received IV Toradol with minimal relief and oral Tylenol with relief of symptoms after that. No telemetry abnormalities were recorded at that time. ECG the following day showed improving ST changes and troponin of 26.328 with CRP 4.2. He had no further symptoms for over 24 hours and is responding well to treatment. He is advised to take Tylenol as needed in addition to the above-mentioned medicines should he have any recurrent chest pain.


VAERS ID: 1307523 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Wyoming  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

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

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

Write-up: Full body measle like rash. Symptoms are small red bumps or patches covering skin. Severe itching. Have been taking Benadryl and using hydrocortisone topical creme. There is no relief from the itching. It has been one week since the vaccine was recieved. The rash is on going.


VAERS ID: 1307552 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Computerised tomogram, Magnetic resonance imaging, Mental impairment, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: bayer low dose clopidogrel rosuvastain lisinopril metoprool
Current Illness: when to the hospital and they ran a cat scan and a MRI
Preexisting Conditions: i have two stints
Allergies: lates power and robaxin
Diagnostic Lab Data: they did a cat scan along with a MRI and blood test all done on the 05/4/2021
CDC Split Type:

Write-up: my vision got real blurry and i could''t think straight


VAERS ID: 1307670 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-04-26
Onset:2021-05-04
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram cerebral normal, Aortic valve incompetence, Aortic valve sclerosis, Arteriogram carotid normal, Atrial enlargement, Cerebral small vessel ischaemic disease, Cerebrovascular accident, Computerised tomogram head normal, Diastolic dysfunction, Echocardiogram abnormal, Lacunar infarction, Left ventricular hypertrophy, Mitral valve incompetence, Mitral valve prolapse, Speech disorder, Tricuspid valve incompetence
SMQs:, Cardiac failure (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Psychosis and psychotic disorders (broad), Pulmonary hypertension (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (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? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: atenolol (TENORMIN) 50 MG tablet Take 1 tablet by mouth daily. benazepril (LOTENSIN) 20 MG tablet Take 1 tablet by mouth daily. Coenzyme Q10 100 MG TABS Take 100 mg by mouth daily. fish oil 1000 MG CAPS Take 1,000 mg by mou
Current Illness:
Preexisting Conditions: Apical myocardial infarction with mild coronary atherosclerosis Coronary artery disease Hyperlipidemia Hypertension Atrial fibrillation Pacemaker
Allergies: NKDA
Diagnostic Lab Data: 5/5/21 CT brain IMPRESSION: No CT evidence of an acute intracranial process. While unenhanced CT cannot exclude an acute small vessel or lacunar infarct, there is no CT evidence of an acute large territorial infarction on the current exam. 5/5/21 CTA head/neck IMPRESSION: 1. No evidence of significant intracranial arterial steno-occlusive disease. 2. No significant narrowing involving the common carotid, internal carotid or vertebral arteries within the neck. 5/6/21 Echo IMPRESSION: 1. Concentric left ventricular hypertrophy with preserved systolic function and ejection fraction of 65%. 2. Diastolic dysfunction. 3. Abnormal mitral valve with posterior leaflet prolapse and moderate anteriorly directed mitral regurgitation. 4. Mild to moderate tricuspid insufficiency. 5. Sclerocalcific aortic valve with mild insufficiency 6. Biatrial enlargement. 7. Pacemaker wire visualized in the right atrium which is coiled. Pacer interrogated on 5/6/21 with AT/AF burden <0.1%.
CDC Split Type:

Write-up: Patient admitted on 5/5/21 for suspected acute ischemic CVA after presenting with altered speech for a day (last known well on 5/4/21 PM). No CT evidence of an acute intracranial process. Her pacemaker precluded MRI evaluation. Pacer interrogated on 5/6/21 with AT/AF burden <0.1%. She was seen in consultation by neurology. Evaluation and clinical deficits were suggestive of acute ischemic CVA. Risk factors for CVA include age, HTN, Afib. Patient recently received her first COVID-19 vaccine (Pfizer) on 4/26/21. Patient?s symptoms improving with antiplatelet and statin therapies along with blood pressure management. Per Neurology consult, possible etiologies include cardioembolic versus atheroembolic versus thrombotic versus inflammatory related to recent COVID-19 vaccine. The neurologist specifically stated that ?The COVID vaccine was temporally close to this event. I have seen transient CNS inflammation from the vaccine--probability low but still possibility.?


VAERS ID: 1307873 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / SYR

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

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

Write-up: High fever, chills, body aches, extreme fatigue for 24 hours. Mild fatigue for an additional 96 hours. Treated with Tylenol.


VAERS ID: 1307888 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-28
Onset:2021-05-04
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

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

Write-up: NSTEMI (non-ST elevated myocardial infarction)


VAERS ID: 1307966 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 1 RA / IM

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

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

Write-up: patient not of authorized age when vaccine administered. Parents lied about patient''s age on consent form


VAERS ID: 1308022 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cerebrovascular accident
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Unknown. Patient indicated that she did go to the emergency room and stayed overnight.
CDC Split Type:

Write-up: Patient indicated that she had a stroke the evening of 5/4/2021 after she received the Janssen Covid 19 Vaccination.


VAERS ID: 1308052 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cerebrovascular accident, Echocardiogram, Facial paralysis, Magnetic resonance imaging head abnormal, Speech disorder
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: ECHO, and MRI and diagnosed stroke.
CDC Split Type:

Write-up: Received the Johnson and Johnson vaccine, went to get haircut. Went home, watched TV, and went to bed. Got up to use the restroom and noticed face was droopy and speech was off. Stayed in bed through the night and roommate cam in the morning and took to hospital


VAERS ID: 1309246 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Georgia  
Vaccinated:0000-00-00
Onset:2021-05-04
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21S / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Inflammation, Insomnia, Rash, Rash pruritic
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: ZYRTEC [CETIRIZINE HYDROCHLORIDE]
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210516966

Write-up: INSOMNIA; ITCHY BUMP; ONE INCH OF REDNESS ON STOMACH/GENERAL REDNESS THROUGHOUT THE BODY/HARD TO TOUCH BUMPS THROUGHOUT THE BODY; 4-5 INCHES OF INFLAMMATION ON NECK; This spontaneous report received from a patient concerned a 74 year old female. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 206a21s, and expiry: UNKNOWN) dose was not reported, administered on 03-MAY-2021 for prophylactic vaccination. Concomitant medications included cetirizine hydrochloride. On 04-MAY-2021, the subject experienced 4-5 inches of inflammation on neck. On 04-MAY-2021, the subject experienced itchy bump. On 04-MAY-2021, the subject experienced one inch of redness on stomach/general redness throughout the body/hard to touch bumps throughout the body. On 09-MAY-2021, the subject experienced insomnia. The action taken with covid-19 vaccine was not applicable. The patient had not recovered from itchy bump, one inch of redness on stomach/general redness throughout the body/hard to touch bumps throughout the body, insomnia, and 4-5 inches of inflammation on neck. This report was non-serious.


VAERS ID: 1309390 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205421A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Headache, Malaise, Nausea, Pain, Rash, Somnolence, Swelling face, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Ful shot and t b vaccine
Other Medications: N/A
Current Illness: At the time 1 hr later felt sick sleep
Preexisting Conditions: N/A
Allergies: Iodine
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 1st day after an hour I felt sick with a headache. 2nd day nausea headache body aches rash hives on body 3rd day rash swelling on face and headache 7 th day body aches stomach pain MD I was prescribed steroids medrol dosepak 4 mg


VAERS ID: 1309394 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Feeling abnormal, Headache, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Dementia (broad), 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies: Avocado
Diagnostic Lab Data:
CDC Split Type:

Write-up: Foggy head, headache, muscle pain, joint pain, fatigue


VAERS ID: 1309948 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Hypotension, Loss of consciousness, Skin warm, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Severe, Systemic: Hypotension-Severe, Additional Details: Pt asked for some water then tilted his head back and passed out. He was very warm and sweaty. My technician and I lowered him to a exercise mat where he recovered. I offered him water and a granola bar. He drank the water, declined the bar. Pt was observed in waiting area for 30 min. I suggested he call a friend or family member to pick him up, he said he was ok to drive.


VAERS ID: 1310111 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-01-26
Onset:2021-05-04
   Days after vaccination:98
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A-1 / 2 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Balance disorder, COVID-19, Neurological symptom
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Pt is @ hospital (admitted 5/4) for an undiagnosed neurological episode (equilibrium)- potentially COVID related per hospital doctors


VAERS ID: 1310149 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-20
Onset:2021-05-04
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO162 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blindness, Disability, Ophthalmic vein thrombosis, Ophthalmological examination abnormal, Pain, Retinal vein occlusion, Visual impairment, X-ray limb, X-ray of pelvis and hip
SMQs:, Anticholinergic syndrome (broad), Embolic and thrombotic events, venous (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Corneal disorders (broad), Retinal disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: High blood pressure & chloresterol under control
Preexisting Conditions: same as #11
Allergies: none
Diagnostic Lab Data: VISION: OPTHMOLOGICALTESTS 5/4/2021; OSTEO XRAYS LEFT HIP/LEG 5/11/2021 ALL DETAILED RESULTS ARE AVAILABLE- CONT PAGE NOT WORKING
CDC Split Type:

Write-up: TW0 EVENTS; #1 retinal oclusion, #2 disability and pain at left side Details #1 L I VITREO RETINAL, DIAGNOSE RETINAL OCCLUSION, SMALL BLOOD CLOT BACK OF RT EYE. CAUSED LOSS OF VISION ON TUE 5/4/21 AT 2AM, VISION CONSISTED OF BLACK CLOUDS AND PATTERNS WITH HOLES. NO TREATMENT OBSERVATION AND REPORT TO DR. PRESENT CONDITION IS OF CONSTANT THIN PATTERNS WITH HOLES DISTURBING ANY CLOSE READING OR COMPUTER WORK. DISTANCE WITH BOTH EYES HAVE THE PATTERNS BUT MUCH LESS NOTICABLE. #2 ORTHOPEDIC DR. 5/8/2021 6AM SAT 5/8/2021 SEVERE PAIN L SIDE


VAERS ID: 1310414 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-03-12
Onset:2021-05-04
   Days after vaccination:53
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 1 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031A214 / 2 AR / IM

Administered by: Public       Purchased by: ?
Symptoms: Exposure during pregnancy, Foetal death, Induced labour, Second trimester pregnancy, Ultrasound antenatal screen abnormal
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Foetal disorders (narrow), Termination of pregnancy and risk of abortion (narrow), Normal pregnancy conditions and outcomes (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prenatal Multi-Vitamin
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: Prenatal lab work 2/22/2021 WNL. Routine anatomy scan on 5/4/2021 fetal heartbeat not detected. Follow up ultrasound to confirm IUFD on 5/5/2021 Hospitalization for induction of labor on 5/6/2021. Fetus delivered at 21:02 hours. Pathology pending.
CDC Split Type:

Write-up: G6P4 Patient with estimated due date of 9/17/2021 presented for 20-week ultrasound on 5/4/2021. No heartbeat detected, diagnosis of 2nd trimester intrauterine fetal demise of fetus weighing approx. 300 grams delivered after induction of labor on 5/6/2021. Previously uncomplicated pregnancy with FHT last auscultated on 4/19/2021. 4 previous uncomplicated full-term deliveries. 1 miscarriage at ~8 weeks between first and 2nd pregnancy in ~2008


VAERS ID: 1310564 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-01-10
Onset:2021-05-04
   Days after vaccination:114
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abortion spontaneous, Foetal disorder
SMQs:, Foetal disorders (narrow), Termination of pregnancy and risk of abortion (narrow)

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

Write-up: Rare Birth defect, Opmhocele which resulted in miscarriage 2nd trimester. Dr. covering for patient''s normal Dr. stated this rare birth defect was seen twice this month.


VAERS ID: 1310605 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-09
Onset:2021-05-04
   Days after vaccination:56
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Prior to Admission Medications Prescriptions Last Dose Informant Patient Reported? Taking? DULoxetine (CYMBALTA) 60 mg oral delayed release capsule 4/27/2021 Nursing Home No Yes Sig: Take 1 capsule (60 mg) by
Current Illness:
Preexisting Conditions: Principal Problem: Osteomyelitis (HCC) Active Problems: Gait disorder Glioblastoma multiforme R temporal lobe s/p craniotomy and radiation 2004 Chronic obstructive airway disease with asthma (HCC) Cognitive disorder GERD (gastroesophageal reflux disease) Seizure disorder (HCC) Back pain, chronic
Allergies: Cilantro, Nitroimidazoles, Barbiturates, Dilantin [phenytoin], Flagyl [metronidazole], Penicillin g, Penicillin v, Penicillins, Sulfa (sulfonamide antibiotics), Sulfasalazine, Tetracycline hcl, and Tetracyclines
Diagnostic Lab Data:
CDC Split Type:

Write-up: POSITIVE COVID 05/04/2021


VAERS ID: 1310705 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-08
Onset:2021-05-04
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Cozaar Pletal Pepcid Lioresal Celebrex Lipitor Zyrtec
Current Illness: None known
Preexisting Conditions: Atrial Flutter COPD HTN Dyslipidemia
Allergies: Morphine
Diagnostic Lab Data:
CDC Split Type:

Write-up: HOSPITAL COURSE: The patient was admitted to the hospital with acute respiratory failure secondary to COVID pneumonia


VAERS ID: 1310742 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-17
Onset:2021-05-04
   Days after vaccination:76
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Asthma, COVID-19 pneumonia, Condition aggravated, Cough, Dyspnoea, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol Singulair Estrace
Current Illness: None Known
Preexisting Conditions: Asthma HTN
Allergies: Codiene
Diagnostic Lab Data:
CDC Split Type:

Write-up: past medical history significant for asthma, pulmonary sarcoidosis, hypertension presents to the hospital with fever, cough and worsening dyspnea. Patient had struggles with asthma exacerbation in February 2021 and since then has never felt back to her baseline in spite of 3 separate prednisone courses. Most recently she finished a prednisone course just prior to this hospitalization. It is unclear when her symptoms that are specific to COVID-19 started. Nonetheless she was tested negative for COVID-19 prior to most recent prednisone start but did test positive at this ER visit. Patient admitted for COVID-19 pneumonia associated with acute hypoxic respiratory failure.


VAERS ID: 1310751 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EW0167 / UNK LA / IM

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

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

Write-up: At clinic for first pfizer vaccine . Lightheaded after vaccine Walked to observation area Given ice pack and water. BP 110/60 seen by Dr. observed x 30 min D/c to home


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