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

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

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 173 out of 8,753

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VAERS ID: 1785979 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 2 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Inappropriate schedule of product administration
SMQs:, Medication errors (narrow)

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

Write-up: Patient received their second dose of Pfizer 3 days earlier than the grace period of 4 days before and any time after 10/21/21. Patient was in their second week of the waiting period between the first and second dose and the patient came to get their vaccine. The dates on the vaccine card were not carefully read and seen by the vaccinator and thus the vaccine was given too early.


VAERS ID: 1785980 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Immunodeficiency, 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: Omeprazole, Meloxicam, proair,amend, carafate, topomax, zofran, skelaxin, immitrex,elavil, tylenol, flonase, flovent
Current Illness: none
Preexisting Conditions: many
Allergies: PCN
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt came in with father and confirmed they were getting the flu vaccine and a pfizer vaccine and consents were obtained physically for covid and verbal consent for flu and pfizer booster. Pt was given the booster and it was not indicated for a booster and RN had already given it.


VAERS ID: 1785981 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 2 RA / IM

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

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

Write-up: Gave Moderna shot at 25hours after opening


VAERS ID: 1785984 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Headache
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: PT REPORTED CHEST PAIN AT 2AM THAT NIGHT AFTER HER VACCINE WHICH LASTED ABOUT 5 MINUTES. SHE ALSO HAD HEADACHE THE FOLLOWING MORNING.


VAERS ID: 1786175 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Immunodeficiency, 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: prozac, motrin, ducosate sodium, zofran prn
Current Illness: none
Preexisting Conditions: none
Allergies: cat hair extract
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt came in with father and confirmed they were getting the flu vaccine and a pfizer vaccine and consents were obtained physically for covid and verbal consent for flu and pfizer booster. Pt was given the booster and it was not indicated for a booster and RN had already given it.


VAERS ID: 1786184 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hypopnoea, Immediate post-injection reaction, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Hypoglycaemia (broad)

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

Write-up: Patient began to feel dizzy 1 minute or less after given first dose of Moderna. She then became unresponsive. Called 911 . Her mother held her upright in chair until it was safe to move her to floor. And I cradled her to monitor that she still had a pulse and was breathing. Continued to talk with her while waiting for ambulance to arrive. She did not respond to verbal interaction, she did have a pulse and was breathing, however it was shallow. Her eyes were open but unresponsive. We moved her to the floor as soon as it was safe after about 10 minutes. Once we moved her to the floor she became responsive once again. gave her a bottle of water and at that time the EMT arrived. They checked her out and she was able to answer their questions. They completed their care for her and left her to her mother''s care.


VAERS ID: 1786186 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Feeling abnormal, Feeling hot, Pruritus, Swollen tongue, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Dementia (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: iv contrast - severe allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient came in for vaccine- administered first covid shot. patient waited 15 minute waiting period. felt OK. left to go to car, then started to feel funny. lips and face itchy and warm. came back to pharmacy to get advice. gave her Benadryl, thinking maybe just a localized reaction. after 10 minutes, no improvement. at that point patient started to get hives. then progressed to trouble breathing and tongue swelling. called 911 and administered epipen. patient was then able to breath more easily. rescue squad came and evaluated her and transported her to hospital.


VAERS ID: 1786197 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Vermont  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Inappropriate schedule of product administration
SMQs:, Medication errors (narrow)

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

Write-up: This patient''s booster dose was administered too early. He received his second dose on 5/8/2021 and was given his booster dose on 10/14/2021. The patient was informed of this administration error and counseled to expect routine vaccine side effects and that the dose does not need to be repeated.


VAERS ID: 1786203 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient signed up for vaccine through portal stating they had received pfizer doses for the first and second shot. After vaccinating for the booster, I noticed the vaccine card stated moderna as the first two initial doses. When I spoke to the patient and her daughter, the daughter said she thought the patient had received the pfizer shots initially and so had signed her up for the booster.


VAERS ID: 1786205 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-10-12
Onset:2021-10-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 AR / IM

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

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

Write-up: Described parethesia to right hand. Last 3 fingers numb.


VAERS ID: 1786210 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Burning sensation, Chest discomfort, Dizziness
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypertension (narrow), Vestibular disorders (broad)

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

Write-up: PATIENT REPORTED HEAVY CHEST SENSATION A FEWW MINUTES UPON RECIEVING THE VACCINE AND WENT TO THE er. SINCE THEN HE RECIEVED TEST AND TREATMENT AT THE er. UPON FOLLOW UP CALL WITH PATIENT HE REPORTED TO HAVE HAD, A HEAVY CHEST SENSATION, BURNING FEELING IN THE INSIDE , LIGHT HEADEDNESS AND INCREASED BLOOD PRESSURE.


VAERS ID: 1786553 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-28
Onset:2021-10-14
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       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 e, a, c, b12, biotin, zinc, lysine, vitamin d, probiotics
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: My period isn?t due for 5 days. I so bleeding light pink and have tissue discharge. This has NEVER happened before.


VAERS ID: 1786561 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-10-04
Onset:2021-10-14
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Hypoaesthesia, Injection site pain, Injection site swelling, Lymphadenopathy, Muscular weakness, Pain, Pain in extremity, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling under arm, pain and swelling in injection site, swollen lymph nodes, pain in right arm radiating upwards, severe pain and numbness in both legs from hips and ankles. Falling over from legs being weak. Tingling sensation in both legs.


VAERS ID: 1786666 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Interchange of vaccine products, No adverse event
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: No adverse event reported. Pt requested Moderna vaccine dose 2. Did not present vaccine card until later on today. Patient had Pfizer first dose vaccine instead.


VAERS ID: 1786667 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 2 LA / IM

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

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

Write-up: Within a few minutes after received the 2nd Dose of Moderna at 6:55pm, patient''s face turned pale and broke out with cold sweat and his forehead cool to touch. I checked his blood pressure at for the first time at the result are: 100/50 and pulse 45. Patient told me beside breaking out cold sweat and dizziness, his breathing and everything else is fine. After about 10 minutes later after resting, his cold sweat seem to stop and his face no longer pale. I check his blood pressure again: 118/67, P=60. Patient said he felt perfectly fine now without any symptoms. However, I asked patient to stay for the full 30 minutes post vaccine where I just stood nearby and observe him closely until 7:25pm to be on the safe side. At 7:25pm, patient said thank you for taking great care of him, and he felt fine and he left with his friend. I called patient today at 8:30pm for follow up, he picked up the phone and said he is feeling fine.


VAERS ID: 1786669 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-09-10
Onset:2021-10-14
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? 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: Pain in upper arm and some in shoulder for the past 5 weeks since booster shot.


VAERS ID: 1786694 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Ageusia, Asthenia, Feeling abnormal, Malaise, Nausea, Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: apples, almond, morphine, demoral
Diagnostic Lab Data: none. stayed home, Took otc and waited for it to past.
CDC Split Type:

Write-up: S/S started the following day for both shots. N/V, headache, total body ache, weakness, malaise, fever, no taste. Feeling like I got hit by a train and ran over by a dump truck. Having the actual covid virus never felt as bad as the getting the vaccine. One size does not fit all. This thing is dangerous and should be illegal.


VAERS ID: 1786695 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-10-12
Onset:2021-10-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol, Prozac, claratin, thyroid, cholesterol
Current Illness: Had covid 19 September 9th to 19th.
Preexisting Conditions: Ankylosing spondilitis High blood pressure
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Arm pain, large pink area on arm near injection site that is itchy and feels hot.


VAERS ID: 1787792 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

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

Write-up: Fever, fatigue, nausea, body aches, head ache, chills.


VAERS ID: 1787794 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-01
Onset:2021-10-14
   Days after vaccination:286
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID positive - date of vaccination approximate. Patient noted Pfizer vaccine in January.


VAERS ID: 1787876 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pain, Swelling, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Pain, tenderness and swelling under arm and breast area.


VAERS ID: 1787886 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-24
Onset:2021-10-14
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Moderna 8/27 and 9/24. Positive on 10/4


VAERS ID: 1787889 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: He has a history of feeling dizzy after vaccination
Preexisting Conditions:
Allergies: He has a history of feeling dizzy after vaccination
Diagnostic Lab Data: He is observed and his votal signs were checked every 15 minutes and discharged home after 1 hour.
CDC Split Type:

Write-up: He has a history of feeling dizzy after vaccination He felt dizzy 5 to 10 minutes after the Covid Pfizer vaccination at around 0610. He has a tendency of feeling dizzy after vaccination. He then passed out and fell on his arm. He recovered few seconds after falling down. He does not remember that he passed out. His vital signs are within normal. He was observed for 1 hour and follow-up in the clinic the next day


VAERS ID: 1787890 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Respiratory distress
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms 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: Advair
Current Illness:
Preexisting Conditions: Asthma
Allergies: Soy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe, ongoing respiratory distress Numbness in right face


VAERS ID: 1787904 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186EXP / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site lymphadenopathy
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: advil[ibuprophen]
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: lymphadenopathy ipsilateral of injection site


VAERS ID: 1787909 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Headache, Nausea, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: flu, 2019, 33, weak ,chills, fever, stomach cramps
Other Medications: tylenol
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: started at 3:43 PM. body shake, chills, bad headache and a bit nauseous.


VAERS ID: 1787930 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / UNK - / -

Administered by: Work       Purchased by: ?
Symptoms: Dizziness, Nausea, Taste disorder
SMQs:, Acute pancreatitis (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: BP 148/98 (standard for pt)
CDC Split Type:

Write-up: Pt reported severe dizziness and nausea. Also mentioned odd taste in mouth. Was evaluated by EMS and determined to be non-emergent.


VAERS ID: 1787934 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: New York  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pharyngeal paraesthesia, Throat irritation
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: tylenol, ibuprofen, epi-pen
Current Illness:
Preexisting Conditions:
Allergies: PCN, shellfish, tuna, shrimp, walnuts
Diagnostic Lab Data: patient had vitals and received PO diphenhydramine 25 mg x 1 dose
CDC Split Type:

Write-up: patient had throat itchiness and tingling


VAERS ID: 1787936 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-30
Onset:2021-10-14
   Days after vaccination:198
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive, 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID positive test on 10/14/21
CDC Split Type:

Write-up: COVID vaccine breakthrough event


VAERS ID: 1787942 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-12
Onset:2021-10-14
   Days after vaccination:216
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive, 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID positive test
CDC Split Type:

Write-up: COVID vaccine breakthrough event


VAERS ID: 1787946 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-11
Onset:2021-10-14
   Days after vaccination:245
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M208 / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test positive, 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID positive test on 10/14/2021
CDC Split Type:

Write-up: COVID vaccine breakthrough case


VAERS ID: 1787948 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 1 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Fatigue, Injection site rash, Pain
SMQs:, Hypersensitivity (narrow)

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

Write-up: Fatigue, body aches, and rash at injection site.


VAERS ID: 1787965 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-12
Onset:2021-10-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 LA / IM

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

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

Write-up: Upper body covered in red patchy rash, very mild itching


VAERS ID: 1787970 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-23
Onset:2021-10-14
   Days after vaccination:233
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: alendronate (FOSAMAX) 70 mg Oral Tab allopurinol (ZYLOPRIM) 100 mg Oral Tab atenolol (TENORMIN) 50 mg Oral Tab calcium-cholecalciferol, D3, (CALCIUM 600 + D) 600 mg(1,500mg) -400 unit Oral Tab carisoprodol (SOMA) 350 mg Oral Tab ciprofloxac
Current Illness:
Preexisting Conditions: Fibromyalgia Psoriatic arthritis Sjogren''s syndrome Chronic pain syndrome Hypertension CKD CHF NSTEMI OSA Osteoarthritis Polyneuropathy
Allergies: Erythromycin Keflex [Cephalexin] Levaquin [Levofloxacin] Methotrexate Nitrofurantoin Penicillins Sulfonamide Antibiotics Sulfabenzamide
Diagnostic Lab Data: POSITIVE COVID TEST 10/14/21
CDC Split Type:

Write-up: WEAKNESS, FALL,


VAERS ID: 1787986 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 1 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Chills, Dyskinesia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Dyskinesia (narrow), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client had uncontrollable body movements, shaking, and shivering.


VAERS ID: 1788000 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 3 LA / IM

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

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

Write-up: Patient was given a dose of Moderna on 10/14 that expired on 10/12


VAERS ID: 1788024 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Swollen tongue, Vaccine positive rechallenge
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: pt reported tongue swelling 10mins after receiving vaccination. He reports this happened after his first dose as well (but was not reported to healthcare facility). Vitals were WNL, attending provider assessed, 50mg PO benadryl given.


VAERS ID: 1788028 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: No adverse event reported. Administration error: Patient was given 1 ml of Moderna vaccine instead of 0.5 ml


VAERS ID: 1788037 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 2 AR / IM

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

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

Write-up: None Administration error - patient was given 1 ml of Moderna rather than 0.5 ml


VAERS ID: 1788044 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 RA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UJ694AA / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Arthralgia, Body temperature increased, Bone pain, Gait disturbance, Head discomfort, Headache, Myalgia, Pain, Sinusitis
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Osteonecrosis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LOSARTAN HCTZ; FLUOXETINE; LEVOTHYROXINE; ROPINIROLE; MELOXICAML CALCIIUM; VITAMIN D, MULTIVITAMIN; PROBIOTIC
Current Illness: None
Preexisting Conditions: Arthritis
Allergies: PO Benzocaine, shrimp, copper, cobalt, & nickel
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Had a slight headache the night of vaccination, but about an hour after getting up the next morning, extreme body aches made it difficult to even walk. Every bone, joint, and muscle was sore all day (despite alternating doses of Tylenol and Aleve) until about 8:00 pm when it started to subside. My temperature was also elevated, but no in fever range. I didn''t have a true headache, but it felt like my head was going to explode, kind of like a bad sinus infection, but throughout my whole head. Slight headache this morning, but the body aches have gone away.


VAERS ID: 1788046 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / UNK AR / IM

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

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

Write-up: None administration error - patient was given 1 ml of Moderna COVID vaccine instead of 0.5 ml


VAERS ID: 1788047 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-12
Onset:2021-10-14
   Days after vaccination:155
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood sodium decreased, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Chest discomfort, Cough, Diarrhoea, Dizziness, Dyspnoea, Dyspnoea exertional, Hyponatraemia, Hypoxia, Lung opacity, Malaise, Nausea, Productive cough, Pyrexia, SARS-CoV-2 test positive, Troponin normal
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient originally Covid + on 10/06. Tested positive again on 10/14/2021. Patient fully vaccinated with Pfizer. 1st dose 04/21/2021 and 2nd dose on 05/12/2021. Per HCP: Patient is 49-year-old female with past medical history significant for cardiomyopathy, atrial fibrillation on Eliquis, diabetes mellitus, hypertension, hyperlipidemia presented to the ER with complaints of some chest tightness and feeling out of breath and some lightheadedness. Patient tells me that she was recently diagnosed with COVID-19 infection on 10/6/2021 and she has not been feeling well since then. She said that she has received antibody infusion at a HCF past Tuesday as recommended by her PCP. Although her chest tightness 10 shortness of breath got worsened she said her shortness of breath is more when she exerts and walks. Patient already has been vaccinated with 2 doses of either vaccine in May 2021. Patient also has some coughing and phlegm production. On my evaluation also she has some chest discomfort and she said it is more with the coughing. She denies any chills although she has been having fevers on and off. Patient also is complaining of having diarrhea she denies any abdominal pointer she said she has some nausea here and there no vomiting on further evaluation in the ER her chest x-ray showed patchy opacities throughout the lungs compatible with COVID-19 pneumonia she did not have any leukocytosis she was found to be afebrile her troponin x2 were negative. She had mild hyponatremia with sodium of 130. Patient initially had some hypoxemia although it was resolved on my evaluation patient was maintaining normal saturations on room air


VAERS ID: 1788055 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 2 AR / IM

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

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

Write-up: NONE Administration error - patient was given 1 ml of Moderna COVID vaccine instead of 0.5 ml


VAERS ID: 1788060 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF3590 / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Chest pain, Dyspepsia, Dyspnoea, Electrocardiogram, Sensation of foreign body, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zyrtec Nuvaring Buspar Metaxolone Tylenol Multivitamin L. Carnitine Probiotic None taken at the time I got vaccinated but these are my daily meds
Current Illness: None
Preexisting Conditions: Anxiety Heavy menses
Allergies: Latex Sulfa Penicillin Codeine Bees Walnuts Sulfites
Diagnostic Lab Data: 10/14 blood panels, chest X-ray, EKG 10/15 more blood work, more ekgs (total of 4)
CDC Split Type:

Write-up: Dose given at about 1:20 pm. Almost immediately I had burning in my chest and stomach. Then I had trouble breathing. My throat got tight and felt like there was a ball in it.


VAERS ID: 1788068 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-23
Onset:2021-10-14
   Days after vaccination:205
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 2 LL / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Mental status changes, Vaccine breakthrough infection
SMQs:, Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Admitted with breakthrough COVID-19 infection on 10/14/21. Altered mental status over previous 3 days


VAERS ID: 1788075 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / 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: Lexapro
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: I started a period. I have not had a period in a long time due to having a Mirena IUD. I also know when I''m cycling because I get a cyst on an ovary each month. This was not a scheduled period and started about a day after receiving the vaccine.


VAERS ID: 1788083 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-08-12
Onset:2021-10-14
   Days after vaccination:63
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

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

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

Write-up: person tested positive COVID-19 10/13/21.


VAERS ID: 1788094 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-25
Onset:2021-10-14
   Days after vaccination:231
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Inappropriate schedule of product administration
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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: hospitalization (non-ICU)


VAERS ID: 1788100 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Influenza like illness
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: TOPROL; CARDIZEM; LOSARTAN; CYMBALTA; TRAZODONE; GLUCOPHAGE
Current Illness:
Preexisting Conditions: CAD; Pulmonary hypertension; OSA
Allergies: None
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: The day after vaccine I had flu-like symptoms.


VAERS ID: 1788113 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chills, Dry mouth, Dyspnoea, Fatigue, Feeling cold
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: METFORMIN 500 mg; LISINOPRIL 20 mg; ASPIRIN 81 mg
Current Illness: None
Preexisting Conditions: High BP, DM Type II
Allergies: Lentils, Norco, Cats, Peas, Peanuts
Diagnostic Lab Data: N/A.
CDC Split Type:

Write-up: Shortness of Breath, cold chills, Tired, and dried mouth later the day of receiving the vaccine and next day.


VAERS ID: 1788139 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301258A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blepharospasm, Chills, Gingival pain, Joint range of motion decreased, Lip pain, Lip swelling, Muscle twitching, Pain in jaw, Pyrexia, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dyskinesia (broad), Dystonia (broad), Gingival disorders (narrow), Periorbital and eyelid disorders (narrow), Osteonecrosis (broad), Ocular motility disorders (narrow), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall extended release 20mg 1x a day
Current Illness: UTI 1 month prior
Preexisting Conditions: Ehlers-Danlos Syndrome ADHD/ADD Anxiety/depression
Allergies: Hazelnut (anaphylaxis) latex (localized reaction/hives)
Diagnostic Lab Data:
CDC Split Type:

Write-up: 12/13/21 14:30 began fever and chills (intermittent, not fully resolved) 12/14/21 Swelling to right side of face (18:30) Severe swelling to bottom lip (19:15) Swelling to jaw/under the chin (19:30) Pain in jaw/inability to fully open mouth (19:00) Pain to lip/gum line of bottom teeth (17:00) 10/15/21 Facial twitching to right eye/cheek (resolved) (lasted 04:00- approx. 08:00) Self started taking Tylenol Urgent care visit. Started a course of Augmentin, a course of Prednisone, continue Tylenol, and heat compresses. Self monitor for airway involvement.


VAERS ID: 1788190 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-11
Onset:2021-10-14
   Days after vaccination:245
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 LA / 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? 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: Pt had a positive covid test


VAERS ID: 1788209 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-01
Onset:2021-10-14
   Days after vaccination:166
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH WE8736 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Mechanical urticaria, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic 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: Albuterol Sulfate HFA 90 mcg Inhaler - per needed Azelastine 0.05% Eye Drops - per needed Fluticasone Propionate 50 mcg Nasal Spray - per needed Zyrtec - per needed Multivitamin Omega 3 Trimcinolnone Acetonide 0.5% Topical Ointment
Current Illness:
Preexisting Conditions: Asthma
Allergies: Environmental Allergies Gluten & Lactose Intolerance
Diagnostic Lab Data:
CDC Split Type:

Write-up: Experienced urticaria and symptoms similar to dermatographism. Plan: order COVID test due to fever. Benadryl at night, Zyrtec during the day. Cortisone cream on rash. Providing Prednisone 10mg for severe urticaria. Advised to seek further medical care if feeling any swelling/tingling around mouth.


VAERS ID: 1788217 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-10-15
Onset:2021-10-14
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / UNK - / -

Administered by: Unknown       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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: Afib, LV thrombus, CVA, HTN, HLP
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: hospitalization 10/14/2021


VAERS ID: 1788260 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-09-28
Onset:2021-10-14
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Military       Purchased by: ?
Symptoms: Balance disorder, Dysarthria, Echocardiogram normal, Facial paralysis, Glycosylated haemoglobin, Imaging procedure, Laboratory test, Lacunar stroke, Lipids, Magnetic resonance imaging head, Speech disorder, Tongue paralysis
SMQs:, Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hearing impairment (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: COVID-19 PCR positive 8/1, negative and recovered at the time of receiving vaccine
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: MRI brain 10/14 Hypercoagulable workup ordered 10/14 Echo with no PFO No atherosclerotic disease on imaging of head and neck and no laboratory equivalent/risk on HbA1c or lipid panel
CDC Split Type:

Write-up: Lacunar stroke of the right hypothalamic region initially with loss of balance, facial droop, tongue deviation, and slurred speech now resolved with only minor residual speech deficits. Signs first observed on 10/14 at 0400 by patient and patient''s spouse.


VAERS ID: 1788274 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Advair 250mcg twice a day
Current Illness: None
Preexisting Conditions: Asthma, Menier''s Disease
Allergies: Codeine, Iodine, Cortisone, Celebrex, Shellfish, Fish, Mushrooms, Gluten
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hives, Itching that started at approximately 10pm on day of vaccination and has been getting progressively worse. Advised to take antihistamines. Awaiting for further guidance from MD.


VAERS ID: 1788283 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 4 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 3 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 2 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 - / -

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

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

Write-up: Patient previously completed Pfizer series. Patient then requested Moderna but did not show his completed vaccine card with the previous Pfizer doses. Patient came in for his second dose of Moderna. Patient presented a vaccine card with the initial dose of Moderna. Again, he did not show his vaccine card with the completed Pfizer series.


VAERS ID: 1788304 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3001558A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Chest X-ray normal, Chest pain, Dyspepsia, Electrocardiogram normal
SMQs:, Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Prescriptions: Estrogen patch (.1 mg), Sertraline (12.5 mg), Mirena IUD OTC Supplements: Calcium, Apple cider vinegar, Turmeric, Probiotic
Current Illness: Cold 2 weeks prior + mild sinus infection (no antibiotics).
Preexisting Conditions: None
Allergies: Sulfa, Penicillin
Diagnostic Lab Data: EKG and Chest XRay 10/14/2021, were fine
CDC Split Type:

Write-up: Very strong chest pains 28 hours post injection. Felt like the worst heartburn I''ve ever had, or that I was being stabbed in the chest and back repeatedly.


VAERS ID: 1788309 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 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: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1788316 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 1 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: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1788319 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 3 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site mass, Pain in extremity, Vaccination site erythema, Vaccination site induration, Vaccination site pruritus, Vaccination site rash, Vaccination site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall, Metaprolol, potassium, Lasix, Allegra, Dymista, Vitamin D (50000 every other day), amiodarone
Current Illness: none
Preexisting Conditions: CHF, allergies, obesity
Allergies: Penicillin, sulfa, codeine, vicodin, surgical tape
Diagnostic Lab Data: none
CDC Split Type:

Write-up: when I awoke the next morning, I had extreme fatigue, a headache, and my arm had a rash at the vax site. It''s still there. It''s itchy and red and like a hard lump. Also, it''s warm compared to the surrounding skin. Makes my arm hurt. The fatigue and headache were pretty much exactly like when I had COVID-19 in November last year. I was instructed to get the booster because I work in a healthcare setting.


VAERS ID: 1788321 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: Error: Incorrect Reconstitution-


VAERS ID: 1788328 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Product preparation issue
SMQs:, Medication errors (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: Error: Incorrect Reconstitution-


VAERS ID: 1788340 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness, Computerised tomogram, Differential white blood cell count, Dizziness, Electrocardiogram, Fibrin D dimer, Full blood count, Human chorionic gonadotropin, Hyperhidrosis, Hypoaesthesia, Incoherent, Metabolic function test, Migraine, Pharyngeal swelling, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Junel (1/20)
Current Illness: Symptoms experienced 8 hours after receiving vaccination: (2) syncope events, severe migraine, loss of vision, loss of feeling in all extremities (legs/feet, hands), throat swelling, and excessive sweating, dizziness, incoherency
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Tests conducted on 14 Oct 2021: CT SCAN, COMPREHENSIVE METABOLIC PANEL, D-DIMER, ECG, CBC W/PLAT AUTOMATED DIFF, HCG
CDC Split Type:

Write-up: (2) syncope events, severe migraine, loss of vision, loss of feeling in all extremities (legs/feet, hands), throat swelling, and excessive sweating, dizziness, incoherency


VAERS ID: 1788343 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-10-02
Onset:2021-10-14
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Military       Purchased by: ?
Symptoms: Cardiac disorder, Catheterisation cardiac, Chest pain, Dyspnoea, Electrocardiogram abnormal, Fibrin D dimer increased, Troponin increased
SMQs:, Anaphylactic reaction (broad), Haemorrhage laboratory terms (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol, clobetasol
Current Illness: none
Preexisting Conditions: OSA w/ CPAP Obesity, BMI 36 Asthma WPW, ablation in 2009. Persistent pain but cleared by cardiologists x 2 with neg cardiac cath in 2013 Eczema HTN
Allergies: Latex, seafood
Diagnostic Lab Data: Troponin - 0.092 D-Dimer - 1.02 Unable to view ECG or cardiac cath report
CDC Split Type:

Write-up: MI on 14 OCT while performing vigorous physical exertion as an patient in 80 degree heat for several hours. Complained of CP and SOB and presented to the field aid station. No cardiovascular findings on PE but sent to ER for eval after reported "previous heart surgery." PMH of WPW ablation in 2009. Sent to hospital with pos ECG and elevated Troponins and D-Dimer. Evacuated to Hospital for cardiac cath on 14 OCT. Released on 15 OCT


VAERS ID: 1788348 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Triamterine HCZT, Atorvastatin, Claritin, Zinc, D3, vit C, multi vitamin Ajovy inj monthly
Current Illness:
Preexisting Conditions: hyperlipidemia
Allergies: PCN,
Diagnostic Lab Data:
CDC Split Type:

Write-up: large raised knot at injection site approx 3 inches in diameter. Area is red, hot and painful


VAERS ID: 1788352 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 2 AR / IM

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

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

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


VAERS ID: 1788355 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 2 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Additional Details: Patient also received Flulaval Quadrivalent Flu Vaccine on same day. Few seconds after 2nd COVID shot, patient fainted and slumped forward. She regained consciousness after a few more seconds with low blood pressure and low heart rate. She felt lightheaded right before fainting. Nurse practioner monitored her for another 20 minutes and patient was back to normal.


VAERS ID: 1788362 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Headache
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Severe, Systemic: Headache-Severe, Systemic: Weakness-Severe


VAERS ID: 1788372 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient experienced SOB and was syncopal


VAERS ID: 1788373 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Illinois  
Vaccinated:0000-00-00
Onset:2021-10-14
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test negative, 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: Aspirin; Atorvastatin; carvedilol; Duloxetine; Furosemide; Gabapentin; Hydralazine; Lisinopril; Plavis;
Current Illness: ESRD; Diabetes; Peripheral Vascular Disease
Preexisting Conditions: End Stage Renal Disease on Hemodialysis
Allergies: Metformin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admitted to the hospital on 9/27/21, at that time tested negative for COVID by NAAT. On 10/07/2021 tested negative for COVID by NAAT. On 10/14/21 tested Positive for COVID by NAAT in preparation to be discharged to acute Rehab. Repeat testing by PCR for COVID on the same day was negative.


VAERS ID: 1788384 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 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: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1788386 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Back pain, Chills, Decreased appetite, Headache, Myalgia, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall 20 mg (once daily) Losartan 100 mg (once daily)
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pain all over the body as if was in a car accident. Every muscle and joint was hurting. Extreme back pains, chills, loss of appetite, fever and headache. Upper chest area sore from shoulder, right leg and but cheek is sore.


VAERS ID: 1788389 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 RA / 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: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1788393 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 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: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1788403 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1788406 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Injection site pain, Skin exfoliation
SMQs:, Severe cutaneous adverse reactions (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient removed the bandaid from the injection site the same evening as her injection. She got into the shower and felt stinging on the injection site. She looked and noticed a nickel size area where her top layer of skin had slid off. Patient came back to the clinic the following day 10/15/2021 where she showed me her injection site. I advised her to contact her primary care doctor and to report it to vaers. It was unclear if it was caused by vaccine, bandaid or someother reaction to creams/lotions/sprays.


VAERS ID: 1788409 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FS2590 / 3 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1788415 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Underdose
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: Error: Wrong Dose of Vaccine - Too Low-


VAERS ID: 1788419 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Underdose
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: Error: Wrong Dose of Vaccine - Too Low-


VAERS ID: 1788425 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Flushing, Hyperhidrosis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Flushed / Sweating-Mild, Additional Details: resolved under 15 minutes. patient was given a bottle of water.


VAERS ID: 1788431 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Hypotension
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Hypotension-Mild, Additional Details: Pt received the flu shot and Pfizer 3rd dose on 10/14/2021. after vaccine administration during the 15min wait time, pt became dizzy and light headed. Vital signs taken Bp 100/60 HR 70, SP02 99% on room air, FSBS 87, patient placed in siting position and verbalized that he started feeling better, and he stated that he usually vasovagals after blood draws and he suffers from hypertension. Patient also verbalized his father died from covid 1 week prior. EMS arrived and transported patient.


VAERS ID: 1788447 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bell's palsy, Hypoaesthesia, Injection site pain, Pain
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hearing impairment (broad), Sexual dysfunction (broad)

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

Write-up: Site: Pain at Injection Site-Severe, Systemic: Bell''s Palsy-Medium, Systemic: Numbness (specify: facial area, extremities)-Medium, Additional Details: Patient returned approximately 1 hour after receiving Pfizer booster complaining of pain radiating from inject site up into left side of face. Advised to seek immediate medical attention. Returned with MD orders for Medrol dose pack.


VAERS ID: 1788454 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-26
Onset:2021-10-14
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Atrial fibrillation, Blood magnesium, Blood thyroid stimulating hormone, Brain natriuretic peptide, Cardiomegaly, Computerised tomogram head, Computerised tomogram thorax, Differential white blood cell count, Dizziness, Electrocardiogram, Fibrin D dimer, Fibrosis, Full blood count, International normalised ratio, Metabolic function test, Nausea, Pleural thickening, Pulmonary mass, Toothache, Troponin I, Urine analysis, Vertigo positional, Vomiting
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Lab Tests Completed BRAIN NATRIURETIC PEPTIDE COMPREHENSIVE METABOLIC PANEL D-DIMER QUANTITATIVE LAB ONLY-COMPLETE BLOOD COUNT WITH DIFFERENTIAL MAGNESIUM PROTIME/INR TROPONIN I TSH URINALYSIS DIPSTICK REFLEX TO MICROSCOPIC URINALYSIS MICROSCOPIC Icon Imaging Orders Placed Today Imaging Tests CT HEAD WITHOUT CONTRAST CTA CHEST EKG
CDC Split Type:

Write-up: 71yr old male who presents ambulatory to ED with complaints of dizziness, lightheadedness, and vomiting. Patient states he started throwing up this morning around 0800 and vomited about seven times, which stopped at 1100. Patient states he became nauseous and vomited after turning his head quickly and when he opened his eyes suddenly. Patient states he took some ibuprofen around 1100. Patient called clinic and they advised him to come into ED. Patient rates pain 5/10 to his tooth upon arrival. DIAGNOSIS 1. New onset a-fib 2. Dizziness ASSESSMENT/PLAN/DECISION MAKING: 1. New onset a-fib 2. Dizziness -1715: Assessed patient, placed order for labs/ekg - labs pending, EKG shows new-onset atrial fibrillation. Patient denies cardiac history besides hypertension. Prior EKG studies on hand (2016) do not show a-fib. - 1800: Turned over care of patient to oncoming ER provider Differential diagnosis includes benign positional vertigo although testing is negative, labyrinthitis. CT scan will rule out any intracranial abnormalities. His D-dimer was elevated and he has atrial fibrillation and that is why we will obtain a CTA to rule out pulmonary embolism. His atrial fibrillation appears to be newly diagnosed. We are not sure how long he has been having this condition. He is rate controlled and he is on a beta-blocker. CTA "1. No acute pulmonary embolism identified. 2. Extensive pleural thickening and pleural nodularity left greater than right lungs. Although this could represent asbestosis, mesothelioma or pleural-based metastases are not excluded. I would recommend PET/CT for further evaluation. 2. A few scattered pulmonary nodules are present. Largest is a triangular 9 mm nodule along the minor fissure most likely representing a fissural lymph node but warrants attention on follow-up imaging. There is also a 4.5 mm subpleural nodule right lung base. 4. Severe cardiomegaly. 5. Mild subpleural reticulation suggestive of scarring/fibrosis. 6. Soft tissue right tracheal lumen at the thoracic inlet potentially representing secretions although a soft tissue nodules not excluded. Attention on follow-up imaging is recommended.


VAERS ID: 1788456 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Fatigue, Injection site erythema, Injection site swelling, Lethargy, Lymphadenopathy, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Site: Redness at Injection Site-Mild, Site: Swelling at Injection Site-Medium, Systemic: Body Aches Generalized-Medium, Systemic: Chills-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: Fever-Medium, Systemic: Joint Pain-Medium, Systemic: Lymph Node Swelling-Mild


VAERS ID: 1788459 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

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

Write-up: Fever Headache Vomiting Nausea Fatigue Soreness of injection site


VAERS ID: 1788466 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / UNK AR / IM

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

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

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


VAERS ID: 1788480 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-08-05
Onset:2021-10-14
   Days after vaccination:70
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 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? 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: unknown


VAERS ID: 1788481 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Interchange of vaccine products, No adverse event
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: depression parkinsonism chronic venous insufficiency of lower extremity coronary artery disease type 2 diabetes glaucoma, bilateral chronic low back pain benign prostatic hyperplasia osteoarthritis of both knees peripheral vascular disease
Allergies: meperidine - rash penicillin - rash
Diagnostic Lab Data: none
CDC Split Type:

Write-up: no adverse reaction. Patient was given Pfizer in error as 3rd dose. Patient''s previous 2 doses were Moderna. (I don''t know how the 3rd dose appt was made; unclear from the information I have access to whether this patient is immune-compromised and was supposed to actually get a 3rd Moderna dose.)


VAERS ID: 1788489 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Feeling cold, Flushing, Hyperhidrosis, Hypopnoea, Loss of consciousness, Nausea, Pain, Syncope, Tremor, Unresponsive to stimuli, Vision blurred, Visual impairment, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

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

Write-up: Systemic: Body Aches Generalized-Mild, Systemic: Chills-Mild, Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Mild, Systemic: Nausea-Severe, Systemic: Visual Changes/Disturbances-Severe, Systemic: Vomiting-Medium, Additional Details: Customer sitting next to the patient came to the pharmacist and reported a man had passed out. Rph went over to examine the patient. Patient was unresponsive apon arrival. Pulse 54, shallow breathing. Patient started to regain consciousness. Patient was shaking, sweating, cold, and vomiting. Pt stated "very nauseous, blurred vision, no trouble breathing." Pt symptoms were not resolving after a few minutes pass. Rph instrcuted tech to call 911. Rph waited with the patient until EMS arrived.


VAERS ID: 1788493 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-20
Onset:2021-10-14
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 - / -

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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: ADMITTED TO HOSPITAL FOR COVID


VAERS ID: 1788494 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 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: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1788503 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301258A / 3 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Apraxia, Ataxia, Blindness, Computerised tomogram head normal, Confabulation, Drooling, Extra dose administered, Hyperhidrosis, Influenza virus test negative, Laboratory test normal, Mental status changes, Pain in extremity, Restlessness, SARS-CoV-2 test negative
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Retinal disorders (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Sinemet, Lisinopril, Metformin,VitB12,Vit D3, Xarelto,Ambien
Current Illness: None
Preexisting Conditions: Parkinson''s Disease, Type 2 Diebetes Mellitus, Hypertension
Allergies: No known allergies
Diagnostic Lab Data: CT scan negative for CVA per hospital report. Further tests conducted and results unknown by facility at this time.
CDC Split Type:

Write-up: Resident had previously recieved two doses of the Pfizer COVID19 vaccine on 01/12/2021 and 02/02/2021. No side effects were reported following these immunizations. At 1445 on 10/15/2021, Patient recieved his third dose of the vaccine. At the time of administration the resident denied having any signs or symtoms of illness temperature was 98.1 F at the time of administration. No reactions were reported or observed from 1445 until 1700. At 1700, the resident was ambulating self from the dining room after dinner with an ataxic gait.He described to the nurse that he "can not see" but was unable to describe any other symptoms. The nurse noted confabulatory responses during assessment. Resident was alert only to self, unable to follow basic commans. Unable to follow neuro assessment. Resident was noted by the nurse to be profusely diaphoretic, drooling, restless, and without facial droop. Resident was transported via EMS to Hospital Emergency Department for evaluation. Vitals at the time of transfer to hospital BP 130/84, HR 88, Resp 16, Temp 98.3F, SpO2 98% on RA. The resident''s first report of symptoms occured approximately two hours and 15 minutes after vaccine administration. The time between reported symptoms and departure from the facility via EMS was 10 minutes. Resident was kept overnight in the emergency department for observation. Hospital Update 10/15/21 at 0830, the hospital reported the resident to be in continued observation, CT scan negative for CVA, with only complaint of unilateral leg pain. Hospital Update 10/15/21 at 1500: Admitted for acute mental status change, negative for flu, negative for COVID. Pending neurologist assessment with possible MRI to be completed. Lab results unremarkable. Resident eager to return to facility. All previously reported symptoms resolved at this time.


VAERS ID: 1788507 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect product formulation administered
SMQs:, Medication errors (narrow)

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

Write-up: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1788518 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Client has history of feeling dizzy when receiving any vaccines, fear of needles. No dates or names of vaccines provided.
Other Medications: none stated by patient.
Current Illness: None stated by patient.
Preexisting Conditions: None stated by patient.
Allergies: Allergies to seafood (not specified) reaction: rash Allergy to clothing materials (not specified) reaction: rash and itchiness
Diagnostic Lab Data: no medical test or laboratory tests done.
CDC Split Type:

Write-up: Client reported feeling dizzy at 14:44 after being vaccinated in the gravity chair. Client remained in gravity chair, placed chair in semi fowlers position. Pt was alert and oriented x4, warm to touch, no cyanosis, and no pallor assessed. At 14:45 initial vitals: blood pressure: 106/62, heart rate:63, respiratory rate: 16, 0xygen saturation 98%. Vitals remained stable during client''s evaluation. Client denied having shortness of breath, trouble swallowing, nausea, and vomiting. Client denied any tingling in the hands or fingers. Client states, the top number is between 90 and 100''s. Client did not drink water and only had a fruit the entire day Patient given water and a snack. Dizziness resolved at 14:54 pm. Client states, ?I feel fine and better than I was before.? At 15:15 vitals: blood pressure: 108/64, heart rate: 59, oxygen saturation: 99%, respiratory rate:16. Provided education on VAERS reporting, signs of anaphylactic reactions, and when to call 911. Recommended patient follow-up with MD regarding heart rate between 57 at 15:16. Heart rate returned to 64 at 15:19. Recommended patient follow-up with doctor regarding eligibility for second dose of Pfizer. Patient made aware to continue to inform vaccinators of dizziness episodes after vaccine administration. Patient verbalized understanding of all information given. Client stood from gravity chair with lead RN standing by, no complaints of dizziness. Client ambulated independently out of the facility at 1520, plans on taking the trolley, and escorted out by EMT.


VAERS ID: 1788521 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Other       Purchased by: ?
Symptoms: Heart rate abnormal, Malaise
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (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: Cranberry pill Lovastatin 10mg Lisinopril/Hydrocholorthizide 10/12.5mg
Current Illness: HTN Pulmonary HTN
Preexisting Conditions: HTN
Allergies: Tegretol
Diagnostic Lab Data:
CDC Split Type:

Write-up: Had the booster vaccine 10/13/21 began feeling not well on 10/14/21 contacted wellness nurses on 10/15/21 assessed with 28 apical heartrate and sent 911 to the hospital emergency room.


VAERS ID: 1788532 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 RA / IM

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

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

Write-up: Patient presented on 10-14-21 as second dose for Pfizer COVID19 vaccine, with documentation of what she reported as first dose received on 9-23-21. She was vaccinnated by us for presumed second dose on 10-14-21. However, upon entering dose record into the system, it was determined that she had received an initial dose of Pfizer COVID19 vaccine on 7-15-21, which she did not disclose to us. So she received a third dose of Pfizer vaccine at day 21 after second dose. This would be considered a dose timing error and an error in that she received an additional/third dose that she did not qualify for. No side effects or other adverse effects were noted.


VAERS ID: 1788534 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-01
Onset:2021-10-14
   Days after vaccination:135
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / UNK AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Dyspnoea exertional, Infection, Polymerase chain reaction positive
SMQs:, Anaphylactic reaction (broad), Pulmonary hypertension (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: ?Fatty heart?
Allergies: No
Diagnostic Lab Data: PCR positive Oct 7 and 14
CDC Split Type:

Write-up: dry cough dyspnea on exertion breakthrough infection requiring admission


VAERS ID: 1788538 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-29
Onset:2021-10-14
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysmenorrhoea, Heavy menstrual bleeding
SMQs:, Haemorrhage terms (excl laboratory terms) (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: care/of prenatal fish oil
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: heavy period severe increase in menstrual pain


VAERS ID: 1788542 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Anxiety, Chest pain, Dyspnoea, Electrocardiogram normal, Pain
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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:
Current Illness: No acute conditions informed.
Preexisting Conditions: Hx. of cancer with ongoing medical treatment
Allergies: Sulfa-drugs, Compazine
Diagnostic Lab Data: Pt''s VS-B/P-127/84, HR-102, RR-20, T-97.6 PO, SPO2-96-97%RA with pain 6/10. 12 lead EKG done showing NSR at 92 BPM, non STEMI or ectopy noted.
CDC Split Type:

Write-up: Patients arrives with a CC of SOB and left sternal chest pain with onset 24 hours after taking booster for COV-19 procedure. Patient was anxious and arrived to medical facility by her own means and without assistance. Patient was seen by provider and RN along with initiation of SBAR and transported to local ER for further evaluation. cancer.


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