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

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



Case Details (Reverse Sorted by Onset Date)

This is page 173 out of 3,232

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VAERS ID: 1361569 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood test, Computerised tomogram, Headache, Influenza virus test, Magnetic resonance imaging, Malaise, SARS-CoV-2 test
SMQs:, COVID-19 (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin D, multi-vitamin, biotin, hyaleuronic acid.
Current Illness: None
Preexisting Conditions: Vitamin D deficiency effectively treated with supplements
Allergies: Penicillin/Amoxycillin
Diagnostic Lab Data: Covid test, flu test, CT scan (2), MRI, rocky mountain spotted fever test, lots of blood work.
CDC Split Type:

Write-up: The morning after the shot I had the worst headache, very painful. I drank a lot of water and it temporarily improved. But I''ve been dealing with an almost chronic migraine situation since then which required two ER visits and I''m still not well. I have no history of migraines. Never had one before.


VAERS ID: 1361670 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: mild hives that occurred for a few hours only at night occasionally
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hives in large swollen shapes all over legs, arms, torso, and scalp during both day time and at night. Itchy and affected sleep. Lasted for 48 hours and was controlled temporarily after taking loratadine 10 mg/ day. Hives re-occurred when not taking loratadine.


VAERS ID: 1361697 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-13
Onset:2021-05-04
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044B21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0Z7AZ1A / 1 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Arthralgia, Hypertension, Obesity, Pain
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Hypertension (narrow), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexapro 10mg, Lisinopril 10mg, Hydrochlorothiazide 25mg (daily for each prescription)
Current Illness: None
Preexisting Conditions: High blood pressure & Obesity
Allergies: None
Diagnostic Lab Data: Going to see my doctor just as school lets out on June 4th. Making appointment the week of June 7th. I am a high school teacher and despite my feeling badly, I have still been dragging myself to work. I am taking Motrin (approximately 400 mg per day, although this does not seem to help that much). :(
CDC Split Type:

Write-up: Horrible body aches, extreme joint pain, especially in both knees. (This has been taking place for 3 straight weeks)...


VAERS ID: 1361896 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood potassium, C-reactive protein, Chest X-ray, Chest pain, Dyspnoea, Echocardiogram, Electrocardiogram, Fibrin D dimer, Full blood count, Metabolic function test, Troponin, X-ray
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? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Allergies: See previous report for same patient
Diagnostic Lab Data: 5/18 d-dimer, CBC, CMP, chest x ray, EKG 5/21 serum potassium 5/29 d-dimer, CBC, CRP, CMP, Sed rate, troponin, X-rays multiple views, EKG, echocardiogram
CDC Split Type:

Write-up: Continuing dyspnea and chest pain 1 month following vaccine. Multiple attempts to wean high doses of steroids resulted in worsening symptoms- evaluated in ER 5/18 and 5/29, followed up with primary care and future appointment with allergy/immunology on 6/11. Concern for cardiac involvement.


VAERS ID: 1361940 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014CZ1A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling abnormal, Headache, Tinnitus
SMQs:, Dementia (broad), Hearing impairment (narrow)

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

Write-up: Within a couple hours of the second dose my tinnitus exploded and got extremely loud. It has continued to be very loud. Also Followed by a continued fogginess and occasional dull headache.


VAERS ID: 1362052 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-01
Onset:2021-05-04
   Days after vaccination:64
Submitted: 0000-00-00
Entered: 2021-05-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Vision blurred, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Diovan, Hydrochlorthiazide , Cosopt, COQ10, Vision Essentials, Vitamin D
Current Illness: None
Preexisting Conditions: Glaucoma, hypertension
Allergies: None
Diagnostic Lab Data: No effects on vision after, no signs of anything unusual per ophthalmologic exam. May 21, 2021
CDC Split Type:

Write-up: A hazy, cloudlike coverage of a portion of my visual field. Possible only one eye but not sure. Difficult to see through. Lasted several minutes and then dissipated on its own. Occurred again two weeks later. Same. Unsure if it will occur again.


VAERS ID: 1362419 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Tinnetus


VAERS ID: 1362835 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-05-01
Onset:2021-05-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Blindness unilateral, Eye haemorrhage, Intra-ocular injection, Ophthalmological examination abnormal, Vision blurred, Vitreous floaters
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Corneal disorders (broad), Retinal disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vit D, Zinc, Toprol, Lisinopril, Tylenol
Current Illness: none
Preexisting Conditions: Arthritis Atrial Fibrillation Congestive Heart Failure, medication controlled Diverticulosis
Allergies: none
Diagnostic Lab Data: eye exam by a retina doctor on May 12
CDC Split Type:

Write-up: states "Last May 1st I got my 1st dose of the covid vaccine... on May 4th, when I woke up, I couldn''t see well. Blurry vision on my right eye, I couldn''t even read even with my glasses on. When I blinked I could see big blobs of different colors, black, blue, green, red, yellow... I made an appointment with an ophthalmalogist (May 7) and was told there was bleeding at the back of my eye and referred to a retina doctor. May 12, I saw a retina doctor and was given 2 shots right into my eye. Now I could still see black blobs but much smaller and wherever I look I could see like white clouds with sparkling tiny lights of different colors, even if my eyes are closed. "


VAERS ID: 1363777 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Oregon  
Vaccinated:0000-00-00
Onset:2021-05-04
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Cerebral thrombosis, Computerised tomogram, Pulmonary thrombosis, Thrombosis
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (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, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Arthritis; Non-smoker; Seasonal allergy
Preexisting Conditions: Medical History/Concurrent Conditions: Shoulder operation; Tendonitis; Comments: The patient had a history of surgeries on right shoulder and had the normal wear and tear on her body for her age at the time of this report.
Allergies:
Diagnostic Lab Data: Test Date: 20210504; Test Name: Body temperature; Result Unstructured Data: 102 F; Test Date: 20210518; Test Name: CAT scan; Result Unstructured Data: blood clots found in stomach, brain and neck; Test Date: 20210518; Test Name: CAT scan; Result Unstructured Data: blood clots in right lung
CDC Split Type: USJNJFOC20210546778

Write-up: BLOOD CLOT IN BRAIN; BLOOD CLOT IN RIGHT LUNG; BLOOD CLOT IN STOMACH AND NECK; This spontaneous report received from a patient concerned a 64-year-old, female. The patient''s height, and weight were not reported. The patient''s past medical history included tendonitis in right shoulder, surgeries on right shoulder and concurrent conditions included arthritis in right shoulder, non-smoker, abstains from alcohol, and seasonal allergies, and other pre-existing medical conditions included the normal wear and tear on her body at the time of this report. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, one total, administered on 04-MAY-2021 at the right arm for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. The Patient reported that on 04-MAY-2021, after vaccination, she began feeling unwell with a low grade fever, her highest body temperature was 102F. She experienced headache that she initially felt on the right side of her head but could not determine the source for sure. On 14-MAY-2021, she coughed up blood, but she didn''t think anything of it and continued her normal routine then on 15-MAY-2021, she coughed up more blood but it had some phlegm in it, so she went to the ER (emergency room) on 18-MAY-2021. She received a Computerized axial tomography (CAT) scan of her chest which showed blood clots in her right lung. She got a secondary CAT scan and blood clots were found in her stomach, brain and in her neck. She was admitted to hospital on 19-MAY-2021. The Patient was reportedly hospitalized for 6 days and was supposedly discharged on 24/May/2021. For treatment, she was receiving an Intravenous (IV) blood thinner but later changed to an oral blood thinner. She was also receiving Tramadol for pain. She was receiving other medications when first admitted but could not recall specific names. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from blood clot in brain, blood clot in right lung, and blood clot in stomach and neck. This report was serious (Hospitalization Caused / Prolonged).; Sender''s Comments: V0: 20210546778-covid-19 vaccine ad26.cov2.s- blood clot in brain, blood clot in right lung, and blood clot in stomach and neck. This events are considered unassessable. The events has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the events.


VAERS ID: 1364495 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Hives and itching around the neckline for $g15 minutes after giving but only lasted about 2-3 hours. No trouble breathing and medical assistance was not deemed necessary.


VAERS ID: 1364507 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol ER 25 mg (1) Lisinopril 5 mg (1) Atorvastin 20 mg (1) Alprazolam 0.25 mg (? at night) Caltrate 600+VitD3 (1) Cosamin DS (1 am & 1 Pm) CoQ10 100 mg (1) Caltrate 600+D3 (1) Vit D3 1000 units (1) Vitam
Current Illness: N/A
Preexisting Conditions: After a hearing test October 2020, the volume was raised high while in the box by a salesman, not an Audiologist (or medical professional) and it caused tinnitus. I went to 2 general practitioners at the time and 2 ear, nose and throat specialists.at the time.
Allergies: N/A
Diagnostic Lab Data: I was already familiar having gone to 4 doctors, 2 regular and 2 specialists in October 2020.
CDC Split Type:

Write-up: As soon as I arrived home I noticed the sound was louder. I was very distressed already having experience with Tinnitus. The next night on the news i heard that an increase of cases of Tinnitus after the shot and also as I had and increase in loudness.


VAERS ID: 1364733 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-30
Onset:2021-05-04
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Myasthenia gravis
SMQs:, 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:
Other Medications: Lialda
Current Illness:
Preexisting Conditions: Inflammatory bowel disease: mild
Allergies: None
Diagnostic Lab Data: Still undergoing additional bloodwork and imaging. Results not yet available.
CDC Split Type:

Write-up: Diagnosis of Myasthenia Gravis on May 18.


VAERS ID: 1364821 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-20
Onset:2021-05-04
   Days after vaccination:45
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dysmenorrhoea, Menstruation irregular
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: Taltz: 80 mg/monthly Orilissa 150 mg/daily Mirena IUD
Current Illness: none
Preexisting Conditions: Endometriosis
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Due to the Orilissa medication, I do not experience monthly menstruation. However, about 6 weeks after my vaccine dose from J&J, I experienced menstruation spotting for the first 2 - 3 days and then it turned into an irregular period. All-in-all, my period lasted about 8 days. Additionally, I experienced extreme cramping leading up to the irregular period due to the vaccine. No treatment was needed but I did consult with a doctor and they assured me that this is a none side effect.


VAERS ID: 1364924 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 1 LA / IM

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

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

Write-up: TINGLING SENSATION UNDER THE SOLES OF HER FEET


VAERS ID: 1364943 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Impaired work ability, Injection site joint pain, Injection site pain, Pain, Pain in extremity
SMQs:, Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol inhaler; Spiriva
Current Illness: None
Preexisting Conditions: COPD; history of surgery in Left shoulder - related to shoulder blade and arthritis
Allergies: None
Diagnostic Lab Data: none - referred client to own provider for further follow up and assessment
CDC Split Type:

Write-up: Client received 1st dose of Moderna vaccine at ~11:18am in left deltoid. Around 4 pm, began to have sharp pain radiating to top of shoulder and down left arm. Client continued to have pain throughout past 4 weeks with little relief. Describes pain as sharp at times. Also describes some weakness in left arm. Client is a laborer who reports missing weeks of work due to left shoulder pain.


VAERS ID: 1365001 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-20
Onset:2021-05-04
   Days after vaccination:45
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Ultrasound scan, 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: Synthroid, DHA
Current Illness: none
Preexisting Conditions: Graves Disease
Allergies: sulfa, methimazole
Diagnostic Lab Data: ultrasound (May 28)
CDC Split Type:

Write-up: Frequent and irregular vaginal bleeding


VAERS ID: 1365042 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-04-27
Onset:2021-05-04
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Dyspnoea, Electrocardiogram, Panic attack, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin, Pantoprazole, Meloxicam
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: EKG and lab work on May 27, 2021
CDC Split Type:

Write-up: Shortness of Breath - self corrected around May 9 Tachycardia - self corrected around May 18 Panic Attacks - still occurring, but steadily lessening in frequency and intensity


VAERS ID: 1365224 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-03-03
Onset:2021-05-04
   Days after vaccination:62
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Electrocardiogram, Exposure during pregnancy, Foetal cardiac disorder
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Foetal disorders (narrow)

Life Threatening? No
Birth Defect? Yes
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: prenatal vitamin, ibuprofen 600mg PO Q6H PRN
Current Illness: none known
Preexisting Conditions: none known
Allergies: Gentamicin, grass pollen, watermelon
Diagnostic Lab Data: Chest Xray, EKG
CDC Split Type:

Write-up: Patient was pregnant at time of both her COVID 19 vaccinations. Patient delivered a boy on May 4th, 2021 at 38wks gestation. Per infants discharge, patient was noted to have a loud split S2 this am with progresstive murmur/gallop by this afternoon. pulse ox 88-90% and started on O2 via NC. Able to wean fairly quickly but failed subsequent CCHD with right hand of 98% and R foot of 89% off of O2 with tachycardia of 170s. At that time, restarted O2, CXR showed cardiomegaly and EKG showed LVH. Murmur present loudest at LUSB and moderate tachycardia and pallor. Discussed case with NICU, and decision mace to start prostaglandins 0.03mcg/kg/min adter 10mg/kg bolus of caffeine. Patient discharged to secondary NICU. Per other information, infant has a aorta development issue.


VAERS ID: 1365336 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Injection site pain, Pyrexia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: dusts, pollen, (oak tree), seafood (lobster, shrimp, crabs, scallops, shellfish)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain in the arm where I got the shot about 2 hours after receiving the vaccine, Chills after 10 hours, Fever and Headache after 12 hours, Tiredness and Fainted on the 2nd day


VAERS ID: 1365348 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blister, Burning sensation, Cold sweat, Dissociation, Pruritus, Rash
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 stated he developed a rash on his back near the waistline and down his right leg. Blisters that itched and burned. one blister the size of a half dollar remains on his back , is brown in color and not totally round , more like a patch with varying depths of brown. He took claritin to help with itch. with his second vaccine today he became clammy, and did not feel in his body, when asked his name he took a few moments to answer. we advised he call a friend to take him home.


VAERS ID: 1365437 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-30
Onset:2021-05-04
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C2CA / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Anxiety, Condition aggravated, Depressive symptom, Panic disorder
SMQs:, Depression (excl suicide and self injury) (narrow), 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: Atorvastatin, Metformin, Vitamin D supplements.
Current Illness: Diabetes.
Preexisting Conditions: Diabetes.
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Resurgence of depression symptoms thought to have been dealt with. Increased anxiety and feelings of dread/panic.


VAERS ID: 1365448 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain in extremity
SMQs:, 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: not that I am aware
Current Illness: not that I am aware
Preexisting Conditions: not that I am aware
Allergies: not that I am aware
Diagnostic Lab Data: not aware of .
CDC Split Type:

Write-up: Patient said her arm hurt really bad. She said that she has had other vaccines and it never hurt that bad. It has resolved tho.


VAERS ID: 1365533 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007621A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Immediate post-injection reaction, Mobility decreased, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: Patient reported just before he was about to receive the 2nd shot that he felt numbness and tingling in his right arm and hand immediately after receiving the first shot yet he did not mention this to anyone. The numbness and tingling advanced to include his left arm and hand and he found it difficult to make a fist with either hand. Problem continues. Patient did not get the 2nd shot and was advised to contact his MD as soon as possible.


VAERS ID: 1366323 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chest X-ray, Dyspnoea, Headache, Pneumonia, Pyrexia, Respiratory tract congestion, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: Chest x-rays were done at an urgent care. Received breathing treatments. Was put on prednisone (steroids), an inhaler, a cough medicine and 2 antibiotics, zyrtec. as well as additional over the counter medications.
CDC Split Type:

Write-up: Fever, Severe Chest congestion w/ wheezing, severe headache, shortness of breath. Diagnosed with pneumonia 3-4 days after vaccination. lasted approx. 2 weeks with symptoms. required 2 trips to urgent care, as of today, I still have minor chest congestion. Haven''t been able to fully get rid of it.


VAERS ID: 1367149 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Body temperature, Chest X-ray, Influenza virus test, Investigation, Mononucleosis heterophile test, Platelet count, Platelet count decreased, Pyrexia, Renal disorder, Renal impairment, SARS-CoV-2 test
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Haematopoietic thrombocytopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19
Allergies:
Diagnostic Lab Data: Test Date: 20210504; Test Name: Fever; Result Unstructured Data: Test Result:102.5 Fahrenheit; Test Name: chest x-ray; Result Unstructured Data: Test Result:Unknown results; Test Name: Flu test; Test Result: Negative ; Test Date: 20210513; Test Name: Kidney numbers; Result Unstructured Data: Test Result:low; Test Name: Mono; Test Result: Negative ; Test Date: 20210513; Test Name: Platelet count; Result Unstructured Data: Test Result:low; Test Name: COVID test; Test Result: Negative
CDC Split Type: PFIZER INC2021555942

Write-up: weak; Low kidney function; Low platelets/platelets numbers are low; kidney numbers are low; Fever up to 102.5F; This is a spontaneous report from a contactable consumer. A 32-years-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 2 via an unspecified route of administration, administered in Arm Left on 03May2021 08:00 (Batch/Lot number was not reported) as 2ND DOSE, SINGLE for covid-19 immunisation. Medical history included covid-19 from Nov2020 to an unknown date. Patient previously received the first dose of BNT162B2 for covid-19 immunization. There were no concomitant medications. Consumer is the sister of the patient that after getting the second dose of the Pfizer covid vaccine is experiencing after several days fever up to 102.5F on 04May2021, low platelets and low kidney function. her brother who is too weak right now to call. He got his second vaccine and right now it will be 2 weeks ago, he got it on 03May2021, he had the COVID virus in Nov, it has been 2 weeks since the second dose as of tomorrow and he has had 102 degree fever the whole time throughout the day and night. She is trying to understand if this is something to be concerned about. He had blood work done and his platelets numbers are low and his kidney numbers are low and she is looking for peace of mind of if this is commonly reported adverse event or maybe the steps to be taken. She says she works for (Company) so she familiar with having to report adverse events. Her brother is also awaiting chest x-ray results, he was negative for mono, flu, and negative for COVID.The patient underwent lab tests and procedures which included body temperature: 102.5 fahrenheit on 04May2021, chest x-ray: unknown results, influenza virus test: negative, investigation: low on 13May2021, mononucleosis heterophile test: negative, platelet count: low on 13May2021, sars-cov-2 test: negative. Outcome of events was unknown. Information on the lot/batch number has been requested.


VAERS ID: 1367210 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-02
Onset:2021-05-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acoustic stimulation tests, Deafness, Depression, Ear pain, Influenza, Insomnia, Mental disorder, Pain, Tinnitus, Vertigo, Weight
SMQs:, Dementia (broad), Depression (excl suicide and self injury) (narrow), Hearing impairment (narrow), Vestibular disorders (narrow), Infective pneumonia (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:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Asthmatic; COPD
Allergies:
Diagnostic Lab Data: Test Name: hearing test; Result Unstructured Data: Test Result:The doctor told that what he was seeing is going o; Comments: The doctor told that what he was seeing is going on with right ear is usually seen, when a person has fluid their ears which the patient did not or if they have a traumatic ear injury which the patient also didn''t have; Test Name: Weight; Test Result: 88.45 kg
CDC Split Type: USPFIZER INC2021562529

Write-up: had a flu.; vertigo; severe pain.; depression; mental health; Severe pain in my right ear and sudden loss of hearing in my right ear; Severe pain in my right ear and sudden loss of hearing in my right ear; her ear started ringing; she started to lose sleep.; This is a spontaneous report from a contactable consumer reported for self. This 52-year-old patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on 02May2021 at the age of 52-year-old (Lot number: EW0172) arm left as 2nd dose, single for covid-19 immunisation. Medical history included COPD, asthmatic when was a child. The patient previously received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) on 11Apr2021 at the age of 52-year-old (LOT#: EW0158) for covid-19 immunisation. After her 1st dose, she said she had a robust reaction. After the 2nd dose, she said she felt like she had a flu. Then on Tuesday night, 2 days after the 2nd dose (04May2021), her ear started ringing, and her right ear was in pain. She said that her ear was ringing so loudly that she started to lose sleep. She said she had a sudden loss of hearing in right ear that has caused her emotional damage. She was sudden loss of hearing in right ear, along with ringing and severe pain for 13 days now. She said that her ear has become so sensitive ever since she received the vaccine. She also mentioned that she was given Prednisone to treat the symptoms. She also said that her ENT told her that tinnitus can be caused by a previous traumatic injury to the ear and head injury. She said she had neither, so she is sure that this is really from the vaccine. She also said she had vertigo and was in severe pain. She said her daughter saw something on social media about vaccinated people being able to stick magnets to their arms, so she tried it as well. She said she can now also stick a magnet to her left arm from where she received the vaccine, and she wants to know why this is happening. She said she has searched about these symptoms, and said that it was all over google. She stated, "On 04May2021 in the evening, ears started ringing very loudly. started getting a severe pain in right ear and lost hearing on right ear." She went to doctor. She was referred to an ENT. Got a hearing test. The doctor told that what he was seeing is going on with right ear is usually seen, when a person has fluid their ears which the patient did not or if they have a traumatic ear injury which the patient also didn''t have and he has given Prednisone (treatment) today, need to go back to another hearing test. Dose of Prednisone, consumer stated, "He got me 60 mg for 3 days. Step down the doses and then for 4 days I have to take 1 pill, then for 3 days I have to take 2 and then step down to half." She added, "Because she was truly deaf, it is kind of a ''depression'' because it did kind of ruined part of it, you know quality of my life. She was probably in need of hearing aids, It is very upsetting. She experienced mental health on 18May2021. Lab data included Weight 88.45 kg. Outcome of the events was unknown.


VAERS ID: 1367406 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blister, Chills, Diarrhoea, Fatigue, Headache, Herpes zoster, Pain, Skin burning sensation, Skin exfoliation, Tremor, Wound
SMQs:, Severe cutaneous adverse reactions (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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: SYMBICORT; ADVAIR
Current Illness: Asthma (unsure of when she was diagnosed, it was about 18-20 years ago.)
Preexisting Conditions: Medical History/Concurrent Conditions: Dyspnea; Shingles
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021603722

Write-up: it is freaking burning; open wound; Soreness; Little blister; She stated her whole body was shaking; Skin falling off/It got like an open area besides my pinky on the left side of my face next to my left eye; Exhausted; I had diarrhea.; I had headaches/It has caused a extreme headache.; Shingles in my eyeball/stated her shingles were coming out. She felt like the Shingles were coming through her shoulder blade and 6 days after the shot her shingles were coming out of her left eye.; I have been getting chills since shot two.; This is a spontaneous report from a contactable consumer. This 55-year-old female consumer (patient) reported that. A 55-years-old female patient received second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE, Solution for injection), via an unspecified route of administration, administered in Arm Left on 03May2021 13:52 (Batch/Lot Number: ER8730) as 2ND DOSE, SINGLE for covid-19 immunisation. Medical history included shingles, ongoing asthma and breathing. Concomitant medications included budesonide, formoterol fumarate (SYMBICORT) taken for dyspnoea, fluticasone propionate, salmeterol xinafoate (ADVAIR) taken for dyspnoea. The patient previously took first dose of bnt162b2, administered in left shoulder on 12Apr2021 (Lot number: Lot number: EN6208) for covid-19 immunisation and also took breo and experienced shingles. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The patient reported that she took Valacyclovir which is like Valtrex because of shingles coming out my eyes and took a painkiller it''s a naproxen painkiller for headache during the day since may 4th. She also took Symbicort and Advair for like top of the years now because of my breathing. Dose of Valtrex was stated by the consumer as 1000 mg (Not confirm hence not captured). The patient reported Last night, I had diarrhea and I woke in a little while with chills and this morning I woke up with more of my, more of the skin fell of my face and the worst thing is like that. She stated she felt soreness, a little bit of a headache coming and her shingles were coming out. She felt like the Shingles were coming through her shoulder blade, 6 days after the shot her shingles were coming out of her left eye and went on for two weeks, she thought it was gone and then they came back. She stated that she was looking at on her skin; it was falling off and it was freaking burning. She has an open area the size of her pinky for 3 days now. She reported that her skin is coming off her her left side of her face, clarified right next to her left eye. Diarrhea started 04May2021 and it comes and goes. She also mentioned she woke up with chills last night. She clarified the chills came on shortly after the shot on 04May2021 and went away. She stated her whole body was shaking and she did not had chills like this since she can remember. She was an hour and half late for work because she was so exhausted A section of skin fell off her face. Caller mentioned the shingles in her back were coming out on 04May2021. She took Valtrex she had leftover from before. She stated she had shingles in her eye ever since she took the product called BREO. Sunday, 6 days after she received the second shot, she felt the shingles coming out of her left eye. She went to see her doctor because she was out of Valtrex and he gave her more Valtrex to take. The vaccine pushed the shingles out and made it open up, initially on her back the day she got the second shot. The skin falling off her face started 22May2021. She developed a little blister that fell off. Yesterday the skin also came off. This morning another section of her skin came off. She clarifies there was another bubble that was attached to her skin. The area of her face was an open wound. She took Naproxen to control her headache, at night occasionally she took a nerve block and Singulair and Advair for a couple of years depending on her asthma and allergies. Therapeutic measures were taken as a result of i had headaches/it has caused a extreme headache and Shingles in my eyeball/stated her shingles were coming out. She felt like the Shingles were coming through her shoulder blade and 6 days after the shot her shingles were coming out of her left eye. The outcome for the event diarrhoea, skin falling off/it got like an open area besides my pinky on the left side of my face next to my left eye, it is freaking burning, open wound, soreness, little blister and she stated her whole body was shaking was unknown, for the events i had headaches/it has caused a extreme headache, shingles in my eyeball/stated her shingles were coming out. she felt like the shingles were coming through her shoulder blade and 6 days after the shot her shingles were coming out of her left eye, i have been getting chills since shot two and exhausted outcome was not resolved. No further details provided or obtained. Information on Lot/Batch number was available. Additional information has been requested.


VAERS ID: 1367723 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Wyoming  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Cellulitis, Computerised tomogram, Erythema, Gait disturbance, Oedema peripheral, Pain in extremity, Peripheral swelling, Rash, Skin discolouration, Swelling, Ultrasound scan, Vaccination complication
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), 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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Iron-160 MG Baclofen-10 MG Cephalexin-500 MG Clonidine- .1 MG Gababpentin-400 MG Lemborexant- 5 MG Levothryroxine-50 MCG Pramipexole-.25MG Sertraline-100 MG Tramadol-50 MG
Current Illness: N/A
Preexisting Conditions: Multiple back and neck surgeries 6 plus years ago carpal tunnel Hypothyroidism Muscle spasms Restless Leg GERD Anxiety Depression
Allergies: Adhesive Codeine
Diagnostic Lab Data: She has had 2 ultrasounds which have turned negative for blood clots She has had blood work that has returned negative for any concerns. She is currently waiting on results from a CT.
CDC Split Type:

Write-up: Less than 24 hours after receiving 2nd COVID vaccine my mother develop a weird rash that mirrors a pair of socks reaching to the knees that is red in appearance bilaterally. Then her feet began to swell to roughly triple the size of her feet. They then turned and angry red and her toes turned purple. Her feet have been sore and she at times is not able to walk on them because they are extremely sore. My mother developed what the medical professionals are calling COVID toe. She was taken to the ED 3 times in the course of 3 weeks and had appt''s with PCP 2 times 1st PCP on day #4 was given a course of Fexeril which she finished as directed by PCP. Enormous swelling and redness and was treated for cellulitis and peripheral edema via ED on day #6. She has had 2 ultrasounds which have turned negative for blood clots She has had blood work that has returned negative for any concerns. She is currently waiting on results from a CT. This is still ongoing for my mom.


VAERS ID: 1367744 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-27
Onset:2021-05-04
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Anticoagulant therapy, Deep vein thrombosis, Dyspnoea, Pulmonary embolism, Ultrasound Doppler abnormal
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin 81 mg daily, celecoxib 100 mg twice daily, docusate 10, docusate 100 mg twice daily, emagliflozin 25 mg once daily, gabapentin 300 mg every 12 hours, norco 5-325 mg every 4 hours as needed for pain, pitavastatin 2 mg once daily
Current Illness: None
Preexisting Conditions: Arthritis, CHF, T2DM, GERD, Hypercholesteremia, sleep apnea, TIA, ulcer
Allergies: Erythromycin (GI distress, N/V)
Diagnostic Lab Data: 5/4/21 CTA PE: Bilateral pulmonary embolic disease, right more extensive than left 5/7/21 Vasc Bilateral Lower Extremity Venous Duplex: Deep venous thrombosis involving the right lower extremity predominantly the mid and distal femoral vein and right popliteal vein.
CDC Split Type:

Write-up: Patient presented to the ED on 5/5 after being sent by his PCP after an ultrasound in the office showed a DVT along with patient''s complaint of shortness of breath. Patient denied history of DVT/PE. In the ED, CTA-PE showed bilateral pulmonary embolic disease and Ultrasound confirmed acute right lower extremity DVT. Patient was started on a heparin drip and then switched to enoxaparin 1 mg/kg every 12 hours per pulmonary. Hematology/Oncology was consulted and determined that acute bilateral PE likely provoked by recent vaccination with the second dose of the Pfizer vaccine. Patient was switched to rivaroxaban 20 mg daily prior to discharge for planned duration of 3 months.


VAERS ID: 1367812 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-28
Onset:2021-05-04
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Blood test normal, Chest X-ray, Chest pain, Discomfort, Electrocardiogram normal, Pain in extremity
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Venlafaxine ER 75mg Adderall XR 20mg
Current Illness: none
Preexisting Conditions: none
Allergies: Anaphylaxis to Levaquin
Diagnostic Lab Data:
CDC Split Type:

Write-up: I am a healthy 50 year old male who competes in endurance events including 15 Ironman triathlons and many ultra endurance races. I was diagnosed with acute Pericarditis 8 years ago, after 4 days in the hospital and a couple of weeks of rest at home all of my symptoms had subsided and I have had no reoccurrence of this condition since. Approximately one week after receiving my second dose of the Covid 19 Moderna vaccine I began to experience chest pain. 8 days post vaccination the chest pain was radiating into my Left shoulder and arm, I had significant pain on breathing and was extremely uncomfortable lying on my back and could not lie on my left side due to pain. I went to the ER on the evening of May 6th, they performed a chest x-ray, 2 EKG''s as well as 2 separate blood work panels. While I did relate my history of having pericarditis and that this pain was very similar to what I had felt before, they, of course, were more concerned on if I was having a coronary event. The EKG and blood work showed I was not so I was simply sent home with a "we don''t know why your chest hurts but your are not having a heart attack." After a follow up to a cardiologists almost 2 weeks later it was determined that it was more than likely a flare up of pericarditis but that it had subsided by that time.


VAERS ID: 1367820 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044B21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, No adverse event
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: NKDA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Medication error; incorrect interval between doses 1 and 2. Given 22 days apart. No adverse reactions reported. Error discovered when client requested updated vaccination card.


VAERS ID: 1367863 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 1 LA / IM

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

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

Write-up: Error: Patient Too Young for Vaccine Administered


VAERS ID: 1368089 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Bedridden, Blood test normal, Dizziness, Gait disturbance, Headache, Myalgia, Pyrexia, Urine analysis normal, Vertical infection transmission
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Citralapan 20 mg
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood and urine samples came back normal.
CDC Split Type:

Write-up: On 5/4/2021 I received the second dose of the Pfizer vaccine. I experienced fever, muscular ache, and headache. The next day I experienced fever again and felt dizzy and lightheaded. I called my primary care physician and she advised the symptoms were normal and told me to drink plenty of fluids, including Pedialyte. However, my symptoms only worsened with debilitating vertigo. I had to be rushed to urgent care where they administered several IV''s. I was put on several medications to recuperate. I have been bed ridden since, unable to walk without a cain, and have had my life put on hold as a result. The Department should be transparent about the potential adverse side effects of these vaccines.


VAERS ID: 1368266 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-09
Onset:2021-05-04
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Endotracheal intubation, Guillain-Barre syndrome
SMQs:, Angioedema (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Respiratory failure (broad), Immune-mediated/autoimmune disorders (narrow)

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

Write-up: Client hospitalized on 5/4/2021 to 5/18/2021; diagnosed with Guillan Barre on 5/7/2021. Discharged to long term care facility. Readmit on 5/30/2021. Now inpatient; intubated.


VAERS ID: 1368277 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-04-28
Onset:2021-05-04
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arrhythmia, Extrasystoles, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Tachyarrhythmia terms, nonspecific (narrow), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: I''ve had heart palpitations and arrhythmia sporadically in my life, but I don''t recall ever having them to the extent I had them after the second dose of the vaccine AND after I had contracted COVID back in November.
Allergies: none
Diagnostic Lab Data: I did not seek a doctor''s opinion or assistance
CDC Split Type:

Write-up: Six days after receiving the second vaccination, I had a night of non-stop heart arrhythmia which consists of the heart seemingly skipping a beat and then the next beat is very heavy. It lasted throughout the night. I have had an arrhythmia sporadically in my past, but I don''t recall it ever being this pronounced or sustained. I had the same exact thing happen 12 days after a positive COVID test in which I exhibited mild symptoms.


VAERS ID: 1368343 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Injection site swelling, Laboratory test, Petechiae, Urine analysis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: multi vitamim with biotin, vit D, certirazine
Current Illness: none known
Preexisting Conditions: parathyroid nodules, varicose veins, mitral valve regurgitation, mitral valve insufficiency, seasonal allergies
Allergies: NKA
Diagnostic Lab Data: PA observed multiple areas of Petechiae...lab results not returned yet.
CDC Split Type:

Write-up: observed injection site that afternoon when removing bandage: my upper arm was full of tiny pinpoint dots, injection site was swollen/hard. I was busy that day finishing payroll and preparing for trip . I did not notice so much in the morning, I drove to visit family for a few days. Upon return home, I read the paperwork provided by the clinic after I had received the shot...and began examining my body for tiny blood spots. Now, with each shower etc I would notice random spots and try to remember if they had been there before... My doctor was retiring and called last weekend to followup on a lab test he had previously ordered to take in May. During that conversation I asked him about the random spots, and he made an appt for me to see the PA the next day and do my urine sample for the lab order. PA ordered bloodwork for low platelet counts, which I had had previously, and urine test for abnormal immunofixation.


VAERS ID: 1368530 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: unknown
CDC Split Type:

Write-up: 2 hours after vaccination patient developed rash and hives on both arms and legs


VAERS ID: 1368534 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-29
Onset:2021-05-04
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW 0175 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram normal, Dizziness, Facial pain, Magnetic resonance imaging head normal, Muscular weakness, Neck pain, Pain in jaw, Photopsia, Sensory disturbance, Trigeminal neuralgia, Vocal cord thickening
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Demyelination (broad), Retinal disorders (narrow), Vestibular disorders (broad), Osteonecrosis (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft 200MG Provigil 400MG Buspar 60MG
Current Illness: NA
Preexisting Conditions: Back pain
Allergies: Doxycylcine
Diagnostic Lab Data: 5/20: ER Tests are included in this submission
CDC Split Type:

Write-up: 3 Days following my second shot, I felt a horrible shock/pain through my neck and jaw that made me crouch down in pain in the middle of a busy street. I went straight to an urgent care. The provider said it was a vaccine side effect and gave me steroids to take for four days. The next week, I went back because I began to feel a pulling sensation/pain develop on the side of my face. They referred me to an ENT. I went to the ENT. He found a vocal chord nodule and ordered a CT scan. Before I could make the CT scan appointment, I had an episode in the shower where I began to see flashing lights and my limbs became wobbly and weak. I was very dizzy and had to hug the shower wall for support. My wife took me to the emergency room where a multitude of tests were run including a CT scan. Nothing was remarkable, but the doctor was concerned about the neurological effects, and referred me to a neurologist. I saw the neurologist the next day, and she diagnosed me with trigeminal neuralgia on top of ordering an MRI of my brain (normal). I am taking carbamazepine and baclofen as treatment for the condition. She said it can occur virally.


VAERS ID: 1368753 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-23
Onset:2021-05-04
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Arterial occlusive disease, Condition aggravated, Mobility decreased, Pain in extremity, Pallor
SMQs:, Embolic and thrombotic events, arterial (narrow), Parkinson-like events (broad), Hypotonic-hyporesponsive episode (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: cetirizine 10 mg tablet, multivitamin with minerals, vit c/E/zinc, Refresh eye drops
Current Illness: 2 months of worsening intermittent episodes of left leg pain, swelling, and redness
Preexisting Conditions: 2 months of worsening intermittent episodes of left leg pain, swelling, and redness
Allergies: no known medication allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: admitted to hospital due to left lower extremity pulselessness, patient reports intermittent pain/pallor since 5/4 which worsened to point of being unable to move her leg


VAERS ID: 1368783 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Body temperature increased, Chills, Influenza virus test, Magnetic resonance imaging, Pain, Platelet count decreased, Pyrexia, SARS-CoV-2 test, Vomiting
SMQs:, Acute pancreatitis (broad), Haematopoietic thrombocytopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril 20 mg daily
Current Illness: None
Preexisting Conditions: High blood pressure
Allergies: None
Diagnostic Lab Data: Tested for flu, covid and a full blood work, MRI
CDC Split Type: vsafe

Write-up: I had the vaccine and the day after I had fever, chills, aches, and on the third day vomiting and a 104 temperature. I decided to go to the hospital. They tested for flu, covid and a full blood work and an MRI. 4 days prior to the vaccine my platelet count was 253000 and three days after the vaccine was 45000 and it continued to drop the next few days. My immune system destroyed my blood platelets. They gave me dexametasone, steroids for 4 days.


VAERS ID: 1369031 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-01
Onset:2021-05-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blister, Condition aggravated, Discomfort, Eczema, Migraine, Pain, Pruritus, Scratch, Skin exfoliation, Skin irritation, Skin lesion, Sleep disorder
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Accidents and injuries (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: . Patient described sores/blisters and tight skin all over neck, arms, and in hair. Patient states a lot of pain and discomfort interrupting sleep. She has had increased migraines and flares in eczema (pre-existing conditions). Patient''s states skin looked like it has burns on it around her neck and scaly and very irritated from itching and scratching


VAERS ID: 1369317 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-04-20
Onset:2021-05-04
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044B21A / 1 LA / IM

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

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

Write-up: Tinnitus developed in left ear approximately 2 weeks after first covid vaccine dose. It has persisted with no sign of waning. High pitched frequency is heard constantly. No treatment sought yet.


VAERS ID: 1370621 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-29
Onset:2021-05-04
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Headache, 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: Test Date: 20210506; Test Name: Covid-19; Result Unstructured Data: Test Result:Positive
CDC Split Type: USPFIZER INC2021570331

Write-up: tested positive for COVID; Headache; This is a spontaneous report from a contactable pharmacist. A 17-year-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 via an unspecified route of administration on 29Apr2021 (Batch/Lot number was not reported) as 1ST DOSE, SINGLE for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient had the first dose last 29Apr2021 and scheduled to have the second dose on 20May2021. The patient had symptoms last 04May2021 and tested positive for COVID on 06MAY2021. The patient wants to cancel her second dose schedule since the doctor advised that she should wait for 60-90 days and she should start all over again. She already tested negative for the COVID-19 on an unspecified date and reporter wanted to know how to handle this concern. Patient also experience headache on 04May2021. On Tuesday night, (04May2021,) they thought she was having allergies. On Wednesday 05May2021, she found out she had contact with someone who tested positive for covid-19. She tested on Wednesday and received positive result on Thursday (06May2021). They believe she had contact on the same day as the vaccine on the 29th of APR 2021. She had a negative rapid test on Monday and Tuesday (unknown dates). Outcome of the events was unknown.


VAERS ID: 1370675 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-20
Onset:2021-05-04
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: School       Purchased by: ?
Symptoms: Burning sensation
SMQs:, Peripheral neuropathy (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: USPFIZER INC2021592795

Write-up: I had burning feet at night- so hot; This is a spontaneous report from a contactable consumer (patient). A 36-year-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Solution for injection, Lot number: unknown), via an unspecified route of administration in left am on 20Apr2021 at 01:00 PM as 2nd dose, single for COVID-19 immunization. It was reported that patient also received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Solution for injection, Lot number: unknown), via an unspecified route of administration in left am on 20Apr2021 at 01:00 PM as 1st dose, single for COVID-19 immunization. Medical history and concomitant medications were not reported. Patient had no known allergies. Facility where the most recent COVID-19 vaccine was administered was school or student health clinic. Prior to vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. On 04May2021 at 06:00 PM, patient had burning feet at night- so hot that patient had to pit ice packs around them for two nights in a row after the 2nd dose. No fever. Patient was not pregnant at time of vaccination. Patient did not receive any other medications within 2 weeks of vaccination. Since the vaccination, the patient had not been tested for COVID-19. No treatment was received. The outcome of the event was recovered. Information on the lot/batch number has been requested


VAERS ID: 1370678 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021592814

Write-up: Developed a shingles outbreak that has been getting better; This is a spontaneous report from a contactable consumer (patient). A 73-years-old male consumer patient received first dose of bnt162b2 (PFIZER-BIONTEC COVID-19 VACCINE, Solution for injection, Lot number: Not reported and Expiry date: 31Aug2021), via an unspecified route of administration on 03May2021 (at age of 73-years-old) as a single dose for COVID-19 immunization. Medical history and concomitant medications were not reported. On 04May2021 (1 day after vaccination), patient had developed a shingles outbreak that had been getting better. Treatment received was 7 days of tablets. Patients wanted to know if it was okay for him to receive the 2nd dose since his shingles have not healed completely. Patient mentioned that on the day reporting event (at 6:00), he had an appointment for the second dose. The outcome of event was resolving. Information on lot/batch number was available. Additional information has been requested.


VAERS ID: 1370815 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:2021-05-04
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Hypokinesia, Loss of personal independence in daily activities, Peripheral swelling, Testicular swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (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: LASIX [FUROSEMIDE]
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Aortic aneurysm (Open heart surgery to replace entire ascending aorta related to aneurysm twice, with 1 of 2 aneurysm burst.); Open heart surgery
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210603934

Write-up: BILATERAL SWOLLEN LEGS FROM HIP TO FEET; SWOLLEN TESTICLES; DIFFICULTY AMBULATING UPSTAIRS; DIFFICULTY PUTTING ON SHOES; This spontaneous report received from a patient concerned a 58 year old male. The patient''s height, and weight were not reported. The patient''s past medical history included open heart surgery, and aortic aneurysm. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 204A21A, expiry: UNKNOWN) dose was not reported, administered on 03-MAY-2021 for prophylactic vaccination. Concomitant medications included furosemide for heart surgery. On 04-MAY-2021, the subject experienced bilateral swollen legs from hip to feet. On 04-MAY-2021, the subject experienced swollen testicles. On 04-MAY-2021, the subject experienced difficulty ambulating upstairs. On 04-MAY-2021, the subject experienced difficulty putting on shoes. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from bilateral swollen legs from hip to feet, swollen testicles, difficulty ambulating upstairs, and difficulty putting on shoes. This report was non-serious.


VAERS ID: 1370975 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breast tenderness, Burning sensation, Dysmenorrhoea, Feeling hot, Pruritus
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: PCN, Celor
Diagnostic Lab Data:
CDC Split Type:

Write-up: After 2nd dose body felt like it was on fire/itchy/hot for about 24 hrs after. Was relieved by Benadryl. Continue to have breast tenderness that was never a symptom before as well as odd menstral cramping


VAERS ID: 1371127 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-06
Onset:2021-05-04
   Days after vaccination:87
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / -

Administered by: Unknown       Purchased by: ?
Symptoms: CSF protein increased, Electromyogram abnormal, Guillain-Barre syndrome, Lumbar puncture abnormal, Muscular weakness, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalopathy/delirium (broad), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: losartan, metoprolol, simvastatin, gabapentin
Current Illness: None
Preexisting Conditions: HTN, Hyperlipidemia, Stage 3 chronic kidney disease
Allergies: None
Diagnostic Lab Data: EMG on 5/27/21 consistent with GBS LP showing elevated protein and normal EBC on 6/2/2021
CDC Split Type:

Write-up: Patient was diagnosed with Guillain Barre Syndrome in late May. Symptoms began in early May. Lower extremity weakness and paresthesias. He did not have any other proceeding illness that might be expected to cause GBS. I do not necessarily believe the COVID vaccination he received in Jan and Feb caused his GBS. On the other hand I don''t have another explanation and thought it should be reported to VAERS


VAERS ID: 1371146 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dysgeusia, Epistaxis, Flushing, Paranasal sinus discomfort, Tongue discolouration
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (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: Hydroxychloroquine 200mg BID venlafaxine ER 75mg Daily famciclovir 500mg Daily Rayos 5mg Daily Otezla 30mg Daily Spironolactone 25mg PRN water retention Montelukast 10mg Daily Renvoq15mg Daily
Current Illness:
Preexisting Conditions: lupus
Allergies: allergic to sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: 5-4-21 11:15AM; feeling flushed, taste of rubbing alcohol on tongue, sinus pressure, nose bleed. Followed by nose bleeds with blowing nose. Tongue turned blotchy white 4-13-21 approx. 11:30AM; taste of rubbing alcohol on tongue.


VAERS ID: 1371161 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-04-24
Onset:2021-05-04
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood test, Heavy menstrual bleeding, Oligomenorrhoea, Smear cervix, Ultrasound scan
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Fertility disorders (broad)

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

Write-up: Approximately 10 days after second Pfizer Covid 19 vaccine dose, I had an extremely heavy period unlike any period I?ve ever had. I had to stay home for several days because of how unusually heavy it was. The period also lasted much longer than my normal period. I was so worried about the intensity of this cycle that I called my GYN and went in for a visit. She performed a Pap smear, blood test, and ultrasound of my ovaries and uterus. Everything came back normal and my GYN said the cause of my abnormally heavy period was unknown. It wasn?t until I saw a news report of other women having changes in their cycles that I thought what I experienced might be related to the Covid vaccine.


VAERS ID: 1371162 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Ageusia, Anosmia, Bronchitis, COVID-19, Chills, Diarrhoea, Feeling abnormal, Headache, Oropharyngeal pain, Pyrexia, Rash, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: I had a hysterectomy on March. Seasonal allergies
Allergies: Seasonal allergies
Diagnostic Lab Data: Covid test- positive They recommended a chest x-ray but I was too sick to get it done
CDC Split Type: vsafe

Write-up: I had the vaccine and I got sick immediately after like 4 hours after and each day I got sicker and sicker, I had fever, chills, sore throat, and each day I felt crappier, the head ache, stomach ache, diarrhea, we assumed it was from the vaccine and Friday I woke up with a rash all the way from my arm to my hand, and that day I kind of knew this was not because of the vaccine and I called my doctor and he said this does not seem like from the vaccine but he had me go to his office and when he saw my arm he said we should get you tested for Covid. On Saturday I woke up and we were supposed to go to our friends house and I felt miserable and I could not smell her essential oils. For dinner we were having chicken tacos and I could not taste anything. By then I knew I had Covid and I still went and got the test on Saturday morning, and tested positive. I did not have apetite and I wanted every blanket on me. My boss called and he had Covid too. I insisted my client got tested too. I was scared to sleep because I was shocking in the mucus. They recommended a chest x-ray but I was too sick to get it done. Even now I still have a hard time. Now I have bronchitis and I am going to the doctor on Friday to see if this is a result of Covid or something not related. Right now I am on antibiotics, steroids, and inhaler.


VAERS ID: 1371197 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-26
Onset:2021-05-04
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Apnoea, Asthenia, Choking, Cough, Dyspnoea, Fatigue, Impaired work ability
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow)

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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: I was given a prescription for prednisone which didn''t change anything. I was given a prescription for Fluticasone at the second visit which is nice when I use it but doesn''t last long and I am only prescribed to use it once a day.
CDC Split Type:

Write-up: A cough that is different than anything I have ever heard or had. Had it over a month and it hasn''t gotten any better. It chokes me sometimes and one time I stopped breathing because I was choking. Energy level very low and usually I have a lot of energy and never get tired. It is hard to do a little bit of work and I used to go go go all day. Labored breathing often. Fatigue.


VAERS ID: 1371512 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-08
Onset:2021-05-04
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Critical illness, Intensive care, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (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? No
Hospitalized? Yes, 30 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine failure. This patient received the vaccine on April 8, 2021, presented with severe COVID-19 on May4, and now is critically and gravely I?ll in the ICU.


VAERS ID: 1371657 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Hypertension
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (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: coumadin, protonix, oxycodone/APAP, amitriptyline, tylenol
Current Illness: none
Preexisting Conditions: antiphospholipid antibody syndrome, history of VTE, obstructive sleep apnea, polycythemia
Allergies: Lisinopril
Diagnostic Lab Data: BP readings $g140/90 some readings diastolic $g100
CDC Split Type:

Write-up: New onset Hypertension within first few wks of receiving vaccine, readings were mostly normal prior to Covid vaccine , 3wk later noted diastolic readings $g100 with home monitoring, now requiring anti-hypertensive


VAERS ID: 1373761 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Virginia  
Vaccinated:0000-00-00
Onset:2021-05-04
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Deafness
SMQs:, Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021593202

Write-up: Complete loss of hearing in right ear; This is a spontaneous report from a contactable consumer (patient). A 63-year-old male patient received second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Solution for injection; Lot number: unknown) via unspecified route of administration on an unspecified date (at the age of 63-year-old) in the hospital as single dose for COVID-19 immunisation. Patient had no relevant medical history, concurrent conditions or any known allergies. Concomitant medications were not reported. Patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. Prior to vaccination, the patient was not diagnosed with COVID-19 and since, the vaccination patient has not been the patient been tested for COVID-19. Patient previously received first dose of BNT162B2 on an unspecified date for COVID-19 immunisation. On 04May2021, at 10:00, patient experienced complete loss of hearing in right ear and visited doctor or other healthcare professional office/clinic visit. Reporter considered the events as non-serious. Therapeutic measures in response to the event included treatment with steroid injections in ear and oral steroids. Outcome of the event was recovered with lasting effects (resolved with sequalae) on an unspecified date in 2021. Information on the lot/batch number has been requested.


VAERS ID: 1374004 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cellulitis, Condition aggravated, Feeling abnormal, Feeling cold, Irritability, Limb discomfort, Musculoskeletal stiffness, Myalgia, Pruritus, Skin exfoliation, Vaccination complication, Vaccination site erythema, Vaccination site pain, Vaccination site swelling, Vaccination site warmth
SMQs:, Rhabdomyolysis/myopathy (broad), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Arthritis; Comments: No medical history provided. No concomitant medication information provided.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20211

Write-up: didn''t want to scratch arm because it looked as if it could break open; still throbbing/When patient received dose it stung; skin was swelling/ lumpy; itchy/ it started blowing up again itching the heat /still itching really bad/ started blowing up again itching the heat; hot; weird soreness; red; arm felt angry; my doctor said it looked like cellulitis; they snaked around my arm to the top of my elbow; arm blew up; Skin had tiny little peelings; felt something weird; small area that felt like punched in arm and stiffness/stiffness and hotness is moving down to the elbow; felt a cold sensation crawling up arm; This spontaneous case was reported by a consumer and describes the occurrence of CELLULITIS (my doctor said it looked like cellulitis), CONDITION AGGRAVATED (they snaked around my arm to the top of my elbow), MUSCULOSKELETAL STIFFNESS (small area that felt like punched in arm and stiffness/stiffness and hotness is moving down to the elbow), SKIN EXFOLIATION (Skin had tiny little peelings), FEELING ABNORMAL (felt something weird), VACCINATION COMPLICATION (didn''t want to scratch arm because it looked as if it could break open) and IRRITABILITY (arm felt angry) in a 64-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 017C21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No medical history provided. No concomitant medication information provided. Concurrent medical conditions included Arthritis. On 04-May-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 04-May-2021, the patient experienced FEELING COLD (felt a cold sensation crawling up arm). On 05-May-2021, the patient experienced MUSCULOSKELETAL STIFFNESS (small area that felt like punched in arm and stiffness/stiffness and hotness is moving down to the elbow) (seriousness criterion medically significant). On 14-May-2021, the patient experienced CELLULITIS (my doctor said it looked like cellulitis) (seriousness criterion medically significant), CONDITION AGGRAVATED (they snaked around my arm to the top of my elbow) (seriousness criterion medically significant), LIMB DISCOMFORT (arm blew up), SKIN EXFOLIATION (Skin had tiny little peelings) (seriousness criterion medically significant), FEELING ABNORMAL (felt something weird) (seriousness criterion medically significant), IRRITABILITY (arm felt angry) (seriousness criterion medically significant), VACCINATION SITE WARMTH (hot), MYALGIA (weird soreness) and VACCINATION SITE ERYTHEMA (red). On 15-May-2021, the patient experienced PRURITUS (itchy/ it started blowing up again itching the heat /still itching really bad/ started blowing up again itching the heat) and VACCINATION SITE SWELLING (skin was swelling/ lumpy). On 17-May-2021, the patient experienced VACCINATION SITE PAIN (still throbbing/When patient received dose it stung). On an unknown date, the patient experienced VACCINATION COMPLICATION (didn''t want to scratch arm because it looked as if it could break open) (seriousness criterion medically significant). On 26-May-2021, CELLULITIS (my doctor said it looked like cellulitis), CONDITION AGGRAVATED (they snaked around my arm to the top of my elbow), LIMB DISCOMFORT (arm blew up), SKIN EXFOLIATION (Skin had tiny little peelings) and FEELING ABNORMAL (felt something weird) had resolved. At the time of the report, MUSCULOSKELETAL STIFFNESS (small area that felt like punched in arm and stiffness/stiffness and hotness is moving down to the elbow), FEELING COLD (felt a cold sensation crawling up arm), IRRITABILITY (arm felt angry), MYALGIA (weird soreness), VACCINATION SITE PAIN (still throbbing/When patient received dose it stung), VACCINATION SITE SWELLING (skin was swelling/ lumpy) and VACCINATION SITE ERYTHEMA (red) outcome was unknown and VACCINATION COMPLICATION (didn''t want to scratch arm because it looked as if it could break open), PRURITUS (itchy/ it started blowing up again itching the heat /still itching really bad/ started blowing up again itching the heat) and VACCINATION SITE WARMTH (hot) had not resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown Route) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown Route), the reporter did not provide any causality assessments. Case Crosslinked to MOD21-091006. On Thursday, May 20, 2021- Patient reports that it has been 7 days since her first dose of vaccine and her doctor has put her on antibiotics and prednisone. On Mon, May 17, 2021, Patient is sending pictures of her arm. On Mon, May 17, 2021, 11:45 AM- Patient reported she was still itching really bad even after taking allegra. The only thing that would stop the itching was mentholatum. Crosslinked MOD21-091028 and MOD21-091029 Patient received first dose on 4 May 2021 at 2;30p at a drug store with lot #017C21A in left arm(non-dominant). The over 9 days later on Friday night, she felt a weird soreness and arm felt angry, red and hot. Patient called her doctor who saw a picture of her arm and told her to take Norco that she used for arthritis. The following day her skin felt itchy and swollen- she called her pharmacist who asked her to take Allegra. Patient also reports applying coconut oil and a vapor rub on arm to help her sleep. Patient is scheduled to receive her second dose of the Moderna vaccine tomorrow, 01Jun2021. She had already provided her demographics and her health care and vaccine facility information with previous call. Patient had recently emailed photos of her adverse events. Patient stated she prefers to be contacted by email and not by telephone. No further information provided. Company comment: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. Most recent FOLLOW-UP information incorporated above includes: On 17-May-2021: Additional information received on 17-May-2021 and Pictures of events updated. On 17-May-2021: Additional information received on 17-May-2021 and Event details and treatment information was updated. On 20-May-2021: Follow up information received on 20-may-2021 and Patient treatment details and doctor description were added. On 31-May-2021: Follow up information received on 31-May-2021 and new events were added, Case is upgraded from non-serious to serious.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.


VAERS ID: 1289203 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-05-03
Onset:2021-05-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 21C 10-05 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Influenza like illness, Oropharyngeal pain, Pain, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: solgar formula w?osy; sk?ra; paznokcie
Current Illness: No
Preexisting Conditions: gastritis and esophagitis
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever 37,8, pain in all the body, trembling body, a little of sore throat and flu feelings.


VAERS ID: 1032250 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-02-01
Onset:2021-05-03
   Days after vaccination:91
Submitted: 0000-00-00
Entered: 2021-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Advil 200mg
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fever 102.1 degrees Chills Body aches


VAERS ID: 1281305 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-24
Onset:2021-05-03
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site erythema, 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: None
Preexisting Conditions: None
Allergies: Tide laundry detergent Dill Erythromycin otic ointment
Diagnostic Lab Data:
CDC Split Type:

Write-up: Developed a 5cm x 6cm warm, erythematous patch corresponding with the injection site on day 8/9 post vaccine


VAERS ID: 1281318 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-04-30
Onset:2021-05-03
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: had headache all day Saturday, plus fatigue - slept most of Saturday. Sunday was mostly better but still kind of tired.
Other Medications: daily vitamins, probiotics
Current Illness: n/a
Preexisting Conditions: celiacs disease
Allergies: celiacs disease
Diagnostic Lab Data: none yet, have not gone to the doc yet.
CDC Split Type:

Write-up: sudden sharp stab or tingling sensation in various places - 2 on face near my nose, one in my right lower leg in the front


VAERS ID: 1281413 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-09
Onset:2021-05-03
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

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

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

Write-up: Double Vaccination. No adverse reaction


VAERS ID: 1281454 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-02
Onset:2021-05-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Pain in extremity, Pyrexia, Seizure
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), 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? Yes
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 1st Covid Vax- pt had seizure 3 days after taking vax.
Other Medications: oxcarbazepine 450mg bds, levothyroxine 100mg qd, Caltrate, multivitamin,
Current Illness: seizure on 4/14/21, 3 days after taking 1st Covid Vax
Preexisting Conditions: Down Syndrome, Seizure disorder,
Allergies: nka
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt had some pain in his right arm and fever after taking the vax. Next day he woke up, went to the wash room and then had a seizure. His father gave him a cold compress and provided him with water and extra seizure medicine. His father called the Neurologist. He was told to give him some Tylenol for his fever and extra seizure meds if needed and to FU w/ an office appt if he has another seizure. It had been more than a year since he has had a seizure but had one on 4/14/21 that was 3 days after taking the 1st Covid Vax.


VAERS ID: 1281476 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-09
Onset:2021-05-03
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 - / IM

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

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

Write-up: Double Vaccination. No adverse reaction.


VAERS ID: 1281566 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Gait disturbance
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Trazadone, hydrocodone, atorvastatin, clonazapam
Current Illness: no acute illnesses
Preexisting Conditions: back pain, arthritis, and high cholesterol
Allergies: pollen, vitamin E, latex, and mold
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Felt unsteady after shot, with mild dizziness. Did not eat breakfast. Monitored her for 30 mins.


VAERS ID: 1281594 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: not know
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Visually observed patient looked faint for approximately 5 seconds Patient was reclined on cot, given juice & crackers, BP checked 1st 110/70 BP was weak Patient was observed for 30 minutes, patient verbally reported he was feel much better Left the facility with his father & told to go get food & water


VAERS ID: 1281605 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / IM

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

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

Write-up: Patient lost conscious. Feet elevated, 0.3 ml Amonia inhalant provided. Pt regain consciousness after receiving respiratory stimulant. Powerade drink given ,paramedic staff assess patient. After 5 minutes ,Patient stated" feeling better" family menber came to tent and took patient home.


VAERS ID: 1281657 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Dizziness and vasovagal episode. Hx of vasovagal and seizure x1. Patient went decorticat and immediately awaken after ammonia given.


VAERS ID: 1281745 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Patient threw up 10mins after vaccination, twice, EMS was called. They advised to take her to hospital, she refused against medical advice


VAERS ID: 1281753 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

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

Write-up: ON LOWER LEFT ARM, PATIENT STARTED HAVING WELTS ALL OVER ARM. NO ITCHING, NO ISSUES BREATHING, NO PAIN. STARTED AFTER ABOUT AN HOUR AFTER ADMINISTRATION OF VACCINE. OFFERED TO CALL PARAMEDICS, AND OFFERED BENADRYL, PATIENT DECLINE. INFLAMMATION OF WELTS STARTED SUBSIDING, SO PATIENT DECIDED TO LEAVE WITH NO TREATMENT ACCEPTED.


VAERS ID: 1281758 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

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

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

Write-up: Patient reported feeling light headed approximately 8 minutes after receiving the vaccine, then fainted. Patient came to 2-3 minutes later. Patient was provided water and orange juice, as he had mentioned he had only had a very small breakfast (one poptart). Patient says he has not fainted post-vaccination before, but has fainted before after getting his blood drawn.


VAERS ID: 1281843 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK LA / -

Administered by: Other       Purchased by: ?
Symptoms: Dry throat, Dysphagia, Dyspnoea, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Dehydration (broad)

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

Write-up: Patient returned to site 30 mins after observation as he felt short of breath, difficulty swallowing and dry throat. Patient was evaluated by RN and EMS. No swelling noted. Vital signs obtained. Patient hydrated and was closely monitored. Patient was also evaluated by PA and PA. Patient was then had some complaints of left arm tingling. Patient provided with water to hydrate. Patient felt better after 30 mins. Patient instructed to contact PCP if any worsens Symptoms or if any medical emergency to call 911 or to ER. Patient also advised to report any symptoms using the VAERs online on card.


VAERS ID: 1281869 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN JANSSEN / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none known
Current Illness: none known
Preexisting Conditions: none known
Allergies: Keppra, dextromethorphan
Diagnostic Lab Data: none, EMS is here assessing the patient
CDC Split Type:

Write-up: two seizure episodes. patient was coherent before, between and after


VAERS ID: 1281883 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Syncope, Unresponsive to stimuli, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown, none reported by patient
Current Illness: asthma
Preexisting Conditions: asthma
Allergies: Mango, strawberry, citrus, dairy, dogs, seasonal
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient become unresponsive and faint approximately 5-10 minutes after receiving dose 2 of the covid vaccine. After consuming some water patient vomited and remained unresponsive. Pharmacist went to get epi-pen to administer but upon returning with it the patient was responsive again and reported no difficulty breathing. Epi-pen was not administered.


VAERS ID: 1281934 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Immediate post-injection reaction, Loss of consciousness, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient is not taking any medications, supplements, or herbal remedies.
Current Illness: None
Preexisting Conditions: None
Allergies: No known allergies.
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Immediately after patient was given vaccine, the patient passed out for 1-2 minutes, then vomited, became light-headed, and broke out into sweats. After 2 minutes the patient regained consciousness, however, the other symptoms persisted for about 10 minutes.


VAERS ID: 1281938 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Medical Marijuana Antidepressant Others unknown
Current Illness: None
Preexisting Conditions: Long term effects post Lyme Disease
Allergies: Eggs Wheat
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed out after receiving vaccine while waiting afterwards. He woke up disoriented, sweating. He said he had passed out previously and it felt the same. EMS checked him out and he left on his own.


VAERS ID: 1281974 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 LA / IM

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

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

Write-up: A medical assistant put the epired dose vial back in the fridge instead of throwing awaye on 04/30/2021. Another medical assistant unknowingly drew up and administred this vaccine to patient.


VAERS ID: 1282091 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Formication, Hyperhidrosis, Paraesthesia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine
Current Illness: No
Preexisting Conditions: Thyroid
Allergies: Codeine, kiwi
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fainted, sweating, lightheaded, dizzy, tingling all over, felt like bugs were crawling under her skin


VAERS ID: 1282108 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

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

Write-up: Patient was very very anxious to receive the IMZ. Pharmacist calmed the patient down and administered the IMZ. Patient went over to wait 15 minutes in the post IMZ waiting area . Patient started to become very anxious again while waiting and vomited. Pharmacist came out & assisted and calmed the patient down. Provided water to patient and after patient calmed down & feeling OK patient left with her father. Patient was feeling fine when left with her father.


VAERS ID: 1282126 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Hyperhidrosis, Loss of consciousness, Nausea, Presyncope, Tunnel vision
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Optic nerve disorders (broad), Retinal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Sudden sweatiness, nausea and tunnel vision. Very brief LOC. Immediately better when placed supine. More scarred than anything else. No fall or injury. BP/pulse/O2 saturation all Normal Initial 126/89, 69, 100%. No orthostasis. Classic vasovagal reaction. Resolved.


VAERS ID: 1282143 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Dizziness, Ear pain, Fall, Hypoacusis, Otitis media, Presyncope
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (narrow), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sudafed 30mg
Current Illness: Right Otitis Media - untreated, productive cough x3 weeks
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: No labs performed. Provider evaluated the patient''s ear and the patient was found to have right otitis media. The patient has been complaining of right otalgia and muffled hearing for nearly 3 weeks. He was evaluated at this time and was prescribed decongestants and analgesics.
CDC Split Type:

Write-up: Patient experienced vasovagal reaction approximately 3 hours after receiving first vaccine. Patient was standing in the hallway, squat down and then when he stood up, he felt lightheaded and fell over (not hitting his head). He does not recall the event. Remembers a another individual helping him to sit up.


VAERS ID: 1282185 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Hypotension, Presyncope, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: After injection patient felt dizzy and fainted. Vasovagal episode. Patient has a history of vasovagal. Patient awaken after ammonia. Vital signs taken by EMS. Patient is hypotensive. Patient was placed on stretcher in trendelenburg . Patient recovered


VAERS ID: 1282219 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure decreased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Dehydration (broad)

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

Write-up: Patient. Complained of feeling her blood pressure dropping. Patient closed her eyes and body became relaxed. EMS contacted , patient layed in stretcher, vital signs monitored by EMS. Patient eventually recovered.


VAERS ID: 1282263 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-02
Onset:2021-05-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / N/A LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Chills, Lethargy, Pain, Pyrexia, Rhinorrhoea
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Fever, chills, joint and body aches, runny nose, lethargy


VAERS ID: 1282299 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

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

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

Write-up: Pt fainted immediately after receiving Janssen covid shot


VAERS ID: 1282308 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-04-12
Onset:2021-05-03
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 20TA21A / 1 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Discomfort, Full blood count, Headache, Magnetic resonance imaging, Metabolic function test, Pregnancy test, Syncope, Troponin
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: N/A
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: Initially seen at Urgent Care (EKG) In Emergency Department at Hospital: CBC, BMP, Serum pregnancy, troponin MRI and MRV
CDC Split Type: 20TA21A

Write-up: Patient had syncopal episode with left-sided headache and left-sided heaviness on 5/3/2021.


VAERS ID: 1282344 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Hypoaesthesia, Immediate post-injection reaction
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Anxiety
Allergies: None
Diagnostic Lab Data: Blood pressure reading 125/87 mmHg 30 minutes after receiving the dose.
CDC Split Type:

Write-up: Chest pain immediately after receiving the vaccine described as a 6/10 on pain scale. (10 being the highest) Patient also reported her arm feeling numb after receiving the dose.


VAERS ID: 1282350 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Dyspnoea, Flushing, Hyperhidrosis, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Allergic: Difficulty Breathing-Medium, Systemic: Confusion-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Severe


VAERS ID: 1282378 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 2024A21A / 1 LA / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too Low


VAERS ID: 1282553 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Nausea, Vital signs measurement
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: we measured his blood pressure and it was normal
CDC Split Type:

Write-up: 10 minutes after the patient recieved the vaccine, he felt dizzy, noxious, and sweatting for about 30 min


VAERS ID: 1282598 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-04-30
Onset:2021-05-03
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: DKA


VAERS ID: 1282695 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Delaware  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 2 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Non-verbal, Autistic
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient recieved the first dose of the Moderna COVID-19 mRNA vaccine on 3/25/2021 at another facility. He was 17 years, 10 months old, according to the EUA of the Moderna vaccine, he was underage at the time. After consultaiton with our Medical Director Dr., the second dose of Moderna was administered without incident at the facility (5/3/2021). Parental consent was obtained from his mother prior to his second dose.


VAERS ID: 1282710 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 2 RA / IM

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

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

Write-up: Patient recievd her first dose of the Moderna Covid 19 mRNA vaccine on 3/25/2021 at another facility. She was 16 years 4 months of age at that time. According to the EUA of the Moderna vaccine, she was underage at that time. After consultation with our Medical Director Dr., the second dose of Moderna was administered without incident at the facility (5/3/2021). Parental consent from her mother was obtained prior to the second dose.


VAERS ID: 1282756 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / N/A LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Deafness, Hyperhidrosis, Presyncope, Tinnitus, Tunnel vision, Visual impairment
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (narrow), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: atorvastatin (40mg x1/day)
Current Illness:
Preexisting Conditions: hypercholesterolemia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Almost vasovagal syncope. Vaccine administered at 11:00. Vasovagal symptoms present at 11:03. Profuse sweating, decreased ability to see (tunnel vision), ringing in the ears (subsequent hearing loss). Fainting did not present, and symptoms completely subsided at 11:08.


VAERS ID: 1282765 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Dizziness, Flushing, Heart rate increased, Incorrect dose administered, Incorrect product formulation administered
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Vestibular disorders (broad), Hypersensitivity (broad), Medication errors (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Pfizer Covid 19 (dose 1)--flushing, burning in the lower limbs
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: no known drug allergies
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patient received J&J Covid Vaccine at 1:46 pm. At approx. 2:05 pm she stated she had an increased HR (wears wrist monitor) and was light headed. Spoke to patient about if she had previously felt this way after a vaccine and she stated she felt this after her "first covid vaccine". After questioning, she stated that she had received a Pfized Covid Vaccine in February which was not noted in her consent form. She also did not note that she had been hospitalized post-vaccination for a burning sensation and flushing that would not cease. She received the J&J vaccine at the advice of her primary care physician but had not advised pharmacy staff. After discussing it with the patient, it was determine that EMS would be called. EMS came to evaluate patient.


VAERS ID: 1282820 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK UN / -

Administered by: Other       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: None
Current Illness: NA
Preexisting Conditions: depression
Allergies: None known
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Patient received 1st Moderna vaccine from facility according to mom and immunization card with patient. Patient is 17 yo. Moderna used for second dose; recommended by Pediatric Director after consultation. No adverse reaction.


VAERS ID: 1282843 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 - / IM

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

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

Write-up: Patient received a Janssen Covid 19 vaccine at 3:15pm and was waiting in the observation area when she felt like she was going to faint (she claimed to feel really warm) so she laid down and within seconds a tech and pharmacist approached her where she was responsive. she said that she was just warm and did not want us to call 911 or anyone for her. She remained seated for another 20 minutes and felt fine so she left and shopped for the next hour and felt fine.


VAERS ID: 1282859 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Hyperhidrosis, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

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

Write-up: Patient felt weak and got really sweaty (cold sweat) , then he vomited for a few minutes and felt better. The sick feeling came on within 2 minutes of the administration and he felt better after vomiting


VAERS ID: 1282866 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Fall, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: BP started at 104/65 and pulse 45 (5/3/21)
CDC Split Type:

Write-up: Patient became weak and fell to the floor. Patient felt lightheaded and was sweating profusely. We monitored his blood pressure and it was 104/65 with a pulse of 45. The patient never lost conciousness. We monitored his BP and HR over the next 30 minutes and it eventually went back to normal of 134/86 with HR of 57.


VAERS ID: 1282877 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 1 RA / IM

Administered by: Other       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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine recipient was a minor (17 y/o) and was given the MODERNA Covid-19 vaccine, instead of the PFIZER Covid-19 vaccine. There was a miscommunication and after multiple verbal verifications of age and consent the vaccinator did not confirm the vaccine was PFIZER and instead administered MODERNA. After vaccination, the guardian gave the vaccinator the orange "Pfizer ONLY" paper placard and it was then the vaccinator realized the minor was given the wrong presentation of vaccine. The vaccinator alerted the lead clinician on site, and another individual, spoke with the guardian and explained the medical error that occured and answered any questions or concerns that arose.


VAERS ID: 1282914 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-04-30
Onset:2021-05-03
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute coronary syndrome, Chest pain
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? 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: Patient received first Pfizer COVID vaccination 3 days ago at an outside facility and has presented today to our facility with chest pain found to be acute coronary syndrome. Patient is daily smoker, BMI of 35.5, and drinks 5-6 drinks daily.


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