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

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



Case Details (Reverse Sorted by Onset Date)

This is page 173 out of 6,611

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VAERS ID: 1535628 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Condition aggravated, Hypoaesthesia, Immediate post-injection reaction, Paraesthesia, Vision blurred
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypersensitivity (narrow), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None as of yet. Symptoms will be reported to Doctor tomorrow, August 10, 2021.
CDC Split Type:

Write-up: Immediate: weakness and blurred vision. Difficulty focusing my eyes. This lasted through the evening of July 30th. Since the 30th, (a little over a week now) my carpal tunnel symptoms seem much more severe! I?m experiencing numbness and tingling in my fingers and entire hands, both left and right . The right seems more intense. I have a scheduled appointment with my rheumatologist tomorrow, August 10th for a follow up and plan to discuss this with him.


VAERS ID: 1535933 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Bone pain, Fatigue, Headache, Malaise, Nausea, Pain, Pain in extremity, Pyrexia, Vertigo
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow), Osteonecrosis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Upset stomach, fatigue, body aches, malaise. Soreness in left arm down to ''bone''. Feverish throughout the day, duration of side effects have lasted for up to 1 week. Nausea the next day. Headache and some vertigo like symptoms for next three days after vaccine. Ibuprofen was taken to help with aches


VAERS ID: 1535947 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-21
Onset:2021-07-30
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid 50 mcg once daily 2 fish oil capsules daily 1 multi B-vitamin daiy Lunesta Lyrica
Current Illness: none
Preexisting Conditions: Hypothyroidism
Allergies: Penicillin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Red, itchy rash approximately 5 inches by 3 inches on left deltoid in the area of the vaccine injection.


VAERS ID: 1536040 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / IM

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

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

Write-up: Swollen Lymph Node - still present today 08/09/21


VAERS ID: 1536120 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-27
Onset:2021-07-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Injected limb mobility decreased, Limb discomfort, 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: Vimpat, flonase, pepcid, ranexa, coreg, plavix, zoloft, lasix, imdur, protonix, aspirin, nitro, pravastatin, gabapentin, xanax, zyrtec, valtrex, ventolin albuterol inhaler, stiolto respimat inhaler, buspar, trazodone
Current Illness: Heart failure, congestive heart disease
Preexisting Conditions: Heart failure, congestive heart disease
Allergies: Nicotin patch
Diagnostic Lab Data: None
CDC Split Type:

Write-up: About 2 days after 2nd vaccine injection left arm began hurting and has only become worse over time. Arm feels very heavy, extremely sore going up into my neck. Hard to use arm because of pain


VAERS ID: 1536137 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-03-04
Onset:2021-07-30
   Days after vaccination:148
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Chest discomfort, Cough, Fatigue, Infection, Pyrexia, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: velcade/Dara/Revlimid acyclovir bid calcium with D vitamin B12 nexium 20mg hydroxyzine PRN probiotic (lactobacillus) mvi naproxen zofran oxybutynin
Current Illness: multiple myeloma in active treatment
Preexisting Conditions: multiple myeloma in active treatment
Allergies: hydrocodone
Diagnostic Lab Data: COVID positive on 8/7/21
CDC Split Type:

Write-up: Breakthrough COVID pneumonia, hypoxic respiratory failure, fever, cough, fatigue, chest tightness


VAERS ID: 1536211 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-06-29
Onset:2021-07-30
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / UNK LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest injury, Chest pain, Coronavirus test negative, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Cold/flu symptoms
Preexisting Conditions: Traumatic brain injury
Allergies: Penicillin and nickel
Diagnostic Lab Data: ER visit on June 30, 2021. Coronavirus test on August 6, 2021 came back negative.
CDC Split Type:

Write-up: On June 30, 2021, I had an injury to my chest. I developed chest pain, difficulty with breathing deeply, and shortness of breath. On August 9, I still have all of those symptoms and the chest pain has worsened slightly.


VAERS ID: 1536323 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-15
Onset:2021-07-30
   Days after vaccination:137
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Anosmia, Anticoagulant therapy, Asthenia, COVID-19, Cough, Dyspnoea, Dyspnoea exertional, Headache, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fully vaccinated patient presented to ED for evaluation of weakness, fever, cough, SOB. She was found to be COVID+ originally on 7/30 and discharged to home on Ivermectin . Sx progressed and she was admitted on 8/5/21. She reports loss of taste and smell. No N/V/D. Some headache on admission. Patient was treated with remdesivir x 5 days, decadron (day 5 of 10), Breo, Singulair, Albuterol, Eliquis 2.5 mg BID x 14 days, and ordered home oxygen as pt has SOB on exertion. Discharged to home on 8/9/21.


VAERS ID: 1536397 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-01
Onset:2021-07-30
   Days after vaccination:151
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cellulitis, Herpes zoster, Pyrexia, Rash, Skin burning sensation, Tremor
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Bisoprolol Candascartan Spironolactone
Current Illness: None
Preexisting Conditions: Managed and controlled High blood pressure Managed overproduction of adolsterone
Allergies: None
Diagnostic Lab Data: Met with doctor at hospital ER Aug 2 and treated aggressively with IV antibiotics, steroids and then transitioned to oral antibiotics for a week.
CDC Split Type:

Write-up: July 30, 2021 suddenly developed shingles. By August 2, I saw medical doctor and was diagnosed with shingles allows flesh opening transitioned to cellulitis. High fever, shakes, fast moving rash around the neck and burning skin.


VAERS ID: 1536436 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-03-17
Onset:2021-07-30
   Days after vaccination:135
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Acute kidney injury, Acute myocardial infarction, COVID-19 pneumonia, Chronic kidney disease, Inappropriate schedule of product administration, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Myocardial infarction (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, arterial (narrow), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (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: acetaminophen, aspirin, atorvastatin, calcium carbonate/vitamin, cetirizine, cinnamon bark, cyancobalamin, cyclobenzaprine, escitalopram, famotidine, fergon, furosemide, lower bowel stimulator herbal supplement, Norco, Humalog 75/25, kapspa
Current Illness:
Preexisting Conditions: Patient Active Problem List Diagnosis Date Noted ? Pneumonia due to COVID-19 virus 07/30/2021 ? Acute kidney injury superimposed on chronic kidney disease (CMS-HCC) 07/30/2021 ? NSTEMI (non-ST elevated myocardial infarction) (CMS-HCC) 07/30/2021 ? CHF (congestive heart failure) (CMS-HCC) ? Coronary artery disease ? History of hypothyroidism ? Hx of sleep apnea ? Hyperlipidemia ? Diabetes mellitus type 2, uncomplicated (CMS-HCC) Past Medical History: Diagnosis Date ? Anemia ? CHF (congestive heart failure) (CMS-HCC) ? Coronary artery disease non obstructive CAD ? Diabetes mellitus type 2, uncomplicated (CMS-HCC) IDDM ? History of hypothyroidism reverted to hyperthyroid after AVR ? Hx of cardiac cath 1/2016 non obstructive CAD ? Hx of echocardiogram 3/30/16 EF 60-65% nl. LV size & nl. RVSF (full report in Care Everywhere) ? Hx of sleep apnea ? Hyperlipidemia ? Hyperthyroidism, unspecified
Allergies: no known drug allergies, no known food allergies
Diagnostic Lab Data: 7/30/21 COVID-19 virus detected
CDC Split Type:

Write-up: Patient admitted to Hospital on 7/30/21 with pneumonia due to COVID-19 infection. The patient was fully vaccinated with a 2 dose series of Moderna COVID-19 vaccine on 2/21/21 and 3/17/21.


VAERS ID: 1536446 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspnoea, Hypersensitivity, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. reported to vaccine checkout window after 30 minute observation period stating she had an allergic reaction in the waiting room. Pt. reports not wanting to tell nurse due to frequently having allergic reactions. Pt reports trouble breathing and tingling in the chest but it resolving. Pt reports getting reactions to insect stings all the time and knowing if it''s bad enough or not. Pt declined evaluation by medical staff. Pt given follow-up precautions.


VAERS ID: 1536456 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-02-01
Onset:2021-07-30
   Days after vaccination:179
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Dyspnoea, Fibrin D dimer, Malaise, Myalgia, Oropharyngeal pain, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: History of lung cancer, status post right lower lobe lobectomy, chronic steroid use due to polymyalgia rheumatica, hypertension, hyperlipidemia
Allergies: NKDA
Diagnostic Lab Data: 8/7: D-dimer 1.28 mg/L; WBC 6.5 New O2 requirements (up to 9L on 8/7)
CDC Split Type:

Write-up: Fully vaccinated patient (Moderna dose #1 2/2/21, dose #2 3/10/21) began experiencing COVID symptoms 7/30/21. Symptoms included shortness of breath, chills, myalgia, and sore throat. Admitted to Medical Center 8/7/21. Patient still admitted on hospital day 3.


VAERS ID: 1536510 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Electrocardiogram, Headache, Restlessness, Supraventricular tachycardia
SMQs:, Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Dementia (broad), Akathisia (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Restlessness, SVT, dizziness, HA


VAERS ID: 1536587 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Circumstance or information capable of leading to medication error, Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

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

Write-up: Vaccine given to an 11 year old patient, wrong birthday supplied on forms.


VAERS ID: 1536603 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Minocycline 100mg capsule, spironolactone 100mg tablet, tri-lo-marzia tablet, fluoxetine hcl 20 mg capsule, magnesium 500mg, vitamin c 500mg, biotin 10,000mcg, probiotics
Current Illness: Pre- diabetic
Preexisting Conditions:
Allergies: Dairy intolerance
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chest pain for 1 day, the day of vaccine, lasting for a few hours


VAERS ID: 1536614 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-15
Onset:2021-07-30
   Days after vaccination:137
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19 pneumonia, Hypoxia
SMQs:, Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (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: Hospital admission due to hypoxia and COVID-19 pneumonia following full vaccination


VAERS ID: 1536633 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 3 RA / IM

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

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

Write-up: Medication Error- Gave a 3rd dose. 2nd dose was given 1-27-2021. First dose was given 12/30/2020.


VAERS ID: 1536653 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

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

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

Write-up: Vaccine given to an 11 year old patient, wrong birthday supplied on forms.


VAERS ID: 1537788 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heart rate irregular
SMQs:, Cardiac arrhythmia terms, nonspecific (narrow)

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

Write-up: Heart rate 155 while resting and irregular. I have no other medical problems. Heart beat also felt irregular.


VAERS ID: 1539346 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: North Carolina  
Vaccinated:0000-00-00
Onset:2021-07-30
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chills, Decreased activity, Eye disorder, Eye pain, Headache, Pain in extremity, Peripheral swelling, Pyrexia, Skin discolouration, Vision blurred
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Lens disorders (broad), Corneal disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Blurry vision; Skin discoloration (The ones on right shin were already there before vaccine but less pronounced, also worse when standing.); Varicose veins (Just the veins pop out only when standing.)
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210815086

Write-up: BLURRED VISION; LEFT EYE HAS BEEN ACHY; LEFT EYE HAS BEEN SENSITIVE; PERSISTENT HEADACHE/DULL HEADACHE RIGHT BEHIND FOREHEAD; DULL ACHE IN LEGS /PAIN IN LEGS; CHILLS; FEVER; HASN''T BEEN ACTIVE; SWELLING IN LEGS; PURPLEISH LARGE PATCH ABOUT SIZE OF NICKEL OR QUARTER ON BOTH SHINS UNDER THE SKIN/ WORSE WHEN STANDING; This spontaneous report received from a patient concerned a 53 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: varicose veins, dark spots on right shin, and tiny bit of blurriness in left eye regardless as an underlying issue. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 205A21A, expiry: UNKNOWN) dose was not reported, administered on 30-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 30-JUL-2021, the patient experienced swelling in legs. On 30-JUL-2021, the patient experienced purpleish large patch about size of nickel or quarter on both shins under the skin/ worse when standing. On 30-JUL-2021, the patient experienced hasn''t been active. On 30-JUL-2021, the patient experienced dull ache in legs /pain in legs. On 30-JUL-2021, the patient experienced chills. On 30-JUL-2021, the patient experienced fever. On 02-AUG-2021, the patient experienced blurred vision. On 02-AUG-2021, the patient experienced left eye has been achy. On 02-AUG-2021, the patient experienced left eye has been sensitive. On 02-AUG-2021, the patient experienced persistent headache/dull headache right behind forehead. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from persistent headache/dull headache right behind forehead, blurred vision, left eye has been achy, and left eye has been sensitive, and the outcome of fever, swelling in legs, purpleish large patch about size of nickel or quarter on both shins under the skin/ worse when standing, chills, dull ache in legs /pain in legs and hasn''t been active was not reported. This report was non-serious.


VAERS ID: 1540147 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 5 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Nodule, Skin warm, Sleep disorder, Vaccination complication
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: Lisinopril, Atenolol
Current Illness: None
Preexisting Conditions: High Blood Pressure
Allergies: Codeine
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: I may have what they call COVID arm? I still have a sore spot (small red circle) on my left arm where I received the injection and today is day 11 afterwards. It is still warm and there is lump under my skin about the size of a nickel and very painful - still waking me up at night.


VAERS ID: 1540352 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine, ferrous sulfate, labetalol, lisinopril, metoprolol, vitamin D (note meds NOT verified at time of event, based on review of medical record).
Current Illness: none
Preexisting Conditions: hypertension elevated BP obesity type 2 diabetes vitamin D deficiency
Allergies: wheat, shellfish
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Vaccine 9 days past beyond-use date


VAERS ID: 1540362 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-28
Onset:2021-07-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 08/04. Received chest XRays, Blood pressure, oxygen. Oxygen level 98%, xray negative.
CDC Split Type:

Write-up: Received the 1st of 2 shots of covid -19 vaccine on 7/28 at the pharmacy. Injection site was my left shoulder. After 2 days, began to feel chest tightness, heart feels like there is inflammation. Also shortness of breath and light headed mess. Went to immediate care and was prescribed albuterol inhaler and Azithromyacin 5 day antibiotic treatment. Tightness and inflammation still present after completing dr prescribed treatment.


VAERS ID: 1540469 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, Arthralgia, Asthenia, Bell's palsy, Chest discomfort, Cough, Dysgeusia, Dysstasia, Energy increased, Erythema, Facial paresis, Flatulence, Gait disturbance, Headache, Hypersensitivity, Hypoaesthesia, Injection site pain, Insomnia, Mobility decreased, Muscle tightness, Myalgia, Nausea, Neuralgia, Pain, Pain in extremity, Pain in jaw, Pain of skin, Paraesthesia, Peripheral swelling, Photophobia, Respiratory tract irritation, Sensory disturbance, Sensory loss, Sinus disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (narrow), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Hearing impairment (broad), Osteonecrosis (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Finasteride, minoxidil, vitamin D, vitamin K2, zinc, horse chestnut, rutin, ashwagandha, whey protein.
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Swab test of face indicated a partial loss of sensation. Upcoming: MRI, EMG nerve tests, blood work
CDC Split Type:

Write-up: Day 1: Within a few minutes of left arm injection of Pfizer vaccine my fingers go numb on left hand. Several minutes later my right leg gets a slight numb feeling. A few minutes later while I''m still at the vaccination site, the right side of my face starts to go numb and I experience muscle tightness like my jaw is clenching. During this the nurse who injected me apologizes repeatedly saying she only wanted to help people. Nurses observe me for Bell''s and discuss the possible use of a steroid. I am told that I may have a sensitive nervous system and a strong immune system as this is happening. The nurses suggest I go to my doctor, then urgent care, and finally the ER in an ambulance. My mom who was also vaccinated starts crying. I decline. The head nurse/researcher from hospital says instead she will call me every 30 minutes. My shoulder where I was injected gets increasingly sore through the night. Day 2: The feeling comes back to my fingers about 24 hours later and the pain went away at the injection site by 36 hours. On the second night, I got severe abdominal gas pain like a stabbing sensation. I was nauseated and pain was so severe I couldn''t even move. Briefly had a strange metallic taste in mouth. My right side leg and face remain numb. Day 3: Stomach pain is gone. My calf and the back of quad began to get occasional shooting pain if I walked quickly or went up/down stairs. By the end of the night sensation and muscle strength suddenly came back to my face and my right leg. I feel a strange sensation in my sinsues and chest like the last days of a cold. Day 4: My knees became red and very painful. I had trouble sleeping as a result of the pain. My calf and quad continue to experience pain when walking fast, driving (calf muscle is used to press the gas and brake pedals), and using stairs. By end of day noticed left knee was much more red and red line going from knee to ankle. Day 5: Woke up and immediately felt some numbness and weakness on right side of face, covering a larger area than originally. This time from the eyelid to chin and nose to ear instead of just over the cheekbone. Numbness is less than previously, but covering a much larger area of the face. Similar feeling to sleeping on a part of your body, but the numbness does not pass. Mild pain was also observed in a lower section of left calf muscle for first time. Knees feel better than previous day, but knees remain red with a red line going down to ankle. Doctor prescribed high-dose prednisone. Doctor indicates that delaying steroid treatment puts me at risk of permanent damage, recurrent Bell''s Palsy and potentially even Guillain-Barre. He says these conditions are known to be caused by vaccines. Pharmacist agrees with doctor and advises to take prednisone immediately. The nerve pain in my legs is increasing and the feeling of Bell''s Palsy is getting more intense in my face. After discussing side effects with friends and family, I decide to take prednisone. Day 6: I am taking 50mg prednisone for 5 days. I make a big breakfast with milk and take my first pill before 6 am. I haven''t gotten much sleep, but I feel a lot of energy. My face feels much better with none of the numb paresthesia sensation right now. My legs are still painful from the ankles to the knees. My mood feels good, but otherwise don''t feel any side effects. Day 7: Having trouble sleeping from severe pain in legs and knees. Prednisone is making it hard to get sleepy. I am experiencing extreme anxiety, racing heart and am unable to sleep at all. By the afternoon my leg pain is much less than the night before, but still present. The nerves on the side of the knee going to the back are very sensitive. My right and left hands have a strange almost carpal tunnel sensation going down the pinky side. My appointment with the neurologist does not produce many answers and she seems confused by the transcience of my symptoms. Symptoms become noticeably more severe at night with pain shooting up from my shins to lower thighs with every step I take. I am concerned that nerve pain is gradually going up higher on my legs. I try desperately to sleep all day. I am able to finally dose off late at night in a recliner. Day 8: I wake up feeling great after finally getting some sleep. I don''t notice any pain at first and am relieved, but then as I walk to the bathroom and kitchen, the initial numb feeling I had a week ago starts to return to my right cheek and right calf muscle. Vine-like nerve pain is starting to return to my shins and calves with every step I take. I quickly make a big breakfast and take 50mg prednisone knowing I will probably struggle to sleep again. I put on classical music to try to lower my anxiety. It''s been a week now and I just want to get back to my life. By afternoon my face begins to feel better and the pain in my legs is more manageable, but still noticeable and present. Initially going down stairs I have to hold a railing and when doing my laundry I choose to sit instead of stand, but as afternoon approaches I feel less pain. At night I notice occassional shooting pains across sides of head. I decide to drink water and try to relax by watching a movie. At night I notice a cough and tickle in chest. Throughout the week I have noticed that some paresthesia/neuralgia occurs almost like an echo after I''ve been griping/pressing against something tightly (steering wheel/doorknob) or leaning against something. It happens on both my hands and legs. Day 9: Wake up with mild numbness all over right side of face again, observe mild but greatly reduced nerve pain in legs. Some nerve pain remains around the back of the knee and the shins. This is my 4th day on prednisone. I''ve noticed an occaional cough starting last night. The tickle in the chest is gradually becoming more irritating. The echo pain continues in my hands like when I grab a doorknob tightly or hold my smartphone. Sensation it reminds me of is carpal tunnel or arthritis. Driving at night I notice that bright headlights are hurting my eyes. Day 10: Wake up with similar mild facial numbness and mild nerve pain around knees. I take a 5th prednisone pill. Chest tickles a little but not too bad. The past two days the pain has been much more manageable. I''m not sure how big of a role prednisone is playing in alleviating the paresthesia, but I will find out in the coming days without it. After my shower I notice that the left leg has a lot of redness and stinging pain. Knee and top of foot is very red with red line running from foot to knee. Right leg has some redness but it is much less pronounced, becoming more painful toward the evening. Mild numbness of the face is felt throughout the day and into night. My eyelid feels more paresthesia. When I laugh I notice that my jaw hurts around the lower part of my ear. I''m still noticing that bright lights are unbearable at night. I don''t know if this is related to prednisone or something else. Day 11: Relieved to wake up with full feeling in my face in the morning and no more pain in jaw/under ear. My legs start hurting while I am standing on them to make breakfast or take a shower. I try to take a colder shower as the warm water hitting my legs hurts. The left leg is much worse than the right. As the afternoon goes on my hands start going numb. The knuckle joints might be swollen. I wonder if my joints are swelling and cutting off circulation? Appointment with allergist is very good, she says she has seen many patients with similar adverse effects after covid vaccination. She does not believe it is an allergic reaction and usually sends patients to a neurologist, but admits there may not be anyone within Northwell Health specializing on this reaction to the vaccine. Allergist says she will try to find me a neurologist and schedule blood work. At night the pain and swelling in my hands is intense and I am repeatedly losing sensation in my hands. I drink lots of water as I believe it helps a little.


VAERS ID: 1540548 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-08
Onset:2021-07-30
   Days after vaccination:203
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Plavix, low-dose aspirin, monthly infusions of Gammagard, Atorvastatin
Current Illness: None
Preexisting Conditions: COPD, sleep apnea, inability to produce antibodies
Allergies: Seasonal allergies, oats
Diagnostic Lab Data: Pharmacy swab test- negative
CDC Split Type:

Write-up: Extreme fatigue, fever over 101, nausea, sore throat, muscle aches, headache


VAERS ID: 1540559 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Nightmare, Pain in extremity, Sleep disorder, Sleep paralysis
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: Omneprazole Aurovela
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Terrible dreams every night since receiving the vaccine, sleep disruption has been continuous, sleep paralysis the first couple day after vaccine, extreme arm aching and intense (entire arm into fingertips) for about 10 minutes after the shot


VAERS ID: 1540809 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 3 RA / IM

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

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

Write-up: Patient received a 3rd dose of Moderna. 1st dose on 1/13/21, 2nd dose on 2/10/21, and 3rd dose on 7/30/21.


VAERS ID: 1540821 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-07-28
Onset:2021-07-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816022 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Nasal mucosal blistering
SMQs:, Severe cutaneous adverse reactions (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: Dietary supplements include vitamins C, D, E, Elderberry and Zinc
Current Illness: No illnesses or sicknesses. I donated a unit of whole blood on July 26.
Preexisting Conditions: No chronic or long-standing health conditions.
Allergies: No allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Blisters appeared around the opening of my left nostril. I am treating it with antibiotic ointment. This is the first time I ever experienced that. Also learned that an acquaintance also experienced blisters around her mouth after receiving the Moderna vaccine. It seems to be healing.


VAERS ID: 1540904 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-01-06
Onset:2021-07-30
   Days after vaccination:205
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: tested positive covid 19 after receiving covid vaccine


VAERS ID: 1542066 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-07-26
Onset:2021-07-30
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Back pain, Chest X-ray, Chest pain, Dizziness, Dyspnoea, Electrocardiogram, Laboratory test, Pericarditis
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Pericarditis: agonizing chest and back pains, frequent dizziness, shortness of breath


VAERS ID: 1544858 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Hypersomnia, Pruritus, Rash, Rash macular
SMQs:, Anaphylactic reaction (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Extreme fatigue the day after shot, slept most of the day.. Felt like shingles was starting (had shingles before). Rash over both arms, both legs, right side of torso (different from shingles that had had previously) with a lot of itching. Started as individual red spots on skin, went to red bumps, then a larger rash. Still has it on 8/11/21, hasn''t improved yet. Using Benadryl for itching.


VAERS ID: 1544869 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-07-24
Onset:2021-07-30
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, COVID-19, Cough, Diarrhoea, Dyspnoea, Fatigue, Myalgia, Parosmia, Pyrexia, Rhinorrhoea, SARS-CoV-2 test positive, Wheezing
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Former Smoker
Allergies: Unknown
Diagnostic Lab Data: Covid 19 Rapid Antigen = Positive
CDC Split Type:

Write-up: As of disease investigation date of 8/2/21 case reported onset of symptoms as 7/30/21 which included fever, muscle aches, runny nose, new olfactory disorders, fatigue, cough, wheezing, shortness of breath, abdominal pain and diarrhea.


VAERS ID: 1544877 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-25
Onset:2021-07-30
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 OT / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: None reported
Allergies: Unknown
Diagnostic Lab Data: Covid 19 PCR = Positive
CDC Split Type:

Write-up: As of disease investigation date of 8/3/21 case reported onset of symptoms on 7/30/21 which included Fever, subjective fever, chills, muscle aches, runny nose, sore throat, fatigue, cough and nausea


VAERS ID: 1545205 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-03-01
Onset:2021-07-30
   Days after vaccination:151
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Dyspnoea, Fatigue, Oropharyngeal pain, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CORONAVIRUS TEST ON 07/30/2021 IS POSITIVE.
CDC Split Type:

Write-up: Pt arrives to ED and admitted on 07/30/2021. His c/o were increased sob, cough, and fever r/t covid-19 dx a week ago. Pt reports sore throat and generalized fatique. On going fevers and chills at home. Pt is tested as positive for COVID. Pt discharged on 08/04/2021 in stable condition and on home oxygen 2-3 liters.


VAERS ID: 1545217 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-05-12
Onset:2021-07-30
   Days after vaccination:79
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / N/A LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / N/A LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Cerebral thrombosis, Chills, Computerised tomogram head abnormal, Dyspnoea, Heart rate irregular, Ischaemic stroke, Paralysis, Pyrexia, Speech disorder
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Furosenide, 40mg Atorvastatin, 80mg Metoprolol Tart, 50mg Warfarin, 6mg Insulin, Novolog Flex Pen
Current Illness: Diabetes, renal failure, high cholesterol
Preexisting Conditions: Diabetes, high cholesterol
Allergies: N/a
Diagnostic Lab Data: Admitted on 7/30/2021 CT scan 8/2/2021 Patient still in hospital as of this submission 8/12/2021 and being monitored daily.
CDC Split Type:

Write-up: Patient suffered irregular heartbeat, muffled breathing, chills, and fever from May 13-May 16 after receiving the second dose of the Pfizer shot. Patient then suffered an ischemic stroke with blood clot forming in the frontal lobe of his brain leading to paralysis and speech impairments on July 30, 2021.


VAERS ID: 1545221 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: California  
Vaccinated:2021-01-08
Onset:2021-07-30
   Days after vaccination:203
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Blood culture negative, Blood glucose normal, Blood thyroid stimulating hormone decreased, COVID-19 pneumonia, Cough, Depression, Dyspnoea, Euthyroid sick syndrome, Glycosylated haemoglobin increased, Intensive care, Lung opacity, Pyrexia
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypothyroidism (broad), Hyperthyroidism (broad), Depression (excl suicide and self injury) (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Clobetasol (TEMOVATE) 0.05 % Top Crea Sig: Apply to affected area(s) 2 times a day Cyclobenzaprine (FLEXERIL) 5 mg Oral Tab Sig: Take 2 tablets by mouth 3 times a day as needed for muscle spasm or as directed Ibuprofen (MOTRIN) 800 mg O
Current Illness: Sciatica
Preexisting Conditions: Graves disease, Graves Ophthalmology, hx of difficult intubation, Osteoarthritis of the left knee
Allergies: Fentanyl Nausea/Vomiting Not Specified 9/15/2015 Past Updates... Norco [Hydrocodone-acetaminophen] Not Specified 7/30/2021 Past Updates... Hydrocodone makes her have nausea/vomiting, tylenol fine Prochlorperazine Not Specified Past Updates... CNS EFFECTS Sulfa (sulfonamide Antibiotics) Not Specified Past Updates... RASH
Diagnostic Lab Data: X-ray: 7/30/21 Trachea is midline. Cardiac mediastinal silhouette is within normal limits. There are patchy airspace opacities within the bilateral lower lung zones, similar to the prior exam. No pneumothorax or effusion. No acute bony abnormality. 7/31/21 LUNGS: Worsening patchy and confluent consolidations in both lungs, right worse than left. MEDIASTINUM/OTHER: Normal cardiomediastinal silhouette. 8/2/21 LUNGS: Moderate bilateral airspace opacities greatest in the right lower lung. No pleural effusion. MEDIASTINUM/OTHER: Normal cardiomediastinal silhouette. 7/30/21 TSH 0.3
CDC Split Type:

Write-up: 49 Y female with h/o Graves disease and opthalmopathy, h/o difficulty with intubation, s/p Pzifer vaccine (12/20 and 01/21), presented 7/24 secondary to fever and shortness of breath and admitted for acute hypoxemic respiratory failure secondary to COVID pneumonia. Due to worsening respiratory failure, she was transferred to the ICU on 7/31/2021 - 8/4/2021 and was placed on HFNC with iNO. She completed 5 days of remdesivir (7/30 - 8/3), tocilizumab x2 (7/31, 8/1) and was treated with high dose steroids. On 8/4 due to respiratory stability and significant improvement, she was transferred out of the ICU. Acute hypoxemic respiratory failure/COVID-19 DISEASE - s/p Pzifer vaccine (12/20 and 01/21), S/p HFNC with iNO, remdesivir (7/30 - 8/3), tocilizumab x2 (7/31, 8/1) and high dose steroids. S/p levoquin (7/31 - 8/3), vanco (8/1-8/2), was discontinued since one set of blood cx NGTD, 2nd set of blood cx 2/2 coag neg GPCs thought to be contaminant. - Decadron 6mg daily 7/30, solumedrol 125 q6 8/31-8/3, reduced to 60mg q6 8/4, 60 mg TID 8/5 and down to Decadron 20 mg daily today, 8/6. Plan continue Decadron 20 mg x48 hours, then 10 mg x48 hours, then 6 mg daily for 48hrs. - tessalon perles, guaifenasin prn cough - Improved VTE score of 1, 0.6% risk of VTE in next 3 month. - Continue Isolation per county guidelines. H/o Depression/anxiety - Continue PTA sertraline, clonipin 0.5 mg BID PRN for anxiety H/o Anemia Stable. no bleeding Hx of Graves disease and opthalmopathy (not on PTA meds) - TSH 0.3, low. Likely euthyroid sick syndrome I/s/o covid infection - Follow up TFTs as OP. Prediabetes - last A1c 5.9 on 7/30/21. BG 95. - CTM Primary Procedures: None Secondary Procedures: None Reason for Hospital Admission (Admitting Diagnosis): COVID pneumonia


VAERS ID: 1545289 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Crying
SMQs:, Depression (excl suicide and self injury) (broad)

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

Write-up: unkown patient stated she was fine was crying and called her mom.


VAERS ID: 1545633 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 1 LA / IM

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

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

Write-up: patient given Moderna vaccine <18 years of age


VAERS ID: 1545975 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-04
Onset:2021-07-30
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chest pain, Deafness unilateral, Electrocardiogram, Feeling abnormal, Full blood count, Gastritis, Herpes zoster, Hypoaesthesia, Pain, Pain in extremity, Rash, Sinus rhythm, Tinnitus
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Dementia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hearing impairment (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (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: 1st Pfizer COVD vaccines -1/14/2021 - Shingles - got the rash four hours after the vaccine
Other Medications: Zyrtec allergies; Simvastatin - for blood pressure; Omeprazole 20mg by mouth
Current Illness: Shingles - later in the afternoon after the first COVID 19 vaccine; I had recovered from that.
Preexisting Conditions: Nothing
Allergies: no
Diagnostic Lab Data: Friday, the 9th - They did an EKG - sinus rhythm result; CBC; as well as TNI bloodwork. All were negative. Diagnosed with Gastritis related to Ibuprofen. Discharged me home on 40 mg of Omeprazole once a day by mouth. OTC Mylanta was also prescribed. At the Urgent care they gave me IV Protonix as well as a 500 ml of Bolus of normal saline. Chest pain resolved within an hour of IV Protonix. They also gave me a GI cocktail. And was discharged home at 11:00 am.
CDC Split Type: vsafe

Write-up: Shingles again. (I got them after the first vaccine as well) Rash - left side of chest, armpit and back shoulder. Treatment: Gabapentin - 300 mg TID as needed for pain and Lidocaine Patch - once a day to affected area; Ibuprofen and Tylenol and Acyclovir - 400 mg tablets by mouth, 5 times a day. They are minimally helping with symptoms. This time around it''s been pretty miserable. I went to Urgent Care, Wed, the 7th, and following up at the same place with my physician. I went back to Urgent Care - on Friday, 9th at 05:45 am - I had severe chest pain in center of chest. I have had non-stop ringing in right ear (Tinnitus) and subsequent hearing loss in right ear that has not resolved. I still experience these symptoms (in March). Also, I have a new onset of diabetes diagnosis last month - there is no familial history. Jardiance - taking for that. I started that around 19th or 20th July. DISH syndrome - New diagnosis as well - that would have been in May when I had that diagnosis. I am not taking any medication for that except just physical therapy. I did a month of it. That helped with my symptoms of numbness shooting down my right arm - numbness and pain from right shoulder to fingertips. I still have numbness (although it is better) and the pain has gone away.


VAERS ID: 1549145 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-28
Onset:2021-07-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: daily dizziness/vertigo and lightheadedness


VAERS ID: 1549258 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-17
Onset:2021-07-30
   Days after vaccination:104
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Fatigue, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HLD
Allergies: sulfa antibiotics, Bactrim, penicillins
Diagnostic Lab Data: POCT SARS-COV-2 RAPID - Detected (7/30/2021)
CDC Split Type:

Write-up: Patient is 45 yo female s/p full Pfizer COVID vaccination: dose 1 on 3/27 and dose 2 on 4/17. Pt is an employee at this institution and reports new onset cough, fatigue, and congestion/runny nose on 7/30. Patient also report known exposure to COVID-19. Rapid test results back positive on 7/30.


VAERS ID: 1549329 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-19
Onset:2021-07-30
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939676 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac monitoring, 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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: np thyroid, zonisamide
Current Illness: no
Preexisting Conditions: no
Allergies: penicillin, dilaudid
Diagnostic Lab Data: on heart monitor 8/12/21, no results yet
CDC Split Type:

Write-up: vasovagal sycope , fainting , dizzy, started about 2 weeks after second shot


VAERS ID: 1549355 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-26
Onset:2021-07-30
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19 pneumonia, Lethargy, SARS-CoV-2 test positive
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (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? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: minocycline, carvedilol, prednisone, bacitracin ophthalmic, enalapril, atorvastatin, brinzolamide, latanoprost, brimonidine-timolol ophthalmic, moxifloxacin, albuterol-ipratropium, fluticasone-vilanterol, timolol ophthalmic, isosorbide mono
Current Illness:
Preexisting Conditions: HTN, prostate cancer, GERD
Allergies: No known allergies
Diagnostic Lab Data: SARS CoV 2 PCR COVID19 positive on 7/30/2021
CDC Split Type:

Write-up: 7/30/21: Patient arrived at the ER due to generalized weakness and lethargy after being found on the floor during a wellness check. Patient tested positive for COVID on 7/30/2021. Diagnosed with: COVID-19 pneumonia Please note: Patient received First dose of Pfizer COVID-19 vaccine on 1/29/2021, followed by the second dose on 2/26/2021 (confirmed through electronic symptoms) 8/12/21: patient still admitted at the time of this report submission.


VAERS ID: 1549382 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044B21A / 2 LA / SYR

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

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

Write-up: 102 fever for 2 days Severe redness, heat, pain and swelling at the injection site for 10 days from shoulder to elbow


VAERS ID: 1549469 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Body temperature increased, Condition aggravated, Diarrhoea, Fibromyalgia, Headache, Hyperaesthesia, Migraine, Myalgia, Nausea, Neck pain, Neuropathy peripheral, Pain, Sjogren's syndrome, Systemic lupus erythematosus, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (narrow), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Lacrimal disorders (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Tetanus
Other Medications: Vitamin B-12 monthly injections 1,000 units, Vitamin D-3, 1,000 units, weekly injections, clonazepam 2 mg nightly, Gabapentin 1200 mg nightly, Temazepam 15 mg nightly, Mirtazapine 15 mg nightly, Trazadone 10 mg nightly, Famotodine 40 mg
Current Illness:
Preexisting Conditions: Lupus, Sjogrens and Fibromyalgia
Allergies: Tetanus Vaccine-Anaphylactic Reaction, Ability - Permanent Tardive Dykinesia
Diagnostic Lab Data:
CDC Split Type:

Write-up: Initial severe headache, joint and muscle pain, diarrhea, temperature of 100.3 at highest but managed with Tylenol. Two weeks of severe pain at neck and base of skull that wraps over my head causing migraine and nausea daily. Back of head is sensitive to touch. Typical symptoms of migraine with light, sound, smell sensitivity. The level of head on a scale of 1 to a 10 is a definite 10! Initial feeling of flared symptoms with lupus, sjogrens and fibromyalgia and neuropathy badly. The body aches, temperature and diarrhea have improved but headache is two weeks later been reported to 3 of my Dr. and started prednisone which isn''t helping so they have corresponded that the next step they want me to do since this has stopped my daily activities is to reach out to my neurologist and recommended asking for appointment with him or to go to ER and request MRI. Of course, that was my first instinct to do but do not want to walk into ER full of Covid patients being immunocompromised so advised to fill this form out to report neck, skull and headache also sensitive to touch with vomiting and nausea still persisting and I''m waiting to hear back from neurologist. If I don''t. hear back by tomorrow morning I will walk into ER as protected as I can and ask for intervention for pain and an MRI.


VAERS ID: 1549654 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: New York  
Vaccinated:2021-02-16
Onset:2021-07-30
   Days after vaccination:164
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Diarrhoea, Fatigue, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose 01/26/21 pfizer,Lot#EL9262 2nd 02/16/21 dose Pfizer,lot#EL9266 Diagnosed covid positive:08/04/21 Symptom onset:07/30/21 Exposure:unknown Symptoms:Fatigue, diarrhea,runny nose


VAERS ID: 1549658 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: New York  
Vaccinated:2021-02-08
Onset:2021-07-30
   Days after vaccination:172
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Exposure to SARS-CoV-2, Rhinorrhoea, SARS-CoV-2 test positive, Sneezing
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose 01/11/21, Moderna Lot#012L20A 2nd dose02/08/21Moderna lot#012M20A Diagnosed covid positive:08/03/21 Symptom onset:07/30/21 Exposure:Community Symptoms:Runny nose,sneezing


VAERS ID: 1549668 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-27
Onset:2021-07-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Echocardiogram normal, Electrocardiogram ST segment elevation, Electrocardiogram T wave inversion, Myocarditis, Troponin increased
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Other ischaemic heart disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Troponin was elevated ECG showed ST elevation and during follow up there is evidence of T wave inversion in lateral leads Echo has been always normal
CDC Split Type:

Write-up: Myopericarditis chest pain, treated with Motrin


VAERS ID: 1549678 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: New York  
Vaccinated:2021-01-27
Onset:2021-07-30
   Days after vaccination:184
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Headache, Pain, Rhinorrhoea, 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: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose01/06/21 pfizer,Lot#EL3246 2nd dose01/27/21Pfizer,lot#EL9262 Diagnosed covid positive:08.02.21 Symptom onset:07.30.21 Exposure:unknown Symptoms:headache ,body aches, runny nose


VAERS ID: 1549717 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-01-13
Onset:2021-07-30
   Days after vaccination:198
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID-19 nasal swab
CDC Split Type:

Write-up: Fully vaccinated patient tested positive for COVID-19 on 7/30/31. Symptoms included headache, congestion, malaise.


VAERS ID: 1549741 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-21
Onset:2021-07-30
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: Vaginal bleeding for 6 days after being fully menopausal


VAERS ID: 1549819 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / IM

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

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

Write-up: PT GOT THE FIRST DOSE FROM MODERNA AND SECOND DOSE PFIZER( A MISMATCH)


VAERS ID: 1550078 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Connecticut  
Vaccinated:0000-00-00
Onset:2021-07-30
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Suspected COVID-19, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210804984

Write-up: SUSPECTED CLINICAL VACCINE FAILURE; SUSPECTED COVID-19 INFECTION; This spontaneous report received from a news article via a company representative concerned a male of unspecified age, race and ethnicity. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, 1 total, administered on APR-2021 for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On 30-JUL-2021, the patient was diagnosed with covid-19 (breakthrough infections) and experienced suspected clinical vaccine failure. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the suspected covid-19 and suspected clinical vaccine failure was not reported. This report was serious (Other Medically Important Condition). This report was associated with product quality complaint: 90000188201.; Sender''s Comments: V0: 20210804984-COVID-19 VACCINE AD26.COV2.S-suspected clinical vaccine failure. This event is considered not related. The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event than the drug. Specifically: SPECIAL SITUATIONS


VAERS ID: 1550867 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-07-28
Onset:2021-07-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus, Injection site rash, Injection site urticaria
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)

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

Write-up: Rash, itchiness, hives, redness around the jab location. Upper part, left shoulder. Consistent for 2 weeks after the shot. Size - oval or drop like shape, about 3x1.5 in. No treatment applied.


VAERS ID: 1553648 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood pressure increased, Chest X-ray, Eructation, Exercise tolerance decreased, Flatulence, Magnetic resonance imaging, Nausea, Neutrophil count increased, Palpitations, Restlessness, Thirst
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Akathisia (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Minoxidil
Diagnostic Lab Data: Blood panel hospital (7/30/2021) elevated neutrophylls Blood panel hospital (8/1/2021) elevated neutrophylls MRI top chest, x ray top chest and ultra sound of heart. hospital emergency room (8/1/2021)
CDC Split Type:

Write-up: Within the second day after receiving the vaccine : Intermittent drastic rise in blood pressure in conjunction with heart palpatations. Nausea. Drastic Increase in thirst. Intermittent bouts of restlessness. Inability to perform physical exercises without cardiac complications. Burping and excessive gas. Symptoms persist.


VAERS ID: 1553966 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-16
Onset:2021-07-30
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysmenorrhoea, Oligomenorrhoea
SMQs:, Fertility disorders (broad)

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

Write-up: Severe menstrual cramps and delayed period


VAERS ID: 1554210 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-27
Onset:2021-07-30
   Days after vaccination:184
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: CAD, HTN, Barrett''s esophagus, osteoarthritis, skin cancer nose,
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient tested positive for COVID-19 after vaccination


VAERS ID: 1554217 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-26
Onset:2021-07-30
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Systemic inflammatory response syndrome
SMQs:, Tumour lysis syndrome (broad), Sepsis (broad), Opportunistic infections (broad)

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

Write-up: R65.10 - SIRS (systemic inflammatory response syndrome) (CMS/HCC)


VAERS ID: 1554250 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-20
Onset:2021-07-30
   Days after vaccination:160
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 LA / IM

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

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

Write-up: patient tested positive for COVID-19 after vaccination


VAERS ID: 1554352 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-28
Onset:2021-07-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059E21C / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Computerised tomogram normal, Dyspnoea, Heart rate increased, Insomnia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Dehydration (broad)

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

Write-up: Chest pains, short of breath, unable to sleep, heart rate 146. Was referred to a cardiologist by PCP.


VAERS ID: 1554362 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Fatigue, Impaired work ability, Pyrexia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Reports fatigue, fever after vaccine and was out of work. Persistent dizziness and fainted on 8./11/21. Went to ED and informed it was bc of vaccine.


VAERS ID: 1554442 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-30
Onset:2021-07-30
   Days after vaccination:91
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 AND ZR87 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amnesia, Confusional state
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 08/10/21
CDC Split Type:

Write-up: Loss of memory and confusion.


VAERS ID: 1554564 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-07-23
Onset:2021-07-30
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 RA / IM

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

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

Write-up: Patient''s mother stated that her daughter started experiencing an itchy sensation on the scalp starting about one week after vaccination that has continued through today (8/13/21). Upon physical examination, hair looked dandruff free and there was no visible dermatitis/irritation at the hair line or along part. Mother stated they tried benadryl in case it was an allergy but that did not help. Mom checked for lice nits and did not see any either. Lastly, they tried OTC Dandruff shampoo and that also did not work.


VAERS ID: 1554576 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Florida  
Vaccinated:1981-04-08
Onset:2021-07-30
   Days after vaccination:14723
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Herpes zoster
SMQs:, Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 40, 5/11/2021, 6/8/2021, Moderna
Other Medications: Lamotrigine Rabeprazole
Current Illness: NO
Preexisting Conditions: NO
Allergies: NO
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Shingles


VAERS ID: 1554797 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-20
Onset:2021-07-30
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Feeling abnormal, Pain in jaw, Temporomandibular joint syndrome
SMQs:, Dementia (broad), Osteonecrosis (broad), Arthritis (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: Mirena, Metformin, Seroquel, Lamictal
Current Illness:
Preexisting Conditions: N/A
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe jaw pain/symptoms of TMJ, brain fog, excessive fatigue and tiredness


VAERS ID: 1555779 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-07-30
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210822533

Write-up: TERRIBLE PAIN; FEVER; FATIGUE; This spontaneous report received from a patient via a company representative concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. The patient''s past medical history included: covid-19. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 30-JUL-2021 for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On 30-JUL-2021, the patient experienced terrible pain. On 30-JUL-2021, the patient experienced fever. On 30-JUL-2021, the patient experienced fatigue. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the fever, fatigue and terrible pain was not reported. This report was non-serious.


VAERS ID: 1558090 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Dyspnoea, Fatigue, Feeling hot, Hyperhidrosis, Migraine, Nausea, Pain, Parosmia, Pyrexia, SARS-CoV-2 test negative, Taste disorder
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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? No
Hospitalized? No
Previous Vaccinations: See previous report, please.
Other Medications: Vitamin, magnesium, norolytriplyn
Current Illness: None
Preexisting Conditions: Migraines, hypoglycemia
Allergies: Delighted Vicodin Ultron
Diagnostic Lab Data: Covid swab negative
CDC Split Type:

Write-up: Felt dizzy, had a chemical smell and taste right away, was hot and sweating through my clothes. Went home and within 2 hours awful migraine, shortness of breath, with chest discomfort. Mild body aches. Mild nausea. It?s been 2 weeks and still experiencing shortness of breath and chest discomfort. Mild low grade fever for days now, and fatigue. Had a Covid swab this week that was negative because I wanted to be sure I hadn?t caught Covid after getting the vaccine. Have a follow up appointment with provider next Saturday to see what is going on.


VAERS ID: 1558190 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Discoloured vomit, Haematemesis, Headache, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Fever with flu vaccine 2020
Other Medications: Carvedilol, Furosemide, Potassium Chloride, Sertraline, Low Dose Aspirin, Digoxin, Atorvastin, Co Q 10, Melatonin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Violent vomiting of black substance and blood. Vomiting lasted 24 hours, with the first 2 hours non-stop. Weakness, nausea, headache for 2 weeks. Pfizer-BopNTech COVID-19 Vaccine EUA


VAERS ID: 1558318 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Back pain, Condition aggravated, Pain, Pain in extremity, Sleep disorder
SMQs:, Retroperitoneal fibrosis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tegratol, generic. Monelukest.
Current Illness: Epilepsy, Asthma, chronic pain, chronic Fatigue, Restless legs syndrome, arthritis,
Preexisting Conditions: Epilepsy, Asthma, chronic pain, chronic Fatigue, Restless legs syndrome, arthritis,
Allergies: Erythrymicin, Darvocet
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Friday pain started 24 hours pain in shoulder worse than being kicked by horse and being thrown 20 feet, worse than 11 bee stings at same time, pain so bad no sleep for next two nights. crept up my are into shoulder and across my back....Finally got sleep Sunday after taking 2) 625. Tylenol, then 2 more 8 hours later. Shot triggered chronic pain.


VAERS ID: 1558326 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-26
Onset:2021-07-30
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

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

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

Write-up: Four days after getting my first dose of the Pfizer vaccine I woke up at around 5:40 with a stabbing chest pain and difficulty breathing. This lasted for 15-20 minutes. Day five I was fine, however day 6 the pain came back around the night time like at 9:00. Days 6 and 7 I had trouble breathing at night. Lastly today, 8/14/2021 I have had pain in my upper chest near my right side for 5-10 minutes.


VAERS ID: 1558364 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-30
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0161321A / 1 LA / SYR

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

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

Write-up: Hives every night on thighs, abdomen, and arms, some in the daytime too.


VAERS ID: 1558397 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test normal, Chills, Computerised tomogram normal, Exercise tolerance decreased, Immediate post-injection reaction, Loss of personal independence in daily activities, Migraine, Mobility decreased, Myalgia, Neck pain, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Eosinophilic pneumonia (broad), 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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Egg allergy
Diagnostic Lab Data: CT Scan bloodwork 8/5/21
CDC Split Type:

Write-up: Immediately after I had fever, chills, muscle pain for 48 hrs but the neck pain and migraine headache have been persistent for two weeks. I have been seen in the Urgent Care and provided with muscle relaxers. No help. Went to the ER and was given migraine meds and CT scans/blood work(all normal). No help. I?ve consistently taken ibuprofen/Tylenol/ Excedrin. No help. Tried the chiropractor and a massage. No help. Tried a low dose of steroids. No help. Tried oils/muscle relief gels/heat/ice. No help. I am typically a very active, healthy, take no medication and run and work our daily type of person. In the last two weeks I can barely manage my normal daily activities without any exercise or the things I enjoy. It hurts so bad I spend so much time in bed. I?m upset by this, I had Covid in January and was fine. I worked out the whole time I had it. I don?t know what else to do. I?ve seen no improvement.


VAERS ID: 1558405 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-12
Onset:2021-07-30
   Days after vaccination:109
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001A21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA O46A21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: ESRD on hemodialysis
Preexisting Conditions: ESRD, A-Fib, BK viremia, hypothyroidism, HTN
Allergies: Naprosyn
Diagnostic Lab Data: Patient tested positive for COVID 08/02/2021
CDC Split Type:

Write-up: Admitted 8/2/2021 with c/o fever for 2 days. He also c/o runny nose and diarrhea for 2 days. Hx of ESRD on HD. He went to get dialysis today, but he was turned away because he had a fever of 103F at the dialysis center. His temp in the ER is 99.6F. Dx COVID pneumonia. Note: patient previously vaccinated with the Moderna COVID-19 Vaccine: First Dose: 02/25/2021 Lot Number 001A21A, Second Dose: 03/25/2021 Lot Number O4A21A Please note: Patient received First dose of Pfizer COVID-19 vaccine on 3/22/2021, followed by the second dose 22 days later, on 4/12/2021


VAERS ID: 1562810 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-24
Onset:2021-07-30
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Injection site erythema, Injection site swelling, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

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

Write-up: Site: Redness at Injection Site-Severe, Site: Swelling at Injection Site-Severe, Systemic: Allergic: Rash Generalized-Severe, Systemic: Fever-Medium, Systemic: Numbness (specify: facial area, extremities)-Medium


VAERS ID: 1573628 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-16
Onset:2021-07-30
   Days after vaccination:105
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Pulmonary embolism, Thrombocytopenia
SMQs:, Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Embolic and thrombotic events, venous (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pulmonary emboli Thrombocytopenia, unspecified


VAERS ID: 1573876 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site nodule, 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: None.
Current Illness:
Preexisting Conditions: None.
Allergies: None.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Knot at injection site, warm feeling at injection site going on 2 weeks.


VAERS ID: 1573881 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-27
Onset:2021-07-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Condition aggravated, Dysmenorrhoea, Heavy menstrual bleeding, Herpes zoster, Lymphadenopathy, Pain in extremity, Paraesthesia, Rash
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

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

Write-up: Tingling arms & legs since receiving 2nd dose. Reactivation of shingles rash, which i had in my 30?s. Excruciatingly heavy painful and period following the vaccine. Shifting pain in arms and legs. Swollen lymphnodes


VAERS ID: 1573949 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Unknown  
Location: New Jersey  
Vaccinated:2021-07-26
Onset:2021-07-30
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breast pain, Lymphadenopathy
SMQs:, Lipodystrophy (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: Iron vit. and multi vit.
Current Illness: asthma
Preexisting Conditions:
Allergies: fish allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: very strong breast pains. spoke to my gyno. Dr. about and she stated it was normal after the vaccine. Pectoral Lymph node swelling.


VAERS ID: 1574004 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-07-01
Onset:2021-07-30
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Renal pain
SMQs:

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

Write-up: After receiving the second dose of Moderna, pt started to experience Kidney pain, when to MD and was encouraged to increase fluids and if the pain persist to return to MD. Pt states he is fine and he is not experiencing any issues.


VAERS ID: 1574079 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Nasopharyngitis
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: n/a
Current Illness:
Preexisting Conditions: DM, HTN
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had side effects, fatigue and cold like symptoms for 3 days.


VAERS ID: 1574279 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: New York  
Vaccinated:2021-01-21
Onset:2021-07-30
   Days after vaccination:190
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 2 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Exposure to allergen, Impaired work ability, Nasal congestion, Rhinorrhoea, SARS-CoV-2 test positive, Sneezing
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Spironolactone 50mg BID; Valtrex 500mg daily; allegra D daily; dymista nasal spray BID;
Current Illness: strep throat; sinus infection
Preexisting Conditions: sinusitis
Allergies: intolerance to dairy and gluten
Diagnostic Lab Data: positive rapid COVID test
CDC Split Type:

Write-up: Began having sneezing, runny nose and severe nasal congestion on 7/30. I believe it was allergy related as I was vaccinated and around cats (which I am very allergic to). on 8/2 I went to MD to get a rapid COVID test in order to go in to work (I am a healthcare worker) and was told the test was positive. I isolated until 8/10 and returned to work on site once cleared. However, a mild cough started 8/10 and has been persistent - unclear if this is related to allergies or aftereffects of COVID.


VAERS ID: 1574422 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-19
Onset:2021-07-30
   Days after vaccination:133
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802070 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol 108/90 mcg/act inhaler 2 puffs QID PRN, buprenorphine-naloxone 8-2 mg BID, clonazepam 0.5 mg daily, bupropion 150 mg daily, ibuprofen 600 mg TID PRN, buspirone 7.5 mg TID, artificial tears 1.4% solution 1 drop q 6 hr PRN, gabapent
Current Illness: none
Preexisting Conditions: Respiratory Pulmonary nodule Behavioral Health Generalized anxiety disorder Cigarette nicotine dependence without complication Chronic post-traumatic stress disorder (PTSD) Major depression, recurrent, chronic (HCC) History of methamphetamine abuse (HCC) Opioid dependence in remission (HCC) Neurology/Sleep Status post cervical spinal arthrodesis History of fusion of cervical spine Sciatic neuralgia ENT Sensorineural hearing loss, bilateral Gastrointestinal History of hepatitis C virus infection Chronic GERD Eye Chronically dry eyes, bilateral Bilateral presbyopia Pinguecula of both eyes Cataracts, bilateral Other Chronic neck pain Not currently working due to disabled status History of alcohol use Chronic right shoulder pain Chronic pain due to injury History of psychotic reaction History of psychoactive substance use disorder Full dentures Family history of lung cancer
Allergies: N/A
Diagnostic Lab Data: PCR Covid swab
CDC Split Type:

Write-up: patient contracted Covid 19


VAERS ID: 1574517 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-28
Onset:2021-07-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Injection site rash
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Hypersensitivity (narrow)

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

Write-up: AFTER 2-3 DAYS OF VACCINATION, PATIENT DEVELOPED COVID ARM RASH AROUND INJECTION SITE ON LEFT ARM. SLOWLY MOVED TOWARD ELBOW. AFTER 1 WEEK, PATIENT CAME IN HAVING DARK BROWN BRUISING AROUND LEFT ELBOW ABOUT 4 INCHES IN DIAMETER (NO PAIN/TENDERNESS OR REDNESS). UPON FOLLOW-UP 4 DAYS LATER, BRUISING HAD SUBSIDED AND ELBOW RETURNED TO NORMAL.


VAERS ID: 1574541 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Heavy menstrual bleeding
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I have been having menstrual bleeding for 3 1/2 weeks, since the vaccine.
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: I have been having menstrual bleeding for 3 1/2 weeks and it will not stop. It seems to be getting worse.


VAERS ID: 1574559 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Blood test, Chest discomfort, Cold sweat, Cough, Electrocardiogram abnormal, Fatigue, Feeling abnormal, Feeling hot, Hyperhidrosis, Hypoaesthesia, Pericarditis, Tremor, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypertension (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: ED visit on 8/1/2021 with facial numbness, increased BP, cough. Given IV benadryl and IV prednisone, released with 5 day supply prednisone. 8/9/2021 @ 1:45pm: Occupation Health appointment for sustained elevated BP, tremors, increased chest pressure, extreme fatigue, chest flutter, mental fog. EKG performed with abnormalities. Blood workup done. 8/10/2021 @ 10:15am: Occupation Health appointment as follow-up. Symptoms remain the same with increased chest pressure and fatigue after movement. Placed on sedentary work restriction, more blood collected, prescribed colchicine, follow-up appointment with Cardiologist. 8/13/2020 @ 9:30am: Cardiologist consult. Preliminary findings of Pericarditis. Echo cardiogram exam and EKG stress test ordered, increased dose colchicine, directed to take ibuprofen daily for 7-10 days, complete sedentary rest for 2 weeks. Follow-up appointment to come following testing.
CDC Split Type:

Write-up: hives, Diaphoretic, clammy skin, sensation of facial warmth, numbness in face and extremities, tremors. Vitals @0900: 166/104, HR 90, O2 98%, chewable benadryl given at 0905. Repeat vitals @ 0925: 141/86, HR 71, O2 95%. Given juice and released with wife.


VAERS ID: 1574589 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aphasia, Balance disorder, Chest discomfort, Disturbance in attention, Dizziness, Hypoaesthesia, Limb discomfort, Ophthalmological examination abnormal, Paraesthesia, Vision blurred
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Corneal disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Hypoglycaemia (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: sulfasalazine, lotrel, baby asa, tizanidine, sumatriptan, zofran, MVI, D3. calcium citrate, Zinc, vitamin C, crestor
Current Illness: none
Preexisting Conditions: lupus, psoriatic arthritis, HTN, fibromyalgia, osteoarthritis, high cholesterol
Allergies: cymbalta, trazodone, flonase
Diagnostic Lab Data: no labs eye exam with vision change right right eye 0.5. new glasses on May 2021. very little change in 2 years prior to new glasses in may
CDC Split Type:

Write-up: 15 minutes after injection BP 151/104, dizziness, off balance, numbness and tingling to bilateral legs and arms, blurry vision right eye. 7/31/21: same, but with expressive aphasia/difficulty concentrating, intermittent chest pressure symptoms of numbness and tingling to extremities, blurry vision right eye, off balance, extremity heaviness remain as of today.


VAERS ID: 1574652 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Georgia  
Vaccinated:2021-07-21
Onset:2021-07-30
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183EXP:08/21 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Cerebrovascular accident, Laboratory test, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Latanaprost 0.005% Lovoxyl 112mg rosuvastin 10mg Ibersartan 150mg
Current Illness: none
Preexisting Conditions: Thyroid
Allergies: none
Diagnostic Lab Data: Full battery
CDC Split Type:

Write-up: Stroke that lead vision impairment.


VAERS ID: 1577252 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Localised infection, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (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: Asthma
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: PVIUS2021001147

Write-up: Severe arm infection; chest palpitations; This spontaneous case was reported by a consumer and describes the occurrence of LOCALISED INFECTION (Severe arm infection) in a 39-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Asthma. On 30-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 30-Jul-2021, the patient experienced LOCALISED INFECTION (Severe arm infection) (seriousness criterion medically significant) and PALPITATIONS (chest palpitations). At the time of the report, LOCALISED INFECTION (Severe arm infection) and PALPITATIONS (chest palpitations) had not resolved. No concomitant medication details was reported. No treatment medication details was reported. Company Comment: Very limited information regarding these events have been provided. Further information has been requested.; Sender''s Comments: Very limited information regarding these events have been provided. Further information has been requested.


VAERS ID: 1577853 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 1 - / -

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

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

Write-up: patient received Moderna Vaccine on 7/30/21. Spoke with Guardian on 8/13/21. No side effects reported


VAERS ID: 1577894 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Back pain, Dizziness, Fatigue, Feeling abnormal, Headache, Mobility decreased, Musculoskeletal stiffness, Myalgia, Nausea, Neck pain, Pain, Pain in extremity, Vision blurred, Visual impairment
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: Within a couple hours I had a severe headache and slight muscle aches. That night I woke up in the middle of the night with severe back aches and pain in my joints. The worse was in my hips. I was relegated to my bed for over 2 days. I also began having issues with my vision. I get dizzy and at times have trouble focusing. Also was extremely nauseous for the first week steadily....as time has gone on it is not as bad....though always still there. I kept thinking it would go away...and now 3 weeks later and I am still having issues. I have extreme joint pain, esp in my hips & shoots down my legs and up my back, still issues with my vision, dizziness, stiffness and pain in my neck when I turn it tired all the time, and still have headaches, and an overall feeling of not being right.


VAERS ID: 1577979 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-01
Onset:2021-07-30
   Days after vaccination:120
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Illness, Nasal congestion, SARS-CoV-2 test positive, Viral 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies: Omnicef [Cefdinir]
Diagnostic Lab Data: 08/02/21 1008 POCT COVID-19 PCR Collected: 08/02/21 1006 | Edited Result - FINAL | Specimen: Swab from Nares POC COVID-19 PCR DetectedAbnormal C Lot # 1000272387 Point of Care COVID-19 PCR Testing Method Cepheid Lot Expiration Date 6/19/22
CDC Split Type:

Write-up: ? Covid-19 Screening ? Nasal Congestion Viral illness


VAERS ID: 1578013 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-02
Onset:2021-07-30
   Days after vaccination:89
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Nasopharyngitis, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test
SMQs:, COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: bumetanide (BUMEX) 1 mg tablet cephalexin (KEFLEX) 500 mg capsule diphenhydrAMINE (BENADRYL) 25 mg capsule ferrous sulfate 325 mg (65 mg iron) tablet simvastatin (ZOCOR) 20 mg tablet tamsulosin (FLOMAX) 0.4 mg capsule
Current Illness:
Preexisting Conditions: Respiratory Obstructive sleep apnea Circulatory Peripheral venous insufficiency Essential hypertension, benign Digestive Morbid obesity Vitamin D deficiency Genitourinary Chronic kidney disease (CKD) stage G3a/A1, moderately decreased glomerular filtration rate (GFR) between 45-59 mL/min/1.73 square meter and albuminuria creatinine ratio less than 30 mg/g Prostate hyperplasia with urinary obstruction Renal calculus, bilateral Left ureteral calculus Bladder calculus Musculoskeletal Non-pressure chronic ulcer of other part of left lower leg with fat layer exposed Osteoporosis Lymphedema of lower extremity Endocrine/Metabolic Gout Mixed hyperlipidemia Hematologic Anemia MGUS (monoclonal gammopathy of unknown significance) Other iron deficiency anemias Other Lymphedema, not elsewhere classified Other specified abnormal findings of blood chemistry Hematuria, unspecified type Need for influenza vaccination Medicare annual wellness visit, subsequent
Allergies: Bactrim Ds [Sulfamethoxazole-trimethoprim]Other (document details in comments)
Diagnostic Lab Data: 08/02/21 2039 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 08/02/21 1402 | Final result | Specimen: Swab from Nares COVID-19 SARS-CoV-2 Overall Result DetectedCritical 08/02/21 2039 COVID-19 PCR Collected: 08/02/21 1402 | Final result | Specimen: Swab from Nares
CDC Split Type:

Write-up: COLD SYMPTOMS, RUNNING NOSE, CONGESTION


VAERS ID: 1578015 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Head discomfort, Headache, Tinnitus
SMQs:, Anticholinergic syndrome (broad), Hearing impairment (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Benadryl, Pepcid, Tylenol
Current Illness: none
Preexisting Conditions: none
Allergies: Morphine, Penicillin, Doxy, Erythromycin
Diagnostic Lab Data: I have not seen a provider, but plan on doing three things....having antibody tests done and if super high perhaps this vaccine acted more like a booster and sent my immune system on fire. I will also go to an ENT and a neurologist. To Item 21. I have not seen a provider and I do not know if this tinnitus is permanent or not. I will mark the boxes that follow with my plan and what I feel are possible outcomes....that this tinnitus may be permanent.
CDC Split Type:

Write-up: I was fine until almost 12 hours later I woke up feeling very dizzy and had a headache. My head felt full. I took Tylenol and didn''t think much of it. Later, at almost the 24 hour mark my R ear started ringing nonstop. I had had a bout of Tinnitus once before, but it quickly went away a couple of hours later. I figured this would do the same. It has been almost 3 weeks now and my R ear has not stopped ringing. I did a search and found that others, although rare have had similar issues, but most of them had this occur after the second vaccine. This was my first vaccine. I am a registered nurse and work in a busy ER and practically bathed in COVID all last year during the surges. I do not know if I ever got COVID or not ,but if I did the symptoms were very mild. I had a couple of colds, but other than that nothing big at all.


VAERS ID: 1578079 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-03
Onset:2021-07-30
   Days after vaccination:149
Submitted: 0000-00-00
Entered: 2021-08-17
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: hospitalized on 7/30. Moderna on 3/3 and 4/2. Positive on 7/28


VAERS ID: 1578122 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthma, Condition aggravated
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (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
Current Illness:
Preexisting Conditions: Asthma
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: My asthma has been SIGNIFICANTLY worse since receiving the vaccine, there has been no other changes in anything else in my environment or life that would account for this. I do not believe it?s a coincidence, it has not gotten better.


VAERS ID: 1578128 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-01-11
Onset:2021-07-30
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Cough, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol HFA (PROVENTIL;VENTOLIN) 90 mcg/actuation inhaler benzonatate (TESSALON) 200 mg capsule Bifidobacterium infantis (ALIGN) 4 mg capsule busPIRone (BUSPAR) 5 mg tablet COVID-19 test specimen collect misc cyanocobalamin, vitamin B-12,
Current Illness:
Preexisting Conditions: Nervous Ulnar neuropathy of left upper extremity Chronic abdominal pain Numbness and tingling of upper and lower extremities of both sides Respiratory Mild intermittent asthma without complication OSA on CPAP Acute recurrent frontal sinusitis Digestive Gastroesophageal reflux disease Morbid obesity (CMS/HCC) B12 deficiency Musculoskeletal Scalp alopecia Skin candidiasis Boil, thigh Endocrine/Metabolic Prediabetes Hematologic Iron deficiency anemia Other Anxiety Panic attacks Seasonal allergies Difficulty with CPAP full face mask use Use of proton pump inhibitor therapy Stress and adjustment reaction
Allergies: Bee Venom Protein (Honey Bee) Adhesive Tape-siliconesRash Insect VenomOther (document details in comments)
Diagnostic Lab Data: Updated Procedure 08/06/21 1834 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 08/06/21 1124 | Final result | Specimen: Swab from Nares COVID-19 SARS-CoV-2 Overall Result DetectedCritical 08/06/21 1834 COVID-19 PCR Collected: 08/06/21 1124 | Final result | Specimen: Swab from Nares
CDC Split Type:

Write-up: Cough New loss of taste or smell


VAERS ID: 1578146 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2011-07-30
Onset:2021-07-30
   Days after vaccination:3653
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Injection site mass, Injection site warmth, Paraesthesia oral, Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pre-dosed 3mg Dexamethasone 8 hrs and 1 hr before vaccine. Armour thyroid 60mg. Ivermectin 6mg every three days. Pravastatin 5mg. Vit C 2000iu. Vit D 10000 iu. Vit K 200. NAC. Quercetin. Hawthorne berry. Baby aspirin. Omega 3 fish oil. Magn
Current Illness: I have long covid (original infection March 2020), but was much improved at the time of the vaccine.
Preexisting Conditions: Celiac. Hashimoto thyroid. Cold urticaria.
Allergies: Penicillin. Tetracycline. Z pack. Erythromycin. Clindamycin. Paradoxical reaction to Benedryl. Codeine. Vistiril. Shellfish. Wheat. 39 types of stinging insects. Mold, especially Stachybotrys. Dust mites. Cockroaches. Pigeons.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tongue swelling. Tongue and lip tingling. Off and on from 10 minutes after the shot for four days. Nine days after the shot, an egg sized red lump, hit to the touch, at the site of injection and a return of the tongue tingling.


VAERS ID: 1578148 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2020-12-29
Onset:2021-07-30
   Days after vaccination:213
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Inappropriate schedule of product administration, SARS-CoV-2 test positive
SMQs:, Medication errors (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: hospitalized on 7/30. discharged 8/2 Moderna on 12/29/20 and 1/22/21. Positive on 7/23/21


VAERS ID: 1578577 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 2 LA / IM

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

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

Write-up: Patient came to the clinic to receive his 2nd dose of his Moderna vaccine. He was monitored for the standard time and sent home. He did not have any adverse reaction to the medication. He was 17 at the time of the 2nd dose.


VAERS ID: 1578726 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-03-24
Onset:2021-07-30
   Days after vaccination:128
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prior to Admission medications Medication Sig Start Date acetaminophen (TYLENOL) 325 mg tablet Take 650 mg by mouth every 4 hours as needed for Pain. albuterol-ipratropium (COMBIVENT RESPIMAT) 100-20 mcg/puff inhaler Inhale 1 puff
Current Illness: Asthma ? Environmental allergies ? Hyperlipidemia 6/17/2016 ? Hypertension ? NSTEMI (non-ST elevated myocardial infarction) 7/26/2016 7/27/16 PTCA OM 1; Baran, SPH; 40-50% stenosis LAD; 7/26/16 Echo; EF 57%; ? Postoperative hypothyroidism 7/2/2015 ? Thyroid disease
Preexisting Conditions: See section 11
Allergies: Pantoprazole ? Aspirin ? Codeine
Diagnostic Lab Data: Ordered Test: SARS-CoV-2 RNA Resp Ql NAA+probe Ordered Test Codes: 94500-6 (LN LOINC)/ Status: Final Accession Number: 212110094LP-198922 Specimen Source: SOFT TISSUE SAMPLE Specimen Site: ENTIRE NASOPHARYNX(181200003) Specimen Collection Date/Time: 2021-07-30 15:43:00.0 Patient Status at Specimen Collection: Specimen Details:
CDC Split Type: 17297

Write-up: Case completed 2 dose vaccine series on 3/24/21, then tested positive for Covid on 7/30/21 when she was admitted to hospital for Covid related symptoms.


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