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From the 9/3/2021 release of VAERS data:

Found 661,087 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 171 out of 6,611

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VAERS ID: 1519583 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anaphylactic reaction
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: anaphylaxis


VAERS ID: 1519598 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 RA / IM

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

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

Write-up: UNDER 12 Y/O GOT COVID VACCINE ~20 minutes before closing, a customer brought her daughter in to get a Pfizer Vaccine as a walk-in. Before I asked her to fill out the consent form, I asked both mom and the child how old was she, they both answered me that she''s 12 & DOB as 07/20/2009, so we went ahead to do the vaccine. While they were waiting for 15 minutes after the vaccine, I batched the vaccine, got a rejection from Organization saying "name not matching". I confirmed with mom the information while she''s still waiting in the store. She again stated the same thing. I later called Organization and they told me that Organization has patient''s DOB 08/20/2009, not 07/20/2009 as mom wrote in the form and confirmed it. I then called mom to ask for DOB, again, she told me DOB "07/20/2009". I told her about what Organization told me, she then admitted that she said that so her daughter could get the vaccine before the school starts.


VAERS ID: 1519610 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-01-04
Onset:2021-07-30
   Days after vaccination:207
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: atorvastatin 20 mg Tablet Directions: 1 tablet oral daily at bedtime (Active) buPROPion HCl 300 mg Tablet Extended Release 24 hr Directions: 1 tablet oral daily (Active) buPROPion HCl 150 mg Tablet Extended Release 24 hr Directions: 1
Current Illness:
Preexisting Conditions: CAD, Dyslipidemia, HTN;
Allergies: Penicllins
Diagnostic Lab Data: COVID-19 PCR Positive
CDC Split Type:

Write-up: Hospitalized on 7/30/2021 for COVID 19 +


VAERS ID: 1519616 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-07-23
Onset:2021-07-30
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydrocodone 5-325 mg 1 tablet 2 - 3 times daily Cyclobenzaprine 10 mg 2 tablet daily ( 1 am, 1 pm) Fish oil 2400 mg daily Zinc 50 mg daily Vitamin C 500 mg daily
Current Illness: None
Preexisting Conditions:
Allergies: Cocaine, anything latex. Also allergic to grass, dirt, dust,
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen gland in armpit of left arm (injection arm)


VAERS ID: 1519625 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Vaccination site cellulitis
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:
Current Illness: none
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received her first Pfizer Covid-19 vaccine on 7/29/2021 and on 7/30/2021 patient notices cellulites on her left arm were she received the vaccine. .Patient was seen by health professional and was started on Keflex , ibuprofen, and an antihistamine.


VAERS ID: 1519633 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-02-03
Onset:2021-07-30
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin biotin carvedilol dicyclomine fenofibrate nanocrystallized furosemide meTHIMAzole NIFEdipine olmesartan pantoprazole saccharomyces boulardii (Florastor) warfarin
Current Illness:
Preexisting Conditions: atrial fibrillation on warfarin, HTN HLD TIAs (2019-2000) COPD Graves disease Barrett''s esophagus Diverticulitis.
Allergies: Sulfa, erythromycin
Diagnostic Lab Data: COVID-19 PCR Positive on 7/30/2021
CDC Split Type:

Write-up: Hospitalized for COVID-19 infection post vaccination


VAERS ID: 1519646 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-26
Onset:2021-07-30
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Myalgia, Oropharyngeal pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: In the last 48 hours, have you had a fever* OR symptoms that are unrelated to a preexisting illness?: New cough, New sore throat, New muscle aches, Fever


VAERS ID: 1519648 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-13
Onset:2021-07-30
   Days after vaccination:108
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Exposure to SARS-CoV-2
SMQs:, COVID-19 (narrow)

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

Write-up: Contact With And (Suspected) Exposure To COVID-19


VAERS ID: 1519650 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-16
Onset:2021-07-30
   Days after vaccination:164
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Exposure to SARS-CoV-2
SMQs:, COVID-19 (narrow)

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

Write-up: Contact With And (Suspected) Exposure To COVID-19


VAERS ID: 1519687 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: throat swelling after flu vaccination
Other Medications: insulin, metformin
Current Illness:
Preexisting Conditions: allergic rhinitis and diabetes
Allergies: nkda
Diagnostic Lab Data:
CDC Split Type:

Write-up: lightheadedness


VAERS ID: 1519696 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-23
Onset:2021-07-30
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 1 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Full blood count normal, Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth, Lymph node pain, Lymphadenopathy, Mononucleosis heterophile test negative, SARS-CoV-2 test negative, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: 12.5mg Zoloft
Current Illness: Tooth abscess 3weeks prior. Took Penicillin for 10days. Completed course 1 week prior to vaccine
Preexisting Conditions: None
Allergies: Sulfa
Diagnostic Lab Data: 7/31/21 saw Urgent Care PA-C. Covid-19 test and Monospot, both negative and CBC normal.
CDC Split Type:

Write-up: Vaccine given left arm 07/23/21. Armpit Lymph nodes swollen, tender under same arm as well as neck glands 07/30/ 21. 7/31/21 woke to vaccine arm itching, hot,welted, and swelling in diameter to size of softball. Continued thru to today. Have taken benadryl at night and claritin during day for relief. Today, Day 3 of arm reaction, now enlarged to double size and covering most of upper arm w bright red, inch size border.


VAERS ID: 1519702 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Headache, Nausea, Pain, Seizure, Vaginal haemorrhage
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (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: ciprofloxacin.
Current Illness: UTI
Preexisting Conditions: no
Allergies: none
Diagnostic Lab Data: 7/30/2021, 911 call, EMT transport, testing in ED. ****diagnosis was "chronic headache".. which is the biggest falsehood I have seen in years.
CDC Split Type:

Write-up: significant vaginal bleeding, nausea, extreme body ache, difficulty breathing, small seizures, dizziness, light headed,


VAERS ID: 1519714 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Dizziness, Dysarthria, Headache, Magnetic resonance imaging, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular 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: Zanaflex 4mg, Jardiance 10mg, Tresiba 200mg, Losartan 100mg, prozac 20mg, metformin 1000mg, amlodipine 10mg, coreg 12.5mg, ibuprofen 800mg,
Current Illness: he stated no previous illness
Preexisting Conditions: diabetic heart disease
Allergies: nkda
Diagnostic Lab Data: Patient stated he had blood work and MRI''s
CDC Split Type:

Write-up: Patient called pharmacy 07/30/21 with dizziness, headache, slurred speech and blurred vision. Pharmacy technician was on phone with patient while the pharmacist called 911. He was then hospitalized.


VAERS ID: 1519716 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Cough, Dysgeusia, Gaze palsy, Hypoaesthesia oral, Injection site erythema, Nausea, Neck pain, Pain in jaw, Pharyngeal paraesthesia, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Osteonecrosis (broad), Ocular motility disorders (narrow), Arthritis (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: Similar reaction to #1 Moderna Covid vaccine rec''d 1/29/21
Other Medications: multivitamin
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Immediate tingling in throat, metallic taste, red streak appeared from injection site to elbow. within 3 hours developed headache, jaw/neck pain, fever to 102.7 F, severe joint pain, nausea, cough I took Benadryl on 7/30/21, Advil q 8 hours 8/02 tongue remains slightly numb, headache and jaw pain persist


VAERS ID: 1519724 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH G11S8RT / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Injection site pain, Injection site swelling, Pain, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Pt. states that after receiving the 1st dose of Phizer 0730/2021, started to experience a headache, body pain, feet swelling, bump located at the injection site, and tenderness. No noted Primary visit, still continuing experiencing symptoms.


VAERS ID: 1519745 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, 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:
Current Illness:
Preexisting Conditions: tinnitus
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: worsening tinnitus


VAERS ID: 1519746 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-28
Onset:2021-07-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: metoprolol and loratadine
Current Illness:
Preexisting Conditions: chronic migraine HA, prediabetes, orthodromic paroxysmal supraventricular tachycardia
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: tachycardia lasting about 2 days


VAERS ID: 1519778 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-04
Onset:2021-07-30
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Chest injury, Condition aggravated, Dyspnoea, Emphysema, Fall, Fatigue, Haemothorax, Pneumothorax, Retroperitoneal haematoma, Rib fracture, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Osteoporosis/osteopenia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amio, amlodipine, apixaban, lidocaine patch, pantoprazole, sertraline, spironolactone, ascorbic acid, MVI, citrucel, simethicone, docusate, scheduled APAP
Current Illness: rib fractures, pneumothorax/hemothorax
Preexisting Conditions: Afib, IBS, HTN, hx of prostate CA, microcytic anemia, GERD, DJD
Allergies: azithro, doxy, methylprednisolone, cefuroxime, NTG, sulfa
Diagnostic Lab Data: 7/19 & 7/29: SARS CoV2 RNA PCR- negative; 7/31: SARS CoV2 RNA PCR- positive 7/31: CXR- stable R chest trauma, no acute process; 7/20:CXR- R chest wall emphysema, unchanged from prior exam.
CDC Split Type:

Write-up: Inpt rehab pt s/p fall at home w/subsequent R-sided tension pneumothorax/hemothorax & multi rib fxs and trace retroperitoneal hematoma was admitted after developing fatigue and SOB (7/30) and was found to be COVID+ (7/31) despite having two prior COVID- tests and have had received Pfizer vaccinations (1/14 & 2/4). Was started on dexamethasone w/aggressive pulmonary hygiene. Is oxygenating well on RA. Plan to transfer back to inpt rehab if remains stable.


VAERS ID: 1519789 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Joint swelling, Migraine, Peripheral swelling, Swelling face, Vision blurred
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypersensitivity (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Not shared with Pharmacy staff
Current Illness: RA
Preexisting Conditions: None mentioned
Allergies: Not stated by patient.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient stated that starting Friday (7/30/21), approximately 24 hours after receiving the vaccine, she experienced swelling in her legs. She ended up have swelling in her face and joints as well. She experienced migraine and blurry vision since Friday as well. She stated the blurry vision and leg swelling has persisted until today 8/2/21. She does not report a headache or migraine today. Instructed patient to go to ER for follow-up since primary care provider was not available.


VAERS ID: 1519845 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-26
Onset:2021-07-30
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Fatigue, Feeling abnormal, Nausea, Palpitations
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? No
Previous Vaccinations:
Other Medications: Wn Pharma Multi Vitamins Fluoxetine 20mg once per day Vitamin C
Current Illness: None.
Preexisting Conditions: Patent Ductus Arteriosus (This was fixed with a stent in 2014)
Allergies: Penicillin Clindamycin Bananas Clear plastic medical tape (the adhesive)
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: I received my second dose of Moderna on the 26th of July, I felt the expected run down fatigue and nausea for the first three days. Then on the 29th I noticed that my heart was pounding harder than normal and on the 30th my chest hurt. When I say my chest hurt I don''t mean my heart, but rather my ribcage and the muscles in that area. It hurt to laugh and to contract those muscles. This pain lasted for approximately 36hrs after which I returned to normal. Because it didn''t feel like my heart was hurting (no heart pain, just noticed it pounding on the 29th) I didn''t seek medical attention. However, I considered it due to the pain as it was very uncomfortable. I would describe the pain as moderate.


VAERS ID: 1519854 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Chest discomfort, Condition aggravated, Dizziness, Electrocardiogram normal, Headache, Hypertension, Seizure, Troponin normal, Urine analysis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: bilateral lower extremity neuropathy d/t flu shot
Other Medications: Asa, ntg, vit D, calcium, zonisamide, CoQ 10, MVM, clonezepam, atorvastatin
Current Illness: NA
Preexisting Conditions: Seizures(head trauma 1995), heart murmer. OA, neuropathy (bilateral lower extremity d/t reaction to a flu shot), stroke, smoker, TIA
Allergies: ? Aluminum Aspirin Shortness Of Breath ? Amoxicillin-Pot Clavulanate Shortness Of Breath ? Nucynta [Tapentadol] Hives, Shortness Of Breath and Itching ? Acetaminophen ? Ibuprofen Itching ? Acetaminophen-Codeine ? Antivert [Meclizine] Other (seizure) ? Aspirin ? Azithromycin ? Ciprofloxacin (flu like symptoms) ? Codeine Phosphate ? Cortisone ? Dilantin Infatabs [Phenytoin] ? Flagyl [Metronidazole Hcl] ? Flexeril [Cyclobenzaprine] ? Gabapentin (memory loss) ? Hydrocortisone ? Hydromorphone (Itching) ? Ketorolac ? Lacosamide ? Lamotrigine ? Levetiracetam (hives) ? Macrobid [Nitrofurantoin Monohyd/M-Cryst] ? Metaxalone ? Morphine ? Phenylephrine-Guaifenesin ? Phenytoin Sodium Extended (tremor) ? Prednisone (TIA''s) ? Simvastatin (vomiting) ? Sulfamethoxazole-Trimethoprim ? Terbinafine ? Topiramate ? Tramadol (hallucinations) ? Trazodone (Swelling and blisters in mouth) ? Tylenol-Codeine #2 ? Citalopram (Anxiety) ? Clarithromycin (Palpitations) ? Keflex [Cephalexin] ? Metronidazole (Palpitations)
Diagnostic Lab Data: 7/30/2021: Work-up here was overall unremarkable with normal initial troponin, urinalysis negative for infection, chest x-ray negative for any acute pathology. EKG was nonischemic. Head CT was not done as patient left prior to the study being completed.
CDC Split Type:

Write-up: -received Pfizer COVID-19 vaccine on 7/30/2021 @ 1125. Patient reports the following adverse reactions: Pt stated she was light headed. I gave her some water. Pt stated she had a hx of seizures. Pt began to seiz. EMS called. Seizure began @ 1140 and lasted about 2 minutes. O2 via nasal canula started. VS were taken: B/P 209/96. P-81. O2 95%. 2nd set taken 5 minutes later. B/P 207/103. P-80. O2-95%. Pt taken to Hospital ER via emergency vehicle 7/30/21: Patient presented to the ED following 2 seizures today. She also complained of mild headache and chest pressure. She did have one 10 to 15 second seizure in the ED. She remained vitally stable during the seizure and no intervention was needed. Work-up here was overall unremarkable with normal initial troponin, urinalysis negative for infection, chest x-ray negative for any acute pathology. EKG was nonischemic. Head CT was not done as patient left prior to the study being completed. She has been vitally stable throughout her time in the department, but mildly hypertensive around the 180s systolic. She did not have any further seizures in the department. She was given her home dose of zonisamide here in the department.


VAERS ID: 1519876 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-01
Onset:2021-07-30
   Days after vaccination:59
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039821A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Back pain, Cardiac imaging procedure abnormal, Cardiac ventriculogram left abnormal, Catheterisation cardiac normal, Chest pain, Echocardiogram, Ejection fraction decreased, Electrocardiogram abnormal, Hyperdynamic left ventricle, Hypokinesia, Intensive care, Magnetic resonance imaging heart, Pain, Pain in extremity, Pericarditis, Stress cardiomyopathy, Troponin I increased
SMQs:, Cardiac failure (narrow), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, arterial (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (narrow), Other ischaemic heart disease (narrow), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 7/31/21 18:06 - EKG with signs of pericarditis 7/31/21 18:24 - Troponin-I 22.10 ng/mL 8/01/21 00:17 - Cardiac catheterization with angiographically normal coronary arteries, but left ventriculography with LVEF of 40-45% consistent for Takotsubo''s cardiomyopathy with hyperdynamic basal segments and hypokinetic distal segments, and hypokinesis was most prominent in the anterior and apical portion with the inferior wall being normal. 8/01/21 09:30 - Trans Thoracic Echocardiogram positive for mildly decreased LVEF (40-45%) 8/02/21 09:11 - Cardiac MRI consistent with patchy small foci of mid myocardial and epicardial enhancement which could be secondary to myocarditis.
CDC Split Type:

Write-up: On 7/30/2021, patient developed sudden onset chest pain that worsened to midsternal, radiating pain to the back and left arm on 7/31/22 that forced him to seek medical attention in the emergency room. Patient had just returned from a camp earlier that day. On admission, his troponin-I was noted to be elevated at 22.10 ng/mL, admission EKG showed signs of pericarditis, mildly reduced EF on TTE (404-5%), cardiac catheterization showed angiographically normal coronary arteries and left ventriculography was positive for Takotsubo cardiomyopathy with hyperdynamic basal segments and hypokinetic distal segments, and hypokinesis was most prominent in the anterior and apical portion with the inferior wall being normal. Patient was started on colchicine, metoprolol tartrate, lisinopril, and furosemide, has transitioned out of the ICU and is pending a rheumatology consult prior to discharge.


VAERS ID: 1519894 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Oropharyngeal pain, Peripheral swelling, Pyrexia, Skin warm
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Swelling of arm throwing off strong heat. Fever for 48 hours, sore throat, dizzy.


VAERS ID: 1519921 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-08
Onset:2021-07-30
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blister, Herpes zoster, Rash, Rash erythematous, Skin burning sensation
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hypersensitivity (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna 7/8/21, previously reported canker sores and incontinence due to the vaccine
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient described a red burning rash with blisters going down the center of her abdomen. She reported that she has a positive diagnosis for shingles due to the vaccine''s effect on her immune system.


VAERS ID: 1519949 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chest discomfort, Dizziness, Headache, Nausea, Neck pain, Pain, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Pain in arm: 7/30-7/31 Pain in shoulder radiating up the neck 7/31 morning, subsided with one dose of Tylenol, returned 8/2 Tight chest 7/31-8/1 Lightheadedness, nausea, mild headache 7/31 morning


VAERS ID: 1519963 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-20
Onset:2021-07-30
   Days after vaccination:71
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 - / -

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

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

Write-up: breakthrough COVID


VAERS ID: 1519982 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-15
Onset:2021-07-30
   Days after vaccination:137
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 - / IM

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

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

Write-up: Breakthrough COVID


VAERS ID: 1519997 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-08
Onset:2021-07-30
   Days after vaccination:113
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 - / IM

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

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

Write-up: Breakthrough COVID


VAERS ID: 1520047 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2020-12-23
Onset:2021-07-30
   Days after vaccination:219
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data: Coronavirus 2 PCR Detect, V symptomatic POSITIVE
CDC Split Type:

Write-up: symptoms started 7/30, unknown symptoms


VAERS ID: 1520097 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A 2 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Nausea, Tachycardia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Dehydration (broad)

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

Write-up: Approximately 5 minutes after receiving 2nd moderna vaccine developed mild nausea with no vomiting. On exam noted to have tachycardia to the low 100s, otherwise no other physical exam changes or vital changes. Observed for 1.5hrs with nausea improving, tachycardia resolved. Given zofran x1 and benadryl x1


VAERS ID: 1520113 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

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

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

Write-up: Patient was sitting in the waiting area post vaccine for observation. A person noted the patient was sweating, went out to check.. Patient stated he had passed out, sweating, and his both of his hands were stuck in in a clenching position. Patient was responsive, breathing was a little elevated, lightheaded. After about 10 minutes, patient''s hands started unclenching slowly...took 20 minutes total for the his hands to become completely unclenched. Patient was able to drink water, was cooling down with cool compresses. About 45 minutes, patient was doing fine.


VAERS ID: 1520129 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, Injection site injury, Muscle tightness
SMQs:, Dystonia (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? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: ACUTE BROCHITIS , HYPOTHYRODISM, OSTEOARTHRITIS
Allergies: TORADOL
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: patient reported immediate injection site injury and felt some tightness in her arm


VAERS ID: 1520154 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-20
Onset:2021-07-30
   Days after vaccination:132
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: THE PATIENT CAME WITH COVID SYMPTOS AND TESTED FOR COVID ON 7/30/2021 THE RESULT CAME POSITIVE COVID


VAERS ID: 1520167 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heart rate irregular, Palpitations, Sleep disorder
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (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: LATANOPROST OPHTHALMIC SOLUTION AND ATORVASTATIN
Current Illness:
Preexisting Conditions:
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported feeling an irregular/racing heart rhythm on Friday night after receiving the vaccine. He had this all day Saturday and could not sleep at all due to this. He went in to be seen at the emergency room on Sunday morning and was prescribed metoprolol succinate.


VAERS ID: 1520201 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Interchange of vaccine products
SMQs:, Medication errors (broad)

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

Write-up: Patient already received Johnson & Johnson COVID-19 vaccine prior to Pfizer.


VAERS ID: 1520214 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

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

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

Write-up: Swollen Lymph node


VAERS ID: 1520216 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-22
Onset:2021-07-30
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Injection site reaction, Injection site swelling, Injection site warmth, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: On 7/30/2021 around 4pm I went to scratch my left deltoid and felt that it was a raised bumpy feeling and warm to touch. I looked at the site and there was a red welt. I?m not aware how long it had been there before i noticed it because I was wearing a scrub top w sleeves while working at hospital. I put an ice pack on the site and took a Claritin allergy pill. I got home around 6pm and took 25 mg of Benadryl. The next day swelling was down but I still had a pink circle. By 8/1/21 symptoms were gone.


VAERS ID: 1520284 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-03-24
Onset:2021-07-30
   Days after vaccination:128
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Xarelto, rosuvastatin, diltiazem cd, alprazolam, Lopressor, metformin, flomax
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: nkda
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient called the pharmacy on august 1st to report that she had been hospitalized due to developing several blood clots after receiving the 2nd vaccine. She did not have a timeline on when the clots developed but felt it was soon after the vaccine.


VAERS ID: 1520479 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

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

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

Write-up: Pfizer was administered at 07/30/2021 at 10:49 AM. At 10:52, patient began feeling lightheaded and dizzy. Vitals were taken 10:52 AM : Spo2: 98% Pulse: 58 BP 90/62 . Patient was assessed by Dr. and provided Gatorade for hydration and had patient inhale amonia inhalant as needed. Per Dr. monitored patient for 30 additional minutes. After 30 Minutes vials taken again at 11:30 AM BP: 110/72 Spo2: 100% Pulse :72, per Dr. advised patient to hydrate and advised to eat something since patient did not have breakfeast. Notified if symptoms persist may go to nearest emergency for further evaluation. Patient verbalized understanding and agreed.


VAERS ID: 1520480 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Arthralgia, Back pain, Fatigue, Headache, Retching, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: abuterol inhaler, melatonin, pantoprazole sodium, acyclovir, claratin
Current Illness:
Preexisting Conditions: I got incredibly sick in December 2019. I was bed ridden for several months. I broke ribs twice from coughing. I never really recovered. I still have most of the covid symptoms. It was never actually diagnosed.
Allergies:
Diagnostic Lab Data: None. I''m told this is normal. This is actually poisoning.
CDC Split Type:

Write-up: vomiting/retching for 22 hours. exhaustion, back and shoulder pain, abdominal cramping, headaches


VAERS ID: 1520506 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Vaccine was administred at 1:30 PM. patient begain experiencing dizzness and sweating excessively after 15 minute obervation 1:55 PM Vitals were obtained Spo2: 92% Pulse : 76 BP: 115/78 mmhg Pulse: 76. Patient assessed by Dr. Per Dr. provided gatarade for hydration and monitored additional (15) minutes. After 15 minutes Vitals were obtained: 02:15 PM BP: 120/87 mmhg Pulse: 77 Spo2: 100%. Symptoms were relieved per patient. Per Dr. release home . Patient advised if symtpons persist may go to emergency room for further evaluation. patient verbalized understanding and agreed


VAERS ID: 1520712 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Dizziness, Eye pain, Fatigue, Hyperhidrosis, Nasal congestion, Nausea, Oropharyngeal pain, Pain in extremity, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Vestibular disorders (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nexium
Current Illness: Undergoing evaluation by gastroenterology for chronic nausea and and abdominal pain.
Preexisting Conditions: Chronic nausea, abdominal pain.
Allergies: None known.
Diagnostic Lab Data: none
CDC Split Type:

Write-up: fever to 102F, weakness, mild sore throat, sore eyes, arm soreness, nausea, sweating, lightheadedness, nasal congestion, all occurred the day after 2nd dose of Pfizer vaccine. By the next day, everything resolved except for fatigue and sore throat. The day after that, everything had resolved.


VAERS ID: 1520729 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-07-01
Onset:2021-07-30
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site rash, Petechiae, Rash
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: On Friday morning woke with a rash on my left shoulder. It has since gotten worse and has progressed across chest, up neck and cheek and right shoulder. Also have patecheia on my legs. Went this morning .. was prescribed something for the rash.


VAERS ID: 1520759 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-26
Onset:2021-07-30
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059EZ1A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Feeling hot, Immediate post-injection reaction, Mobility decreased, Pain in extremity, Rash papular, Skin warm, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Parkinson-like events (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Copd, emphysema, svt/afib. Diabetes, high blood pressure,
Allergies: Declomycin and zpac
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Immediate sore arm that I could hardly move. Was hot to the touch for days then the raised welted rash that is red and warm to the touch


VAERS ID: 1520957 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Muscle twitching, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Dyskinesia (broad), Dystonia (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Yaz birth control
Current Illness: No
Preexisting Conditions: None
Allergies: Codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Muscle twitching in bilateral lower legs starting 12 hours after vaccination. Periods of pins and needles occurring in conjunction with twitching. Has been going on for 3 days straight now.


VAERS ID: 1520967 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-28
Onset:2021-07-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 1 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Burning sensation, Erythema, Herpes zoster, Neck pain, Paraesthesia, Rash, Rash macular, Rash papular, Vaccination complication
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), 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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/a
Current Illness: N/a
Preexisting Conditions: N/a
Allergies: N/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Starting feeling pain in left armpit of arm shot was given on 7/29 on 7/30 I woke up to a small red spot under the arm. On 7/31 spot got bigger and noticed another spot on the other side of same arm pit. On 8/01 red spots became larger, bumpy and more red, burning and tingling sensation. Spots are very painful. On 8/2 I went to emergency road where a doctor took a look and diagnosed me with Shingles, he stated it was due to the ingredients in the moderna shot causing shingles to surface as a reaction. I''ve never had this before. Never any skin issues like this. And it''s very painful.. I now have noticed a red painful mark on the left side of my neck.


VAERS ID: 1521193 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-07-24
Onset:2021-07-30
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Progesterone, t3/t4 thyroid
Current Illness: none
Preexisting Conditions: lyme, babesia, bartonella
Allergies: fin fish allergy, penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Six days after receiving the vaccine I woke up with an itchy rash on both of my legs from knee to ankle. Within a couple of hours the rash had progressed up my legs, and soon up my torso and chest. At this point the rash was large hives, all over my body reaching my neck and face. At this point (around 11am Friday 7/30) I went to the Urgent Care. I was prescribed prednisone in tapering doses. I began to see relief from my symptoms by Saturday afternoon and more significantly on Sunday. I am still having random itch spots here and there but mostly experiencing full recovery, today Monday 8/4.


VAERS ID: 1521341 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-21
Onset:2021-07-30
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac flutter, Chills, Dyspnoea, Fatigue, Hypersensitivity, Pyrexia
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: On Friday, July 30 in the evening around 5pm, I began experiencing symptoms of fatigue, chills, and body sensitivity while making dinner and so I sat down and rested. My temperature was 99.7. I took ibuprofen 600mg around 8pm and the symptoms resolved. However the same symptoms returned the next evening on July 31 and I also began experiencing shortness of breath in the morning and fluttering heart. I called my doctor on Sunday August 1 to determine course of action. I reported the fatigue symptoms and she suggested that I may be experiencing a delayed reaction to the 2nd dose of covid vaccine which I had received earlier on July 21st. A COVID is unlikely because I was self-isolating in my home 14days prior to the start of my symptoms. This morning on August 3 I woke up again with shortness of breath and fluttering heart which have been ongoing all day. I had difficulty washing my hair because of the shortness of breath,. I feel like I need to work harder to get a single breath. I believe these symptoms were caused by the vaccination .


VAERS ID: 1521355 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-02-03
Onset:2021-07-30
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 1 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 2 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: seasonal allergies ?achalasia GERD BPH ?COPD obesity
Allergies: unknown
Diagnostic Lab Data: COVID-19 rapid test 7/30/2021 at - positive for COVID 19
CDC Split Type:

Write-up: Breakthrough case of COVID after fully vaccinated.


VAERS ID: 1521365 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Guam  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 1 LA / IM

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

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

Write-up: Moderna Vaccine given first dose to 16yrs old pt on July 2nd with no adverse reactions and was instructed by CDC to adminster 2nd dose with same vaccine, Moderna and report to VAERS same as first dose. No adverse events encountered.


VAERS ID: 1521909 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-07-30
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Military       Purchased by: ?
Symptoms: Poor quality product administered, Product storage error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210800461

Write-up: VACCINE ADMINISTERED AFTER MORE THAN 12 HOURS OUTSIDE OF RECOMMENDED STORAGE AREA; INCORRECT PRODUCT STORAGE; This spontaneous report received from a pharmacist concerned a male of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 30-JUL-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 30-JUL-2021, the subject experienced vaccine administered after more than 12 hours outside of recommended storage area. On 30-JUL-2021, the subject experienced incorrect product storage. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the incorrect product storage and vaccine administered after more than 12 hours outside of recommended storage area was not reported. This report was non-serious.


VAERS ID: 1521910 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Michigan  
Vaccinated:0000-00-00
Onset:2021-07-30
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Bone pain, Chills
SMQs:, Osteonecrosis (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: USJNJFOC20210800490

Write-up: DEEP BONE PAIN IN LEGS; CHILLS; This spontaneous report received from a consumer concerned a 20 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 30-JUL-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 30-JUL-2021, the subject experienced deep bone pain in legs. On 30-JUL-2021, the subject experienced chills. Treatment medications (dates unspecified) included paracetamol. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from chills, and had not recovered from deep bone pain in legs. This report was non-serious.


VAERS ID: 1521913 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Michigan  
Vaccinated:0000-00-00
Onset:2021-07-30
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210800588

Write-up: UNDER DOSE; PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE; OFF LABEL USE; This spontaneous report received from a pharmacist concerned a 15 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, and batch number: 042A21A expiry: UNKNOWN) dose was not reported, administered on 30-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 30-JUL-2021, the subject experienced under dose. On 30-JUL-2021, the subject experienced product administered to subject of inappropriate age. On 30-JUL-2021, the subject experienced off label use. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the product administered to patient of inappropriate age, off label use and under dose was not reported. This report was non-serious.


VAERS ID: 1521919 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-07-30
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chills, Dyspnoea, Hypokinesia, Myalgia, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210800831

Write-up: BREATHING ISSUES; UNCONTROLLABLE SHAKING; CAN NOT MOVE ARMS; CHILLS; MUSCLES HURT; This spontaneous report received from a consumer concerned a 22 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 203A21A, and expiry: 21-SEP-2021) dose was not reported, administered on 30-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 30-JUL-2021, the subject experienced breathing issues. On 30-JUL-2021, the subject experienced uncontrollable shaking. On 30-JUL-2021, the subject experienced can not move arms. On 30-JUL-2021, the subject experienced chills. On 30-JUL-2021, the subject experienced muscles hurt. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from breathing issues, chills, uncontrollable shaking, can not move arms, and muscles hurt. This report was non-serious.


VAERS ID: 1522313 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-25
Onset:2021-07-30
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Chest discomfort, Chest pain, Cough, Neck pain, Palpitations
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (broad)

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

Write-up: Heart Palpitations. Random Sharp pain around left side of chest area and even left side of neck and left back side. Strange feeling in chest area which makes me cough frequently.


VAERS ID: 1522442 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthritis, Condition aggravated, Eczema, Myalgia, Pyrexia, Spondylitis
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I regularly take an Omega 3 in the AM.
Current Illness: None
Preexisting Conditions: Arthritis primarily in the lower back. Eczema
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1. Fever of up to 100F max. Onset appx 10 hours after shot. Duration 12 hours. No treatment. 2. Sore muscles (both arms, shoulders, neck). Onset appx 10 hours after shot. Duration 2 days. Treatment 400 mg ibuprofen in PM both days. 3. Low back arthritis flare up. Onset appx 10 hours after shot. Duration 2 days. Treatment ibuprofen as stated for item 2. 4. Eczema flare up in both arm pits. Onset appx 24 hours after shot. Duration 24 hours. Treatment prescription Protopic cream.


VAERS ID: 1522445 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 RA / ID

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site haemorrhage, Injection site induration, Injection site pain, Injection site swelling
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Site: Bruising at Injection Site-Mild, Site: Swelling at Injection Site-Mild, Systemic: patient bled immedately after injection. A small bump formed at injection site. bleeding stopped after compression with a cotton ball.-Mild, Additional Details: patient bled excessively from injection site and a small bump formed at injection site. advised patient to ice arm and monitor it for the next 72 hours. if it worsens contact md. on 8/2/21 at 11 am i conctacted patient, her daughter answered. Daughter stated her monther is fine she is not experiencing pain, site is still a bit swollen but she is okay and was able to return to work today.


VAERS ID: 1522683 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Systemic: Allergic: Difficulty Breathing-Severe, Systemic: Chest Tightness / Heaviness / Pain-Severe, Additional Details: The patient called the pharmacy to report that shortly after receiving the COVID 19 vaccine, she began to feel severe chest pain and shortness of breath.


VAERS ID: 1522687 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-26
Onset:2021-07-30
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Positive Rapid SARS Antigen Test on 08/01/2021
CDC Split Type:

Write-up: Fever, chills, muscle aches, runny nose, sore throat, headache, fatigue, cough, nausea, and diarrhea


VAERS ID: 1522720 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluoxetine 10 mg, Apple Cider Vinegar
Current Illness: None known
Preexisting Conditions: Right Foot ganglion cyst
Allergies: NkDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt noted intense tinnitus in the right ear 12 hours after the vaccine that has not subsided


VAERS ID: 1522733 (history)  
Form: Version 2.0  
Age: 100.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-04-01
Onset:2021-07-30
   Days after vaccination:120
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Renal impairment, SARS-CoV-2 antibody test positive, SARS-CoV-2 test positive, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin (Aspirin Low Dose) 81 mg tablet,delayed release (DR/EC) Directions: 1 tablet oral daily (Active) carvedilol 6.25 mg Tablet Directions: 1 tablet oral daily Extended Instructions: hold for sys bp less than 120 (Active) cholecalc
Current Illness: COVID 19 Admitted 7/15/2021-7/22/2021 as well at CentraState Medical Center
Preexisting Conditions: Coronary artery disease status Myocardial infarction in 2002 and STEMI 05/31/2016 Ischemic cardiomyopathy Chronic Systolic congesitve heart failure Pulmonary hypertension Hypertension Hyperlipidemia CVA BPH Vertigo Hypothyroidism.
Allergies: NKDA
Diagnostic Lab Data: 1, COVID-19 Antigen (-) 7/6/2021 2. COVID-19 Antigen (+) 7/15/2021 3. COVID-19 IgG (+) 7/30/2021 4. COVID-19 PCR + 7/30/2021
CDC Split Type:

Write-up: Hospitalized initially and COVID Pos on 7.15-7/22/201, sent to rehab then readmitted with abnormal renal function, elevated WBCs and dyspnea.


VAERS ID: 1522737 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-23
Onset:2021-07-30
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Drooling, Ear pain, Facial paralysis, Headache, Hypoaesthesia oral, Neck pain, Pain
SMQs:, Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: folic acid 1mg, prenatal, quetiapine 50mg, metoprolol 12mg, baby asprin, cyclobenzaprine 10mg
Current Illness: na
Preexisting Conditions: asthma
Allergies: penicillin
Diagnostic Lab Data: Dr. has been contacted, awaiting his response.
CDC Split Type:

Write-up: One week after receiving vaccine, 1st dose, severe left shoulder, neck, ear, and left temple pain. Throbbing and what feels like joint pain. Severe headaches. Left side of face experiencing partial paralysis. Lips cannot pucker, left eyelid will not blink unless forced, slight drooping of jowl. Drooling at night from left side. Tongue has areas of numbness.


VAERS ID: 1522743 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-27
Onset:2021-07-30
   Days after vaccination:153
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Orencia 250 mg IV every 4 weeks Vitamin D Sertraline HCL 50mg Simvastatin 20 mg Furosemide 20 mg Mirtazapine 7.5 mg, 0.5 tab daily Metoprolol Succinate 50 mg Losartan Potassium-HCTZ 100-25 mg
Current Illness:
Preexisting Conditions: T2DM, HTN, RA, glaucoma, hyperlipidemia
Allergies: Lipitor, statins, methotrexate, lisinopril, toprol XL, diovan, prednisone
Diagnostic Lab Data: Rapid antigen test on 8-2-21.
CDC Split Type:

Write-up: Patient contracted COVID despite Moderna vaccination on 1-29-2021 and 2-27-2021. She developed symptoms on 7-30-21 after contact with COVID positive resident at her living facility. Tested positive for COVID-19 with rapid antigen test on 8-2-2021. Mild upper respiratory symptoms.


VAERS ID: 1522759 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Inappropriate schedule of product administration, Interchange of vaccine products, Nausea, Skin discolouration
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Medication errors (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: Pfizer COVID vaccine 4/8/21 (age 36)
Other Medications:
Current Illness: None
Preexisting Conditions: None known
Allergies: Pfizer COVID 19 vaccine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient because dizzy and nauseous about 10 minutes after his vaccine. His skin appeared ashen and clamy. His blood pressure was 78/51. He refused to attempt to stand up. We called 911 given the patient''s previous history with the pfizer COVID vaccine. They arrived immediately and his care was turned over to them.


VAERS ID: 1522763 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-07-30
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Ageusia, COVID-19, Pyrexia, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: RT-PCR test came back positive for Covid. recovering from symptoms.
CDC Split Type:

Write-up: had loss of taste and mild fever after returning from a trip.


VAERS ID: 1522783 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-07-23
Onset:2021-07-30
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood culture negative, Blood test normal, Chills, Cognitive disorder, Computerised tomogram normal, Condition aggravated, Electroencephalogram normal, Lumbar puncture normal, Magnetic resonance imaging normal, Oral herpes, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal infections (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Herpes on lips
Allergies: Food dyes
Diagnostic Lab Data: Between 7/31-8/2 he had, full blood panels and cultures, eeg, 2 MRIs, lumbar puncture, and CT scan.
CDC Split Type:

Write-up: 7 day after the shot on 8/30/2021, my husband developed fever, chills and loss of cognitive functions. He didn''t know his name, day, month and could hardly answer yes and no questions without struggling. He was admitted to the hospital and had CT scan, MRIs, blood work, lumbar puncture, eeg. All tests have come back normal. Awaiting to see the lab tests to see if its viral encephalitis from the herpes virus since he developed a cold sore at the time of the fever. He was treated 7/31 with antiviral medication every 8 hours intravenously and has recovered to almost 100% by 8/3/2021.


VAERS ID: 1522785 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-20
Onset:2021-07-30
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Hypoaesthesia, Prostatic disorder
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: -
Current Illness: -
Preexisting Conditions: -
Allergies: -
Diagnostic Lab Data: 07-31-2021 blood test was done
CDC Split Type:

Write-up: Numbness on same side of shot, loss of feeling in hands, arm and both feet on occasions. Generally occurred while stationary and sometimes while eating. Had loss of feeling in the prostate area for some time too.


VAERS ID: 1522790 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2020-12-26
Onset:2021-07-30
   Days after vaccination:216
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Cough, Headache, Myalgia, Pain, SARS-CoV-2 RNA increased, SARS-CoV-2 test
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Taste and smell disorders (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: levothyroxine (SYNTHROID) 112 mcg tablet
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 07/31/21 2051 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 07/31/21 1712 | Final result | Specimen: Swab from Nares COVID-19 SARS-CoV-2 Overall Result DetectedCritical 07/31/21 2051 COVID-19 PCR Collected: 07/31/21 1712 | Final result | Specimen: Swab from Nares
CDC Split Type:

Write-up: Cough Muscle or body aches Headache New loss of taste or smell


VAERS ID: 1522793 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Intermenstrual bleeding, Muscle spasms
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Dystonia (broad)

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

Write-up: Muscle spasms and muscle cramping in legs. Abnormal spotting between periods.


VAERS ID: 1522801 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: 1) Nausea, vomiting, chills, fever (101.5) started 12 hours after receiving the Covid vaccine-all symptoms lasted 24 hours (1 day after Covid vaccine) 2) Headache (started ~5 hours after receiving the Covid vaccine and continued for 3 days after Covid vaccine) gave ibuprofen and Tylenol to help relieve headache symptoms.


VAERS ID: 1522820 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-28
Onset:2021-07-30
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, COVID-19, Diarrhoea, Pyrexia, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Hip pain, fever, diarrhea, and COVID +, daughter in law tested positive on 7/30/2021


VAERS ID: 1522856 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Depressed level of consciousness, Erythema, Oral pruritus, Presyncope, Rash macular
SMQs:, Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Patient was given 1st dose of Pfizer covid vaccine at approximately 950am by RN. Patient notified RN that her mouth was starting to itch and she felt like she may pass out. RN administered 50mg of oral diphenhydramine hcl at 955am. Vitals: BP 125/79, HR 96, O2 98% Patient''s face began to redden in a splotchy pattern. RN called 911 at 10am. At 10:01am began began coughing and her alertness started to decline. I administered 1 dose of Adrenalin 1mg/ml 0.3mg in her right outer thigh per protocol. 10:03am Vitals: BP 122/75, HR 89, O2 98% 10:04am Patient stated the itching in her mouth was improving. 10:07am Vitals: BP 122/78, HR 80, O2 97% 10:10am Vitals: BP 104/74, HR 78, O2 97% Patient stated that the itching was continuing to improve. She was also able to tell me the day of the week and her weekend plans with clarity. 10:15am RN called 911 again; Vitals: BP 114/75, HR 84, O2 96% 10:17am Patient states all symptoms have resolved. 10:20am Vitals: BP 117/74, HR 87, O2 98% EMS arrived at 10:21am and took over care of the patient. Patient was to be transported to the ED. Meds given: 2 capsules of Diphenhydramine Hcl 25mg, Lot 202451 Exp 8/2023 NDC 0904-5306-61 Adrenalin 1mg/mL 0.3mg IM x1, Lot 342523 Exp 10/2021 NDC 42023-159-01


VAERS ID: 1522859 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Head discomfort, Limb discomfort, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Per patient, she broke out in a cold sweat and felt faint about 20 seconds after the shot. She also reports that her head and arms felt very heavy, and had trouble seeing. The staff gave her water and she was eventually okay to leave.


VAERS ID: 1522930 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-28
Onset:2021-07-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

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

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

Write-up: headache which resolved after 2 days. swelling at injection site & redness from injection site to elbow. raised & red. Burning & itching. iced it . took some ibuprofen & tylenol & applied hydrocortisone 1% otc cream on it for itching. Is going to continue to ice. Is going to take zyrtec otc qd as well. It is better but not co/mpletely gone & still itches. (day 5 after injection)


VAERS ID: 1522933 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-28
Onset:2021-07-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

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

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

Write-up: headache which resolved after 2 days. swelling at injection site & redness from injection site to elbow. raised & red. Burning & itching. iced it . took some ibuprofen & tylenol & applied hydrocortisone 1% otc cream on it for itching. Is going to continue to ice. Is going to take zyrtec otc qd as well. It is better but not co/mpletely gone & still itches. (day 5 after injection)


VAERS ID: 1522946 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-11
Onset:2021-07-30
   Days after vaccination:169
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: Positive results after full vaccination


VAERS ID: 1522948 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-03-26
Onset:2021-07-30
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 LA / SYR

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

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

Write-up: Pfizer 1st dose 3/05/21 (lot # EN6198), Pfizer 2nd dose 3/26/21 (lot # ER8727). Patient is fully vaccinated with Pfizer COVID vaccine back in March 2021. Patient came to ED for SOB and tested positive for COVID on 7/30/21.


VAERS ID: 1522993 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-07-27
Onset:2021-07-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

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

Write-up: 3 days s/p second shot developed myocarditis


VAERS ID: 1522999 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 UN / IM

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

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

Write-up: Client''s guardian gave inaccurate information regarding client''s name and date of birth (given as name and date of birth as 3/10/2011). Client is only 10 years old and is not eligible for Covid vaccination. No adverse event is known to have occurred.


VAERS ID: 1523008 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-03-02
Onset:2021-07-30
   Days after vaccination:150
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 1 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 mg tablet amLODIPine (NORVASC) 2.5 mg tablet amoxicillin (AMOXIL) 500 mg capsule atorvastatin (LIPITOR) 80 mg tablet calcium carbonate-vitamin D3 500 mg(1,250mg) -400 unit tablet carvediloL (COREG) 12.5 mg tablet
Current Illness:
Preexisting Conditions: Nervous Carpal tunnel syndrome Low back pain Respiratory Lung nodule Circulatory Benign essential HTN Left ventricular ejection fraction of 35-39% Chronic systolic heart failure Status post transcatheter aortic valve replacement (TAVR) using bioprosthesis Transient ischemic attack Aortic stenosis Pulmonary hypertension Demand ischemia Cardiac arrhythmia Digestive Vitamin D deficiency Genitourinary Prolapse of vaginal vault after hysterectomy Continuous leakage of urine Fistula involving female genital tract Musculoskeletal Bone disorder Osteopenia of multiple sites Arthritis Costochondritis Knee osteoarthritis Presence of right artificial knee joint Endocrine/Metabolic Hyperlipidemia Hypomagnesemia Type 2 diabetes mellitus with microalbuminuria, with long-term current use of insulin Solitary thyroid nodule Hematologic Anemia Other Microalbuminuria Never used chewing tobacco Never smoked cigarettes
Allergies: Lisinopril Coughing Adhesive Low Allergic (an Altered Rxn Of Body Tissue To A Specific Substance)
Diagnostic Lab Data: Updated Procedure 07/31/21 0259 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 07/30/21 1351 | Final result | Specimen: Swab from Nares COVID-19 SARS-CoV-2 Overall Result DetectedCritical
CDC Split Type:

Write-up: UNKNOWN


VAERS ID: 1523105 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-16
Onset:2021-07-30
   Days after vaccination:136
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 RA / 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: aspirin, buffered (BUFFERIN) 325 mg oral tablet famotidine (PEPCID) 20 mg tablet QUEtiapine (SEROquel) 25 mg tablet(Expired) XARELTO 20 mg tablet
Current Illness:
Preexisting Conditions: Circulatory Elevated blood pressure Genitourinary Urge incontinence of urine Musculoskeletal Actinic keratosis Adhesive capsulitis of left shoulder Osteopenia of left upper arm Hip fracture, right, closed, initial encounter (CMS/HCC) Endocrine/Metabolic Hypercholesterolemia Immune Allergic reaction Other Localized edema
Allergies: CiprofloxacinHeadaches, Diarrhea, Nausea and Vomiting
Diagnostic Lab Data: 07/31/21 0103 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 07/30/21 1959 | Final result | Specimen: Swab from Nares COVID-19 SARS-CoV-2 Overall Result DetectedCritical
CDC Split Type:

Write-up: UNKNOWN


VAERS ID: 1523107 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-23
Onset:2021-07-30
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Activated partial thromboplastin time, Cellulitis, Computerised tomogram, Fibrin D dimer, Full blood count, International normalised ratio, Jugular vein thrombosis, Laboratory test, Metabolic function test, Prothrombin time, Red blood cell sedimentation rate, Scan with contrast, Streptococcal infection, Ultrasound Doppler, X-ray limb
SMQs:, Embolic and thrombotic events, venous (narrow), Infective pneumonia (broad), Opportunistic infections (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Chronic ITP
Allergies: Avelox Phenergan (intravenous)
Diagnostic Lab Data: Venous Doppler left upper extremity 7/31/21; CT left upper extremity with contrast8/1/21; Humerus x-ray7/31/21; Numerous lab tests CBC, BMP, CMP, Protime INR, APTT, D-Dimer, Sed Rate 7/31/21
CDC Split Type:

Write-up: Severe cellulitis left arm (Streptococcal) requiring 3 day hospitalization; Also acute clot in internal jugular vein


VAERS ID: 1523154 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pt presented himself as not having any Covid shot yet. Requested Pfizer. Actually, had 1st Moderna vaccine 2/12/21 2nd Moderna vaccine 3/12/21
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Adverse events not known. Patient lied to get his 3rd Covid vaccine. After facts he said he wanted a booster and will take full responsability for it.


VAERS ID: 1523236 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Burning sensation, Chest X-ray normal, Chills, Computerised tomogram head normal, Dizziness, Electrocardiogram abnormal, Full blood count, Headache, Hypophagia, Malaise, Metabolic function test, Micturition urgency, Nausea, Pregnancy test negative, Tremor, Troponin
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec 10 mg losartan 25 mg Sertraline 50 mg HCTZ 12.5 mg Glucosamine 2000 mg Multivitamin (Women''s Health Formula)
Current Illness: I am a post covid syndrome patient aka "long hauler" (Covid positive 8/6/2020) but I was not having any long hauler symptoms at the time of vaccination.
Preexisting Conditions: High BP depression/anxiety obesity Impaired fasting glucose occasional migraine
Allergies: Sulfa Peppermint Latex Sensitivity Nickel Seasonal Allergies
Diagnostic Lab Data: CBC CMP Troponin- first test showed that I needed to have a second troponin drawn EKG-sinus rhythm CT Head-negative chest xray negative serum pregnancy test-negative
CDC Split Type:

Write-up: 10 hours after receiving vaccine I had severe headache, chills, shakes, sweating, weakness, inability to hold my urination, dizziness, hot sensation on the right side of my head (I wasn''t laying on that side, nor did I have a heating pad on me.). I was also very nauseated, so I tried taking Compazine by mouth every 6 hours with no relief; I was taking Tylenol by mouth every 6 hours with no headache relief. This lasted all night, with no sleep. The next day, I did not feel any better, and my husband had to help me get off the couch just so I could urinate. I was not able to eat much due to the nausea. I was attempting to drink water and Gatorade. On 7/31, at around 7 PM, I asked my husband to drive me to the Emergency Room, because I was not feeling any better. These same things happened with the first vaccine as well; but I started to notice improvement the next morning (although I was still sick a total of 3 days with that episode.


VAERS ID: 1523263 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-14
Onset:2021-07-30
   Days after vaccination:107
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 325 mg tablet atenoloL (TENORMIN) 50 mg tablet calcium carbonate (CALCIUM 500 ORAL) cyanocobalamin, vitamin B-12, (VITAMIN B-12 ORAL) dextran 70-hypromellose, PF, (ARTIFICIAL TEARS, PF,) 0.1-0.3 % dropperette glucosa
Current Illness:
Preexisting Conditions: Nervous Cogan''s corneal dystrophy Circulatory Intermittent palpitations Musculoskeletal Scoliosis of thoracic spine Endocrine/Metabolic Hypothyroidism
Allergies: NKA
Diagnostic Lab Data: Probable COVID-19 Specimen information: Swab / Nares Added: 7/30/2021 by POCT COVID-19 Antigen (Collected 07/30/21) Onset date: 7/30/2021 Resolve
CDC Split Type:

Write-up: UNKNOWN


VAERS ID: 1523266 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-24
Onset:2021-07-30
   Days after vaccination:156
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / UNK LA / IM

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

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

Write-up: COVID-19


VAERS ID: 1523269 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Unevaluable event
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: Dr. ordered a booster shot.


VAERS ID: 1523272 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Photopsia, Vitreous detachment, Vitreous floaters
SMQs:, Accidents and injuries (broad), Retinal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitafusion women''s Gummy vitamins Energy, Metabolism and Bone Support.
Current Illness:
Preexisting Conditions:
Allergies: Hazelnuts Lexapro
Diagnostic Lab Data: Eye exams, Retinal scans
CDC Split Type:

Write-up: Flashing light left eye, black floaters. Emergency Room Trip evening of 7/30 - 8/1/21. Diagnosis of PVD. (Posterior Vitreous Detachment)


VAERS ID: 1523274 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Interchange of vaccine products
SMQs:, Medication errors (broad)

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

Write-up: Patient accidentally received Pfizer vaccine instead of Moderna for the 2nd covid shot.


VAERS ID: 1523286 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-19
Onset:2021-07-30
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Breast pain
SMQs:, Lipodystrophy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: zyrtec, allegra, flonase, singulair
Current Illness: No acute illnesses
Preexisting Conditions: depression, anemia, chronic rhinitis, idiopathic angioedema, migraine, obesity, h/o urticaria
Allergies: clindamycin, decadron
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Left breast pain - no masses, nodules, palpable lymphadenopathy


VAERS ID: 1523457 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-07-09
Onset:2021-07-30
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 2 LA / SYR

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

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

Write-up: Nothing happened after the first shot. With the second shot I have broken out into hives. The area where I got the shot became feverish and swollen as well.


VAERS ID: 1523480 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-09
Onset:2021-07-30
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: CBC, CRP, ESR. CK all pending
CDC Split Type:

Write-up: Pt developed significant arm pain with possibility of myositis, labs pending


VAERS ID: 1523663 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-03
Onset:2021-07-30
   Days after vaccination:118
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026B21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

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

Write-up: Patient is fully vaccinated and tested positive for COVID


VAERS ID: 1523671 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Incomplete course of vaccination, Insomnia, Musculoskeletal stiffness, Neck pain, Pain in extremity, Sensory disturbance, Spinal pain
SMQs:, Peripheral neuropathy (narrow), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: In college, I think it was an MMR, not sure, lost some hearing in one ear.
Other Medications: Multi-Vitamin, Vit B, HPA Axis, all one capsule a day (under recommended dosage) and bioidentical hormone therapy lozenge (1/2 day)
Current Illness: None
Preexisting Conditions: None
Allergies: Yes, allergic to Penicillin, mold, sensitive to many chemicals, foods, and drugs.
Diagnostic Lab Data:
CDC Split Type:

Write-up: I got the expected sore arm for a few days. The day of the shot I started getting a headache, that soon got pretty bad, and my neck and spine started hurting, so bad that by that night I could hardly sleep. Eventually I took two Advil to help me sleep, and the next morning I did feel slightly better, but by nightfall the next day it came on hard again, again I took two Advil to help me sleep, hoping things would improve over time. This is day 5 and I''ve still got the headache and my spine is stiff and generally feels like my spinal cord doesn''t have room in channel in my spine. That is how I would describe this feeling I''ve had. My doctor doesn''t call me back, I''ve called to ask if I should even bother with the booster in a couple more weeks, at this point I''m thinking no I won''t get the booster as it is expected to hit harder and I don''t want to mess with my spine. So far I''m just riding it out.


VAERS ID: 1523682 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2020-12-28
Onset:2021-07-30
   Days after vaccination:214
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: not known
Current Illness: none
Preexisting Conditions: not known
Allergies: not known
Diagnostic Lab Data: PCR 8/1/2021 positive for Covid
CDC Split Type:

Write-up: Client was vaccinated with Moderna vaccines on December 28, 2020 and January 28, 2021 (client not exactly sure about dates but they are correct within a few days. Vaccines given at hospital. Client tested positive for Covid on 8/1/2021 with PCR and was symptomatic. Reported as breakthrough Covid case in previously fully vaccinated person.


VAERS ID: 1523688 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-23
Onset:2021-07-30
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Exposure to communicable disease, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), COVID-19 (broad)

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

Write-up: cough, congestion x 4 days, exposure, rapid


VAERS ID: 1523874 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-07-23
Onset:2021-07-30
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Menstruation irregular
SMQs:, Fertility disorders (broad)

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

Write-up: Menstruation disruption


VAERS ID: 1524139 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blister, Feeling abnormal, Paraesthesia, Pruritus, Urticaria
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Dementia (broad), Guillain-Barre syndrome (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: Claritin D
Current Illness: None
Preexisting Conditions: None
Allergies: Non that are known
Diagnostic Lab Data: Steroids and itch cream given. They are still very present as well as blisters on the bottom of the foot and toes.
CDC Split Type:

Write-up: I started with hives about 15 minutes after leaving the pharmacy. I went to the walk in clinic that night. My feet were also feeling weird. The hives ere present Saturday but we?re full blown on Saturday night / Monday morning ( about 3 am I woke up and was covered ). My feet were also tingly. I called off work Monday and went to another doctor and received a steroid shot, and steroids to take by mouth this week. He also prescribed oral medicine for the itching. I currently still have hives and blisters on my feet and toes.


VAERS ID: 1524500 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysgeusia
SMQs:, Taste and smell disorders (narrow)

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

Write-up: Metallic taste in my mouth within 5 minutes of injection, which lasted for at least 12 hours.


VAERS ID: 1524512 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-04-30
Onset:2021-07-30
   Days after vaccination:91
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Fatigue, Hypogeusia, Hyposmia, Nasal congestion, Pain, Rhinorrhoea, SARS-CoV-2 test positive, Throat irritation
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: hyperlipidemia, fatty liver, OSA
Allergies: none
Diagnostic Lab Data: COVID positive PCR on 08/02/2021
CDC Split Type:

Write-up: scratchy throat, cough, nasal congestion, runny nose, chills, body aches, decreased taste, decreased smell, fatigue. COVID positive PCR on 08/02/2021


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