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

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

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 174 out of 8,753

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VAERS ID: 1788546 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Decreased appetite, Erythema, Fatigue, Gait disturbance, Headache, Induration, Limb discomfort, Nausea, Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (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: Arms swelled up and hurting. Age 60
Other Medications: Lunesta 1mg Benazepril 10mg Amlodipine 5mg Escitalopram 20mg
Current Illness: muscle spasms in back and hip
Preexisting Conditions: Back and neck issues. Degenerative disk problems
Allergies: Bactrim
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: My arm is red and Swollen. It is hard to the touch. I have had a headache and very tired. My legs started hurting at work , they felt very heavy andI barely made it through the rest of the afternoon. Today I''ve been very fatigued and Nauseous, and as of last night I haven''t ate much much. Not very hungry


VAERS ID: 1788558 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-14
Onset:2021-10-14
   Days after vaccination:273
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL92261 / 2 LA / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Laboratory test, No adverse event
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Methotrexate, Folic Acid, levothyroxine, multivit, Remicade
Current Illness: None
Preexisting Conditions: GERD, Hypothyroidism, AAA, Rheumatoid arthritis, CKD Stage 3
Allergies: Oxycodone
Diagnostic Lab Data: Facility Outbreak testing
CDC Split Type:

Write-up: N/A


VAERS ID: 1788610 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 2 UN / IM

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

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

Write-up: The patient had initially received dose #1 of PFIZER vaccine on 09/16/2021 however, the chart completed in the office was labeled MODERNA. The patient received PFIZER and it was documented as MODERNA for first dose w/ a PFIZER LOT number. When the patient came into the office on 10/14/2021 for his second vaccine, he claimed he lost his vaccine card and needed a new card. His chart was accessed by our front desk team member, which showed a MODERNA vaccine documented. He was escorted to the vaccination area and greeted by the MA who confirmed with the patient chart that he had Moderna, but did not notice the that the lot numbers for the initial vaccine belonged to the PFIZER vaccine. She proceeded to confirm his identity and his review of his PRE vaccination checklist and vaccinated the patient with MODERNA for his second dose on 10/14 on the understanding that the note in his chart was accurate. As his COVID-19 card was being rewritten and updated for the patient, I was called as the discrepancy in LOT number from dose 1 was noted (noted to be Pfizer lot # w/ Moderna documented in the chart). Upon review of paper documentation from his initial day of service on 9/16 and databse it was confirmed that he received a PFIZER vaccine for his first dose on 9/16. Therefore, the patient received his first dose of vaccine as Pfizer on 9/16 and his second dose on 10/14/21 as Moderna. The patient was notified of this and sent home after his post vaccination wait time was completed.


VAERS ID: 1788618 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-10-08
Onset:2021-10-14
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 2 RA / IM

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

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

Write-up: Chest pains beginning mid morning after light activity (walking) and lasting until the evening (10am-6pm) including at least two instances of a gripping sensation in the chest. The sharp pain was evident in the front and back of the chest especially during inhalation. Some tiredness and shortness of breath was also experienced. Pain seemed to resolve itself.


VAERS ID: 1788636 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breast pain, Chest pain, Lymphadenopathy
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Lipodystrophy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: lymph nodes inflamed due to the vaccine and pain protruding to her left breast causing chest pain


VAERS ID: 1788642 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-29
Onset:2021-10-14
   Days after vaccination:258
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 2 RA / IM

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

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

Write-up: Tested PCR positive for COVID 10/14/21 after being fully vaccinated.


VAERS ID: 1788647 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-10-01
Onset:2021-10-14
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Extra dose administered, Fatigue, Headache, Tinnitus
SMQs:, Hearing impairment (narrow), Arthritis (broad), 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: Zyrtec and sudafed as needed for seasonal allergies
Current Illness: None
Preexisting Conditions: Reflux, dust and pollen allergies
Allergies: None
Diagnostic Lab Data: None. I didn''t report it to my PCP
CDC Split Type:

Write-up: Sudden onset of chills, joint pain, headache, ear ringing, and tiredness. No fever, sneezing, coughing or shortness of breath. Took Covid 15-minute test and it was negative. Symptoms were gone this morning. This was almost two weeks to the day after my booster shot -- I''d had a little tiredness after the first shot and nothing after the second. All were Pfizer.


VAERS ID: 1788659 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-20
Onset:2021-10-14
   Days after vaccination:267
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 2 LA / IM

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

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

Write-up: 10/14/21 breakthrough covid case after 2 doses of Pfizer Covid vaccine


VAERS ID: 1788675 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-12
Onset:2021-10-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Chills, Computerised tomogram head, Disorientation, Fatigue, Gait disturbance, Headache, Injection site pain, Lymphadenopathy, Pain, Pyrexia, Syncope, Urine analysis
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (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), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: MVI
Current Illness: None
Preexisting Conditions: None
Allergies: Patient reports previous false positive to a tuberculin test. The solution contained preservatives. She was told the preservatives in the solution could have caused the false positive.
Diagnostic Lab Data: During ER visit: Vital signs, blood and urine tests, CXR, and head CT.
CDC Split Type:

Write-up: 1 day post vaccine-patient experienced fever, chills, body aches, fatigue, headache, swollen lymph nodes, and injection pain. 2 days post vaccine-patient''s supervisor called with concerns that patient was faint and husband was picking her up. Husband called back later to report patient was disoriented and unstable gait. Patient was taken to ER.


VAERS ID: 1788712 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / IM

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

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

Write-up: Patient was at a vaccination clinic where Moderna, Pfizer and J&J were provided. Patient filled out a consent for a Moderna vaccine. She went to the Pfizer vaccination station. The vaccinator verified verbally that the patient was here for a Pfizer vaccine. The patient said yes. The vaccinator gave a Pfizer vaccine. After the vaccination clinic, we were processing the paperwork and realized that the patient filled out a Moderna consent form (and not pfizer). Dr., the medical doctor at clinic, was informed and contacted the patient. The patient was understanding. Both Mederna and Pfizer are mRNA vaccinations. She was feeling fine. She was provided a new vaccination card and made aware that her 2nd dose should be a Pfizer. System was updated to reflect the vaccine given and an electronic consent was sent to the patient so we have a consent form for Pfizer on our records.


VAERS ID: 1788735 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-10-12
Onset:2021-10-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FHO820 / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine Phosphate 10mg/day Losartan Potassium 50mg/day
Current Illness: no other know allergies
Preexisting Conditions: hypertension
Allergies: Penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Awoke with entire body itching, did not take medicine due to early hour but could not fall back asleep, took shower at 6:20 notice raash on palms. After shower applied OTC hydrocortisone cream to arms. Took benadryl at approximately 6:45. Reported to school, itching had resolved but fellow employees noticed rash on face and I then noticed my forearms had broken out with hives. Nurse took temperature and pulse ox--both normal, but also noticed rash on shoulder blades. Went to Urgent care vitals were normal with BP 130/84 which is only slightly high for me. By the time I saw doctor it seemed hives were less severe. He advised continuing OTC meds and following up with family physician in five days. Today all has resolved except palms are still splotchy red to pink rash occasional mild itching. NO new or strange foods or meds were ingested and he thought the vaccine was the most likely cause. I had COVID diagnosed on Jan 1, 2021 which was mild and resolved within six days, but has a few lingering effects (Brain fog and loss of taste) now resolved. I was hospitalized in late June with Sepsititis secondary to cellulitis. I am currently over weight 266 lbs down from 306 lbs in June. Weight loss is intentional and physician monitored.


VAERS ID: 1788762 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Chest pain, Differential white blood cell count, Electrocardiogram, Full blood count, Human chorionic gonadotropin, Insomnia, Metabolic function test, Troponin I
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa
Diagnostic Lab Data: On 10/15 in the ER I was given CBC w/ diff, comprehensive metabolic panel, ER troponin-1, HCG,serum, qualitative ECG 12 lead, x ray chest AP portable
CDC Split Type:

Write-up: On 10/13 the night I got my shot I had difficulty sleeping, slept only 2-3 hours which is very unusual, 10/14 started experiencing mild chest pain, 10/15 went to ER doctor because chest pain persisted. My sleep returned to normal by 10/14


VAERS ID: 1788897 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer Lot #EN6200 02/20/2021 Age 83, same reaction, large welts on back and arms with severe itching.
Other Medications: Lisinopril, Vitamin D, Gabapentin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Round welts ranging from quarter size to baseball size on back and arms, with severe itching.


VAERS ID: 1788930 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Divalproex 1000mg po BID, haloperidol 20mg po BID Haloperidol decanoate 200mg IM q 4 weeks Hydroxyzine 25mg po TID olanzapine 30mg po BID
Current Illness:
Preexisting Conditions: schizoaffective disorder; bipolar type severe obesity
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: During previous admission, patient completed the Moderna Covid series on 2/8/21 and 3/8/21. During current admission patient received a third dose of the Moderna covid vaccine in error. Patient''s medical consultant informed this writer that the patient has been under close observation for any side effects, including checking vital signs every shift. So far, no side effects noted.


VAERS ID: 1788931 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Arthralgia, Fatigue, Myalgia, Nausea, Pain in extremity, Palpitations, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Arm severely inflamed, unable to move, requires prescription medication, Tetanus, unknown dates.
Other Medications: Multiple vitamin, complex b, flax seed oil
Current Illness: None
Preexisting Conditions: None
Allergies: Aloe
Diagnostic Lab Data:
CDC Split Type:

Write-up: Heart racing, fever, muscle pain, joint pain, shoot muscle and joint pain, fatigue, nausea, extreme arm pain, and stomach cramping - no treatment for listed events.


VAERS ID: 1788940 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-02-08
Onset:2021-10-14
   Days after vaccination:248
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cystoscopy, Nephrolithiasis, Pyelonephritis, SARS-CoV-2 test positive, Ureteral stent insertion
SMQs:, Retroperitoneal fibrosis (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen prn, apixaban, vitamin b12, duloxetine, mvi, gabapentin, lactobacillus acidophilus, levothyroxine, melatonin, metformin, ondansetron prn, psyllium seed
Current Illness:
Preexisting Conditions: HTN, DM type 2, history of colonic obstruction s/p resection and eventually colostomy takedown in March 2021, atrial fibrillation, hx of TIA
Allergies: codeine, iodine, statins
Diagnostic Lab Data: COVID status positive on 10/14/21.
CDC Split Type:

Write-up: Patient received Pfizer COVID vaccine on 1/18/21 and 2/8/21. On 10/14/21, patient is admitted to our facility for ureteral stone, pyelonephritis, and COVID-19 infection with possible acute respiratory failure with hypoxia. Patient underwent cystoscopy, left ureteral stent placement on 10/15/21. As of today (10/15/21), patient is still admitted in our med/surg unit.


VAERS ID: 1789130 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-01
Onset:2021-10-14
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

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

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

Write-up: Fever, body aches, cough, chills, headache, and fatigue.


VAERS ID: 1789135 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-19
Onset:2021-10-14
   Days after vaccination:56
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, COVID-19, Cystitis, Loss of consciousness, Metabolic encephalopathy, SARS-CoV-2 test positive
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine, atorvastatin, vitamin d3, fish oil, gabapenin, insulin glargine, pioglitazone
Current Illness:
Preexisting Conditions: DM type 2, HTN, and HLD
Allergies: nkda
Diagnostic Lab Data: COVID status positive on 10/14/21.
CDC Split Type:

Write-up: Patient received Pfizer COVID vaccine on 7/22/21 and 8/19/21. On 10/14/21, patient had a loss of consciousness and admitted to our facility for acute metabolic encephalopathy, acute cystitis, and acute kidney injury. Patient was also COVID positive on admission (10/14/21). As of today (10/15/21), patient is still admitted in med/surg unit.


VAERS ID: 1789157 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products, 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: The patient came in for his booster dose on 10/14/21. Database did not show any doses as the patient had received his first two doses in another state. When the technician asked if he was here for his booster dose, the patient stated yes and that it had been at least 6 months since he got his second dose. The patient did not have his vaccine record card on him. The technician then gave him the sticker with the lot#, date, and pharmacy information to update his vaccine record card at home. When the pharmacist went to give him the vaccine and asked if he was here for the Pfizer booster, he said yes. The next day, the patient''s wife came in to get her booster dose. Upon looking at her vaccine record card, we saw that the patient''s wife had received Moderna in another state, and denied her the Pfizer booster, stating that mixing manufacturers had not been approved by the CDC yet. The patient''s wife then got upset, stating that her husband had received the Pfizer booster the previous day, despite also getting Moderna in another state with her. That was when the error was found. No adverse events were reported as of yet.


VAERS ID: 1789313 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 LA / IM

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

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

Write-up: Patient received pfizer COVID-19 vaccine instead of flu vaccine at an offsite COVID/flu clinic.


VAERS ID: 1789482 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hallucinations, mixed, Nightmare, Psychotic disorder, Screaming, Sleep disorder
SMQs:, Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (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: atenolol, statin, lisinopril/hydrochlor
Current Illness: none
Preexisting Conditions: mild Arteriosclerosis
Allergies: none
Diagnostic Lab Data: None
CDC Split Type:

Write-up: experienced psychotic episode, woke at 2am after wickedly violent dreams, hears voices yelling at me. my wife calmed me down. went back to sleep to awaken three more times after extremely violent dreams and I was yelling. Final dream I was partially awake and I heard someone tell me its time for you to go and had a vision of myself securing my firearm and shooting myself in the head. I have never had these experiences, I do not have have any type of mental illness and I am very happy and pretty stress free. I do not use drugs or alcohol.


VAERS ID: 1789484 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Ear pain, Lymphadenopathy, Tongue disorder
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: None
Current Illness: None
Preexisting Conditions: Morbidly Obese
Allergies: None
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: 2 Lesions under the tongue, swollen left armpit lymph node, earache.


VAERS ID: 1789920 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-01
Onset:2021-10-14
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Body temperature, Dyspnoea, Fatigue, Pain
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: same as above - 65- March 10, 2021-2nd dose Pzier COVID 19
Other Medications: vit D, calcium, celexa, vit C, spirolactone, Activella
Current Illness: none
Preexisting Conditions: none
Allergies: sulpha antibiotic
Diagnostic Lab Data:
CDC Split Type:

Write-up: temperature 99.9, body aches, slightly short of breath, very very tired.


VAERS ID: 1789921 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: NA
Preexisting Conditions: Asthma, over weight
Allergies: Aspirin, codeine, peaches and pears
Diagnostic Lab Data:
CDC Split Type:

Write-up: A large, painful, raised red mark developed the day after the injection site. It measured about 2? diameter. By this morning at 8am, 2 days later, it measured 2.25? and the painful area extended much further. By this evening at 8:30, the red blotch has increased in size to 3.5? across. I have been taking ibuprofen, but it is still painful.


VAERS ID: 1789923 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Diarrhoea, Fatigue, Injection site bruising, Injection site erythema, Injection site swelling, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Carafate, Omeprazole, Venlafaxine, Cyphroheptadine
Current Illness: None
Preexisting Conditions: Obesity, Fybromyalgia
Allergies: Penicillin, sulfa, latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fatigue, muscle aches, chills, diarrhea, redness/swelling/bruising at injection site.


VAERS ID: 1789926 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Headache, Heart rate increased, Hyperhidrosis, Hypertension, Influenza like illness, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Copaxone; Norvasc; Crestor; Metformin; Prevacid; Vitamin D3; Vitamin B Complex; Vitamin C; Zinc
Current Illness:
Preexisting Conditions: Multiple sclerosis; hypertension; high cholesterol; pre-diabetic
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Flu like symptoms; fever; chills; sweating; body aches; headache; increased heart rate; high blood pressure (160/93)


VAERS ID: 1789927 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / SYR

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

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

Write-up: Swollen and sore lymph nodes in right armpit


VAERS ID: 1789935 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Hyperhidrosis, Influenza like illness, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: Similar symptoms after 2nd Covid vaccine
Other Medications: N/A
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Fever (101.7), body aches, sweats/chills, headache, tiredness - Flu-like symptoms. Began same day as booster. Symptoms still occurring Day 2. Taking extra strength Tylenol to relieve symptoms. No medical attention at this time.


VAERS ID: 1789940 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Swollen lymph node armpit following 2nd dose pfizer covid vaccine, not as severe as 3rd dose
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen under arm lymph nodes, as big as 1/2 tennis ball size, mild pain


VAERS ID: 1790086 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Washington  
Vaccinated:0000-00-00
Onset:2021-10-14
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dysmenorrhoea, Fatigue, Pain
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Alcohol use (very minimal. 1 drink per month.); Non-smoker
Preexisting Conditions: Comments: The patient had no known allergies. The patient did not have any history of drug abuse or illicit drug use. The patient had finished period last week (Saturday). The patient was taking vitamins in past.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211028478

Write-up: SEVERE MENSTRUAL CRAMPING, NO DISCHARGE; DOUBLING OVER IN PAIN; FATIGUE (COULD GO LAY DOWN AND TAKE A NAP); This spontaneous report received from a patient concerned a 41 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: alcohol user, and non smoker, and other pre-existing medical conditions included: The patient had no known allergies. The patient did not have any history of drug abuse or illicit drug use. The patient had finished period last week (Saturday). The patient was taking vitamins in past. The patient was previously treated with sertraline for drug used for unknown indication. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 211A21A, expiry: UNKNOWN) dose was not reported, administered on 13-OCT-2021 for prophylactic vaccination. No concomitant medications were reported. On 14-OCT-2021, the patient experienced severe menstrual cramping, no discharge. On 14-OCT-2021, the patient experienced doubling over in pain. On 14-OCT-2021, the patient experienced fatigue (could go lay down and take a nap). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from severe menstrual cramping, no discharge, fatigue (could go lay down and take a nap), and doubling over in pain. This report was non-serious.


VAERS ID: 1790088 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Missouri  
Vaccinated:0000-00-00
Onset:2021-10-14
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211028736

Write-up: ADMINISTRATION OF EXPIRED VACCINE; This spontaneous report received from a health care professional concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1820095 expiry: 02-OCT-2021) dose was not reported, administered on 14-OCT-2021 for prophylactic vaccination. No concomitant medications were reported. On 14-OCT-2021, the patient experienced administration of expired vaccine. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of administration of expired vaccine was not reported. This report was non-serious.


VAERS ID: 1790291 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO185 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lymph node pain, Lymphadenopathy, Pain, Sleep disorder
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer-BioNTech confusion and fatigue Day of shot
Other Medications: None
Current Illness: None
Preexisting Conditions: Obesity
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Swelling in the left armpit large and painful enough on the second night to wake me up Minor body aches


VAERS ID: 1793531 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Headache, Injection site pain, Injection site rash, Injection site swelling, Musculoskeletal stiffness
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi vitamins Synthroid Caltrate Zyrtec Cymbalta
Current Illness: None
Preexisting Conditions: Low thyroid Hip bursitis Parsonage-turner
Allergies: Pcn
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Swelling, pain snd rash around injection site. Shoulder pain, stiff neck and headaches


VAERS ID: 1793553 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-10-12
Onset:2021-10-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ezetimide--livalo--allopurinol--81mg aspirin---collagen peptide--ammonium lotion
Current Illness:
Preexisting Conditions: stent placement 2007
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: rash on right upper arm


VAERS ID: 1793573 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-10-11
Onset:2021-10-14
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Neck pain, Tinnitus, Visual impairment, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Arthritis (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: 25 yrs old tetanus shot, broke out in rash and swelling
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: I have had reactions in the past to tetanus shot, years ago
Diagnostic Lab Data: None taken
CDC Split Type:

Write-up: Thursday evening after work , I started to have headaches starting at my lower neck ( brain stem area) getting worse over the next 4 hour to the point of seeing spots, bad pain to the point of vomiting, because of the pain, head throbbing, like zI could feel my pulse pounding in my entire head, ringing in my ears.


VAERS ID: 1793581 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-27
Onset:2021-10-14
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 1 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Computerised tomogram, Deep vein thrombosis, Pulmonary embolism, Ultrasound Doppler
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Suboxone, Celexa, Burpropion, Flexeril. Lasix. Trazadone
Current Illness: None
Preexisting Conditions: Chronic opiate depemdence Chronic back pain
Allergies: Codiene and Ultram
Diagnostic Lab Data: CT scan, US legs
CDC Split Type:

Write-up: Submassive PE and DVT with other risk factors. Started on Anticoagulation and appears to be improving.


VAERS ID: 1793589 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003F21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Chest discomfort, Chills, Injection site pain, Myalgia, Pain, Pain in extremity, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: fever of 101.2 chills & body aches sharp shooting / stabbing pain randomly all over body (in torso, extremity muscles and joints) tightness in chest major pain at injection site and by lungs/heart resting heartbeat of 108 bpm


VAERS ID: 1793594 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWD185 / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Decreased appetite, Headache, 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: aliskiren, allopurinol,proscar, atorvaststin, vitamin d3, aspirin
Current Illness: NA
Preexisting Conditions: high blood pressure, gout,enlarged prostate,boderline high cholesterol
Allergies: penicillin
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: 100.8 fever, headaches, loss of appetite, beginning 7:00 am Oct. 14 lasting 18 hours.


VAERS ID: 1793595 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Lymph node pain, Lymphadenopathy
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: sweaty, light headed, felt like I was going to passout. Had to lay down. BP taken (normal). After 3 mins felt better. on 10/16/2021 have swollen, sore lymph node on side of injection.


VAERS ID: 1793630 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 4 LA / IM

Administered by: Pharmacy       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: NOT KNOWN
Current Illness: DIABETES WAS LISTED IN THE CONSENT FORM
Preexisting Conditions: DIABETES WAS LISTED IN THE CONSENT FORM
Allergies: NO KNOWN DRUG ALLERGY WAS LISTED
Diagnostic Lab Data: NO
CDC Split Type:

Write-up: THE PATIENT WAS GIVEN THE VACCIN: PFIZER , 0.3ML , THE 4TH DOSE , HE SEEMED OK AFTER 15 MINUTES SUPERVISION, NO ADVERSE EVENTS OR SYMPTOMS WAS NOTICED, AND HIS DR WAS NOTIFIED AS WELL.


VAERS ID: 1793633 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Chills, Headache, Influenza like illness, Injection site pain, Injection site swelling, Oedema peripheral, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Von Willibrands Disease, Type I
Diagnostic Lab Data:
CDC Split Type:

Write-up: 10-15-2021: Woke up at 5 am with fever of 102, headache, chills, flu like muscle and joint pains. Left arm was swollen and painful to move. Swollen lumps in arm pit area and chest. Tightness in chest. Took 2x500mg Tylenol every 4x6 hours to attempt to reduce fever and swelling. Fever came and went over next 24 hours, all other symptoms persist 10-16-2021: Woke at 2 am, fever 102, headache, chills, flu like muscle and joint pains. Left arm was swollen and painful to move. Swollen lumps in arm pit area and chest. Tightness in chest. Spoke with Doctor through medical app, was told this was normal for side effect and would subside over the next 3 to 4 days. Suggested I fill out a regulatory authority report.


VAERS ID: 1793638 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 - / IM

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

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

Write-up: ADMINISTERED DOSE FROM EXPIRED VIAL


VAERS ID: 1793639 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-11
Onset:2021-10-14
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3950 / 3 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cerebrovascular accident, Dysarthria, Facial paralysis, Hemiparesis, Magnetic resonance imaging head abnormal, Neurological symptom
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hearing impairment (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: eliquis losartan hydralazine cardizem hydralazine omeprazole hydrochlorthiazide lexapro potassium gabapentin
Current Illness: none
Preexisting Conditions: atrial fibrillation valvular heart disease hypertension GERD depression brain aneurysm Lung cancer
Allergies: codiene
Diagnostic Lab Data: MRI 10/14/21
CDC Split Type:

Write-up: symptoms of stroke started approximately 10:00 on 10/14/21 will in the bathroom getting ready. called for help. found on floor with left facial droop, slurred speech, left side weakness. Called 911. Transported to Hospital. Found to have right MCS stroke. Currently still in hospital under going treatment.


VAERS ID: 1793671 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-27
Onset:2021-10-14
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Rash maculo-papular
SMQs:, 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: Adderall XR, Spironolactone, Naproxen, Vit D3, MVI, low dose aspirin, Allegra-D
Current Illness: none
Preexisting Conditions: adult acne, osteoarthritis, ADHD, environmental allergies
Allergies: Codeine = rash
Diagnostic Lab Data: none at the time of this report
CDC Split Type:

Write-up: acute onset maculopapular lesions along the left dorsal cervical area, consistent with shingles or herpes zoster 17 days following a booster dose of Pfizer COVID vaccine


VAERS ID: 1793675 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301309BA / 3 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Abdominal discomfort, Chest pain, Cough, Diarrhoea, Fatigue, Pulmonary pain, Sluggishness
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (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: Cancer in lymph node
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Didn?t go to dr, or hospital
CDC Split Type:

Write-up: I walk 3-5 miles a day, 10-14-2021 I was very sluggish, chest and lungs started to hurt, starting coughing, sick In stomach , next morning I had diarrhea, tired and sluggish, can?t do my 3-5 miles walk


VAERS ID: 1793697 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Bowel movement irregularity, Chest pain, Dyspnoea, Migraine, Pain, Paraesthesia, Pyrexia, Vision blurred
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Noninfectious diarrhoea (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Shortness of breath, burning sensation in chest, tingling throughout body and primarily head, high fever, migraine, stomach pain, blurred vision, Spontaneous short duration sharp chest pain, irregular bowels, painful body aches.


VAERS ID: 1793724 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH F12590 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Chills, Diarrhoea, Dizziness, Fatigue, Headache, Insomnia, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (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: 75, phizer, 2/9/21
Other Medications: Supplements: calcium, magnesium, tuna oil, iron, vitamin c
Current Illness: 0
Preexisting Conditions:
Allergies: Codeine, morphine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Started with nausea, diarrhea. Then fever 102, headache, total exhaustion, dizzy, poor balance, sleeplessness, chills. Advil for fevers


VAERS ID: 1793776 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angioedema, Hypersensitivity, Lip pain, Lip swelling, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (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: Zyrtec
Current Illness: angioedema chronic spontaneous urticaria
Preexisting Conditions: chronic spontaneous urticaria and angioedema
Allergies: sulfa
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Angioedema, swelling in lower lip and left cheek, face. Etremely painful as lip was stretched so huge. Started 9:30 in evening and lasted 2 days. Went to asthma and allergy center the next afternoon to my treating doctor. Confirmed reaction to vaccine due to my under lying autoimmune disorder


VAERS ID: 1793780 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Neuropathy peripheral, Sensitive skin, Skin discomfort
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Valsartan HCTZ 80-12.5; Fenifibrate 145; Ezetimibe-Simvastatin 10-20; Finasteride 1; Augmentin 875.
Current Illness: Recovering from epidydimitis infection
Preexisting Conditions: History of UTIs
Allergies: sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: The vaccine was administered at 11:30 am. By 3 pm I started experience neuropathy (heightened skin sensitivity on the right side of my face most pronounced around the orbit of my right eye and the right temple.) My skin was uncomfortable to the touch . No fever. By 6 pm all areas of the right side of my face were overly sensitive to the touch. I went to my pharmacy to report reaction, but it was closed. I call the nurse who was unaware of the adverse reaction I described. She recommended that if the symptoms get worse to see a physician. That evening the symptoms abated a little, but some mild neuropathy began in my right forearm and right thigh. The next morning (Friday), the neuropathy in my right forearm and leg were gone. The neuropathy in the right side of my face was slightly better still. The sensitivity in the underside of my right jaw was gone, but the sensitivity in my temple and the spot between my right eye and temple and in the lower part of the orbit of my right eye were more intense. Today (Saturday) I visited my pharmacy and the pharmacist who administered the injection recommended I report this adverse reaction. The sensitivity (which is still uncomfortable) at my right side temple, lower portion of orbit of right eye and the area between my right eye and ear are still present. If condition persists until Monday, I will schedule an appointment with my primary care physician.


VAERS ID: 1793783 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Pain in extremity
SMQs:, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reports that right calf , knee and heel very sore after both Pfizer doses but reported that it got got feeling better 3 to 4 days after first dose and expects it to resolve after this second dose in a few days -- told pt to let us or doctor know if it doesn''t improve or gets worse


VAERS ID: 1793797 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin er 500mg Atorvastatin calcium 20mg IC Lisinopril-hctz 10-12-5 mg Fluticasone propionate nasal spray 50mcg Beep ellipta 100mcg/25mcg
Current Illness: None.
Preexisting Conditions: Diabetes. A1C 6.0 Sarcoidosis
Allergies: Penicillin
Diagnostic Lab Data: None. Day 2 of Vertigo
CDC Split Type:

Write-up: Vertigo and nausea (while spinning) when laying down or sudden movements


VAERS ID: 1793811 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-06
Onset:2021-10-14
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH TWO183 / 3 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cerebrovascular accident, Computerised tomogram head abnormal, Hypertension
SMQs:, Neuroleptic malignant syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Hypertension (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: none known
Allergies: No known allergies
Diagnostic Lab Data: CT confirmed major stroke 10/16/2021
CDC Split Type:

Write-up: Stroke, hypertension, symptoms onset 10/14/2021


VAERS ID: 1793817 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (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: Similar reaction to the Shingrix vaccine
Other Medications: lisinopril, bisopropol fumarate, sertraline, ocuvite, aripiprazole, aspirin, metformin, prazosin, atorvastatin, loperamide
Current Illness: none
Preexisting Conditions: blood pressure, diabetes, obesity, liver disease, colitis
Allergies: Had similar reaction to first shingrix dose
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: The day after receiving the vaccine, she noticed the injection site growing red and painful to the touch. The following day she went to see her doctor because the red area was growing. At that visit they measured the length and width of the area, and she was told to call back if it grew. The next day, 10/16/21 it grew an additional inch. She reported to the doctor, who then prescribed antibiotics and asked her to come to my pharmacy to report the event.


VAERS ID: 1793842 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / UNK RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Cold sweat, Dry mouth, Feeling abnormal, Flushing, Headache, Hyperhidrosis, Pain in extremity, Piloerection, Sciatica, Sleep disorder, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalopathy/delirium (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (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: ALL TAKEN DAILY 1X DAILY EXCEPT WHERE SHOWN: Amlodipine 2.5mg Atorvastatin 80mg Bupropion 75mg Glipizide 5mg Hydrochlorothiazide 25mg Losartan 100mg Metformin 1000mg - 2x/day Metoprolol (Toprol) 25mg Plavix (Clopidogrel) 75mg Low Dose Baby
Current Illness: No other illnesses but being treated for neck and back injuries from car accident (no drugs)
Preexisting Conditions: Adult onset asthma type 2 diabetes
Allergies: No known allergies to anything but ketchup and pancake syrup make me sweat.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: One day after the Covid-19 Pfizer booster shot, my wife and I noticed that I could not finish a meal - this is extremely unusual for me. That night, October 14, 2021, I felt flushed before bed and my right arm where the shot was given was VERY sore. After going to sleep about 09:30pm, I was awakened at about 03:00am with severe chills and shaking all over, with a clammy/sweaty "goose bumped" feeling all over. Additionally, I felt severe "sciatic-like" pain extending from the middle of both right and left shoulders down both arms, and down my left leg. This was miserable. I got out of a sweaty bed and took 3 ibuprofen with a full glass of water, then sitting up until about 4:15am, at which time I went back to bed and slept through until 09:30am on the morning of October 15, 2021. I felt somewhat normal starting around Noon on October 15, but not "completely right"...my body felt "off" somehow. Around 10:00pm October 15, I went to bed and was suddenly awakened at 01:30am with SEVERE SWEATING - the whole bed was soaking wet including the pillow - and SEVERE sciatic like pain again shooting down both arms from my shoulders, but not my leg this time. I also had a mild headache and felt flushed and had dry mouth that I could not "cure" right away. Again, I took more ibuprofen and then again sat up waiting for the extreme pain to subside, which it did by the time I went to bed again around 03:45am. I then slept hard and awoke at 10:15am today, Saturday, October 16, 2021. I still do not feel "right" and at home trying to rest.


VAERS ID: 1793846 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-10-08
Onset:2021-10-14
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Dyspnoea exertional, Fatigue, Gait disturbance, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: tylenol #3, amlodipine 10 mg daily, cholecalciferol 5,000 daily, duloxetine 20 mg daily hydralazine 25 mg bid, hctz 25 mg daily, levothyroxine 100 mcg daily, losartan 100 mg daily, metoprolol tartrate 25 mg twice daily, potassium 20 meq da
Current Illness: unknown
Preexisting Conditions: CAD, depression, history of MI, HLD, HTN, Migraine, neuropathy, thyroid disease
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: She reports that 1 week ago today she received her third Covid vaccine. She reports after this she has had progressive fatigue, shortness of breath and dyspnea on exertion. States she has difficulty even walking between rooms at home now. Today felt might want to worsen so called family to take her to her doctor''s office, on the way she reports she had a syncopal episode while sitting in the car. Currently while in the doctor''s office sitting she had syncope for a few seconds and then complained of significant shortness of breath.


VAERS ID: 1793870 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH0027 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Became very ill within 48 to 72 hours after vaccination. Multi-vaccine cocktail including HepA, tdap, flu, pre-pneumonia. Age 55
Other Medications: Losartan, Rosuvastatin, Nifedipine, Prednisone, Trexall, Metformin ER, HCTZ, Aspirin, Folic Acid, Omeprazole
Current Illness: None.
Preexisting Conditions: Sarcoid, Type 2 Diabetes, and high blood pressure.
Allergies: Codeine, Codeine/Tylenol, opiates, Tramodol, Lisinopril, Ibuprofen, dyes, latex, adhesives, high concentration dye for radiologic procedures, penicillin in combination with other medications, Mepergan
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Moderately severe itching. I had to take Benadryl and Allegra to get relief. I''m still itching 3 days after the injection.


VAERS ID: 1793883 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: localized swelling or redness pain


VAERS ID: 1793911 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chest X-ray normal, Chest discomfort, Chest pain, Dizziness, Dyspnoea, Electrocardiogram, Full blood count normal, Metabolic function test, Pain, Pleurisy, Syncope, Tachycardia, Troponin normal
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (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? Yes
Hospitalized? No
Previous Vaccinations: COVID 19?dose 2 Similar symptoms as listed prior, but not as intense, no testing or medication required.
Other Medications: Prenatal vitamins?vitafusion gummies Zoloft Wellbutrin Zyrtec
Current Illness: NA
Preexisting Conditions: NA
Allergies: Clindamycin
Diagnostic Lab Data: All performed 10/15/2021 EKG-tachycardia Chest x-ray?normal Troponin?normal CMP/CBC?normal MD suspected pleurisy or pleuritis related to vaccine dose. Second adverse event, first adverse event similar to reaction experienced with second dose; however, this adverse reaction to 3rd dose was significantly worse.
CDC Split Type:

Write-up: Cheat pain?substernal pain radiating to back of chest, chest tightening and feeling of sandpaper scratching behind sternum Shortness of breath?both at rest and upon exertion Tachycardia?at rest, measured at 130 BPM Syncope/ feeling of faintness All occurred at the same time, chest pain still present 24 hours post vaccine


VAERS ID: 1793948 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-05-01
Onset:2021-10-14
   Days after vaccination:166
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 2 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Began to get muscle pain at the injection site a few days ago (about 5 months ago). It has not gone away since I first noticed.


VAERS ID: 1793979 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 01712A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site erythema, Rash
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Site: Bruising at Injection Site-Medium, Site: Redness at Injection Site-Medium, Systemic: Allergic: Rash (specify: facial area, extremeties)-Medium


VAERS ID: 1793980 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injected limb mobility decreased, Injection site pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad)

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

Write-up: Site: Pain at Injection Site-Severe, Systemic: Tingling (specify: facial area, extemities)-Mild, Additional Details: pain of the arem received the injection, couldn''t lift the arm well, no mobility of the affected arm


VAERS ID: 1794080 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 RA / IM

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

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

Write-up: Fever, exhaustion, lymph node swelling - size of a plum with pain in the area


VAERS ID: 1794091 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Injection site pain, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Estradol-Noreth 0.5-0.1 MG TB Vitamin D3 50 mg Zinc 50 mg.
Current Illness: none
Preexisting Conditions: none
Allergies: none known
Diagnostic Lab Data:
CDC Split Type:

Write-up: The next morning, 10/14 around at approx. 8:30 am, I started becoming chilled, fatigued, slightly nauseated, slight headache, slight muscle pain and running a slight fever, 100.5. Injection sight was sore. Symptoms started to diminish during the evening of 10/15 and by the morning of 10/16 I was feeling fine, with the exception of injection site was still slightly tender.


VAERS ID: 1794122 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Vermont  
Vaccinated:2021-10-11
Onset:2021-10-14
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 1 RA / IM

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

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: Torsemide, metformin, cozaar, asa, Lipitor, gabapentin
Current Illness:
Preexisting Conditions: HTN, DM II, Prostate CA (remission), gout, hypercoagulable state
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Acute Hypoxic Respiratory Failure. Patient is still admitted to hospital


VAERS ID: 1794159 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Diabetic neuropathy, Disorientation, Dizziness, Extra dose administered, Fatigue, Headache, Pain, Pyrexia, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Patient called on 10/16 to say she had a reaction to her Pfizer booster vaccine she received on 10/14/21. About 2 hours after she felt extremely exhausted, tired, fatigued and sleepy. She also had a fever, body aches, headache was dizzy and disoriented. She also said that her diabetic neuropathy was really acting up. She stated that she was feeling much better by the next day (10/15/2021). I told her that her symptoms were pretty consistent with normal vaccine reaction but to call md if she''s any worse. I also advised her to stay hydrated and to take acetaminophen or ibuprofen if needed and to rest. She was also going to report reaction to VAERS


VAERS ID: 1794175 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-10-12
Onset:2021-10-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abortion spontaneous, Exposure during pregnancy, Human chorionic gonadotropin negative, Progesterone decreased
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow), Sexual dysfunction (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: Zyrtec, Montelukast, prenatal vitamin
Current Illness:
Preexisting Conditions: Became pregnant after 1st dose of Moderna Covid-19 vaccination. Due date approximately June 15, 2022. Miscarried pregnancy 2 days after second dose of Moderna Covid-19 vaccine. Gained Dr approval for both doses with knowledge of pregnancy or efforts to become pregnant.
Allergies: Idiopathic angioedema, triggers are unknown
Diagnostic Lab Data: Blood test on 10/16/21 confirmed miscarriage in progress. HCG ~ 25, Progesterone 0.9.
CDC Split Type:

Write-up: Moderna 1st dose received 9/14/21. Moderna Second dose received 10/12/21. I conceived on or around 9/26/21 and had a positive pregnancy test one day before 2nd dose. I miscarried the pregnancy on 10/14/21, two days after 2nd dose.


VAERS ID: 1794187 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-11
Onset:2021-10-14
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Extra dose administered, Oral herpes
SMQs:, Oropharyngeal infections (narrow), Medication errors (narrow), 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: Herpes labialis after 1st pfizer covid vaccine
Other Medications: Levothyroxine, natpara, amiloride, potassium chloride, nuva ring, magnesium oxide
Current Illness: none
Preexisting Conditions: hypothyroidism, hypoparathyroidism, nephrocalcinosis, CKD
Allergies: none
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Herpes labialis outbreak, started on Thursday 10/14. Began using abreva immediately. Saw MD via telehealth on the evening of 10/14. Started on Valtrex on 10/15.


VAERS ID: 1794198 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-10-12
Onset:2021-10-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061E21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Drainage, Erythema, Peripheral swelling, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: arm - red swollen and had a draining affect - patient also stated that it was itchy


VAERS ID: 1794225 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-12
Onset:2021-10-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 182281 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Dyspnoea, Fatigue, Injection site pain, Malaise, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Tetanus, cellulitis, 31 years, 1998 or 1999
Other Medications:
Current Illness: N/A
Preexisting Conditions: Hypertension, hyperinsulinemia, hypothyroidism, depression, insomnia, Raynaud syndrome
Allergies: Codeine, celebrex
Diagnostic Lab Data: Pulse oximeter readings were 95-96 on room air, slight expiratory wheeze Today, 10/17, I continue to have intermittent shortness of breath whenever I move about. This is not normal for me- I am a registered nurse who works 12-hour shifts.
CDC Split Type:

Write-up: Shortness of breath, feelings of breathlessness (2 days, starting on 10/14/2021) Additionally, tiredness, malaise, aching in joints, soreness at injection site


VAERS ID: 1794264 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 3 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Injection site pain, Injection site warmth, Pain
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: Local reaction to Pfizer COVID vaccine 3/29/21 (VAERS ID: 1159772, E-Report Number: 401420). This reaction was stronger.
Other Medications: ARMOR THYROID, 45MG; LEVOTHYROXINE 25 MCG; CELEBREX 100 MG; DULOXETINE 30 MG; ACYCLOVIR 200 MG; BUSPAR 15 MG 2x per day; SIMVASTATIN 10MG; Xyzal 5 MG Supplements: Omega 3, Philips Colon Health Probiotic 10, Glucosamine/Chondroitin 1500 MG/2
Current Illness: None
Preexisting Conditions: Obstructive Sleep Apnea, Chronic headaches (migraine, tension, sinus), Degenerative joint and disk disease ? cervical, thoracic, lumbar, Hypothyroid, GERD with esophagitis, Hiatal hernia, non-ulcer Dyspepsia, Intermittent asthma, triggered by smoke, chemicals, scents, ? High cholesterol (controlled by medication/diet/exercise), Chronic sinusitis/rhinitis
Allergies: Sulfa drugs & Hydrocholorothiazide ? joint inflammation/pain Milk Protein allergy +Lactose intolerance-gastroenteritis, congestion Codeine ? nausea/vomiting Propranolol ? dizziness, sinus bradycardia, hypotension Nitroglycerine ? hypersensitive Mastisol adhesive ? contact dermatitis Artificial Scents ? asthma trigger, hives, congestion, headache
Diagnostic Lab Data: None. Sent message and photo to my doctor. She was not concerned, but asked that I report the reactions.
CDC Split Type:

Write-up: Localized red area 3" x2" warm and tender to the touch. Generalized body aches starting the day after. Both continue 3 days after receiving the vaccine.


VAERS ID: 1794267 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Patient came on 10/14/21 in the morning to request for her Moderna additional dose (3rd dose). Pharmacy technician provided her the consent form and Moderna booster eligibility (attestation) form. Patient gave us a covid card with 2 doses of Pfizer and pharmacy technician placed a sticker for her 3rd dose with lot number and today''s date (10/14/21). Rph checked the consent form, Moderna booster eligibility form and received a verbal answer from the patient that the patient is here for her 3rd Moderna dose. At the end of the shift, Rph batched all consent forms and found out this is potentially her 4th Moderna dose (based on rx/tx history). Rph called the patient on 10/14/21 but patient cannot be reached. Rph called again on 10/17/21 twice but pt still cannot be reached. Rph filed an incident report on 10/14/12 through company''s (Safeway) website. Rph is currently filing a report on VAERS and will work on submitting QA form today.


VAERS ID: 1794280 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-07
Onset:2021-10-14
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye pruritus, Hypoaesthesia, Injection site pruritus, Injection site swelling, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Over-the-counter Zyrtec, vitamin C, Zinc, and Olly women multivitamin.
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Penicillin Kiwi Tree nuts
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Approximately a week after my first dose, my left arm (injection site) has swollen to the size of a softball, is extremely itchy, and my eyes have started itching very badly. My arm is very sore throughout and feels slight numbness throughout the left side of my body.


VAERS ID: 1794296 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breast disorder female, Breast feeding, Headache, Influenza like illness, Pain, Pain in extremity, Suppressed lactation
SMQs:, Functional lactation disorders (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: Approximately 33 hours after the shot (with having a reaction to the shot within 10 hours- body aches, headaches, sore arm, flu like symptoms) I ended up having a clogged duct. I am a breastfeeding mother of 7 months and have never had a single issue. I got a clogged duct thats still trying to resolved and has significantly decreased my milk supply. There was NO other reasons why this could of happened.


VAERS ID: 1794309 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO187 / 1 LA / IM

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

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

Write-up: Unexpected menstrual bleeding


VAERS ID: 1794315 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF3590 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Blood Pressure (117/81), Pulse/min 98, Resp/min 16, Temp F 98.40, Height 68 inches, Weight 182lbs BMI 27.67, BSA 1.99
CDC Split Type:

Write-up: Starting Friday night, 10/15/2021 I started seeing a few red spots, thought maybe they were Mosquitoes as they itched a little. On Saturday, 10/16/2021 as the day went on I noticed the red spots had turned into a full blown Rash/Hives on my stomach, chest, back and buttocks. The itching was starting to intensify. On Sunday, 10/17/2021 I awoke to find the Rash/Hives was all over my body. I then went to the Emergency Care Facility located close to my house and was seen by PA. I explained the situation and timeline to him. He prescribed Prednisone 10, 18 tablets.


VAERS ID: 1794333 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-10-11
Onset:2021-10-14
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Electrocardiogram, Full blood count, Laboratory test, Palpitations, Troponin
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Femara, Claritin, Metamucil, prenatal multivitamin, DHA, vitamin D, bee pollen
Current Illness: None
Preexisting Conditions: None
Allergies: Latex, lactose intolerant
Diagnostic Lab Data: EKG, CBC, chem, triponin - all 10/15
CDC Split Type:

Write-up: Heart palpitations began morning of 10/14, sporadic until 2am 10/15 when they became consistent and problematic. Visited ER and observed PVCs. Returned to ER as instructed when symptoms continued, was given ZioXT patch for monitoring.


VAERS ID: 1794449 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-10-12
Onset:2021-10-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atenolol, amlodipine besylate, atorvastatin calcium, olmesartan medoxomil, torsemide, sertraline, B complex, biotin, methylfolate, D3, cinnamon, aspirin, omega 3 (fish oil).
Current Illness: None
Preexisting Conditions: Carotid disease, hypertension, obesity
Allergies: plavix, promethazine, phenobarbital
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Hard raised lump at injection site 4-5 cm in diameter; red, itchy rash around injection site 8-10 cm in diameter. Began 2 days after vaccination, worsened for 1-2 days, began to subside on day 5, still present on day 6 but continuing to resolve. Cortisone cream helped the itching, no other treatment provided.


VAERS ID: 1794459 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-09
Onset:2021-10-14
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Advil pm nightly
Current Illness: None
Preexisting Conditions: Sleep apnea
Allergies: Sulfa antibiotics
Diagnostic Lab Data: I have not been to a doctor yet, but plan to go if the bleeding doesn?t stop within a few more days
CDC Split Type:

Write-up: I have a nexplanon implant for birth control and have not had any periods or bleeding for the last 2 years. About a week after receiving the shot, I began moderate bleeding that has not stopped yet. I have had no other changes to my diet, medications, or normal daily routines.


VAERS ID: 1794725 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Migraine, 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: HEATHER birth control pills
Current Illness:
Preexisting Conditions: crohns disease
Allergies: penicillian
Diagnostic Lab Data:
CDC Split Type:

Write-up: fever chills body aches and migraine


VAERS ID: 1794731 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-10-12
Onset:2021-10-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Anosmia
SMQs:, Taste and smell disorders (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? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Complete loss of taste and smell


VAERS ID: 1794739 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-03-09
Onset:2021-10-14
   Days after vaccination:219
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Body temperature increased, COVID-19, Cough, Malaise, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: + 10/8/21 COVID 19
CDC Split Type:

Write-up: Patient became fully vaccinated with Pfizer on 2/16/21 and 3/9/21. Patient tested positive 10/8/21. Since then he states that he has not been feeling too well. He has had elevated temperatures with T-max of around 102 ?F. Dry cough has been persistent. Patient has been admitted since 10/14/21


VAERS ID: 1794792 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: New York  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 3 RA / IM
VARZOS: ZOSTER (SHINGRIX) / GLAXOSMITHKLINE BIOLOGICALS PM35L / 1 LA / IM

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

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

Write-up: Full body urticaria, self treatment w/cetirizine, resolved within about 4 hours of dose


VAERS ID: 1794819 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dyspnoea, Paraesthesia, Sneezing, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Hay fever, ADHD
Allergies: NKDA; hay fever per mother
Diagnostic Lab Data: Vitals 122/67 BP, pulse 128, resp 22, sp o2 83-86 % 0.3 mg epi-pen administered and 40 mg diphenhydramine IM given o2 at 2 L per nasal cannula Within 1-2 minutes after medications administered vital were: 123/86 BP, pulse 101, resp 20, sp 02 98% and patient stopped sneezing and SOB resolved
CDC Split Type:

Write-up: Developed sneezing, tightness of throat, and tingling of the fingers about 7 minutes post vaccination. Continual sneezing, clutching of throat.


VAERS ID: 1794826 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301258A / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site reaction, Migraine, Musculoskeletal stiffness, Myalgia, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Did not go to DR
CDC Split Type:

Write-up: stiff neck on same side as shot administered large welt at injection site achy muscles migraine headache


VAERS ID: 1794836 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-10-11
Onset:2021-10-14
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: I?ve had swollen lymph nodes, fatigue, fever, body aches
Other Medications: Bupropion
Current Illness: None
Preexisting Conditions: Obesity
Allergies: Gold, cinnamic aldehyde, ceclor
Diagnostic Lab Data:
CDC Split Type:

Write-up: I have swollen lymph nodes on the inside of my elbows, both arms. I felt it important to note that it can happen on the opposite arm as the one that the shot was give in.


VAERS ID: 1794856 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-02
Onset:2021-10-14
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest X-ray, Dyspnoea, Electrocardiogram, Fibrin D dimer, Full blood count, Metabolic function test, Oxygen saturation decreased, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine, Atorvastatin, Enalapril, Gabapentin, Lantus, Tramadol, Baclofen, Tessalon Perles, Ibuprofen
Current Illness:
Preexisting Conditions: DM HTN hyperlipidemia GERD chronic low back pain
Allergies: NKA
Diagnostic Lab Data: CBC, CMP,CXR, EKG,d-dimer
CDC Split Type:

Write-up: Short of breath, patient tested positive at home, went for Regeneron infusion, low sats in office and was admitted to ER.


VAERS ID: 1794857 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Arthralgia, Neck mass
SMQs:, Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Centrum silver multi-vitamin Excedrin migraine Acetaminophen Motrin
Current Illness:
Preexisting Conditions:
Allergies: Seasonal
Diagnostic Lab Data:
CDC Split Type:

Write-up: Large lump left side of base of neck/shoulder. Pain over clavicle on left side. Started 10/13/21. Tried Excedrin, motrin, acetaminophen for symptoms with no effect. Same side as vaccine administration. MD notified and aware, has not been seen at this time by MD.


VAERS ID: 1794913 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness postural, Extrasystoles, Fatigue, Fear, Flushing, Gait disturbance, Headache, Heart rate increased, Heart rate irregular, Hyperhidrosis, Immediate post-injection reaction, Injection site pain, Insomnia, Muscular weakness, Pain, Pain in extremity, Pyrexia, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Cardiac arrhythmia terms, nonspecific (narrow), Tachyarrhythmia terms, nonspecific (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Vitamin C Flaxseed Oil capsule
Current Illness: NA
Preexisting Conditions: NA
Allergies: lactose intolerance, sensitivities to animal products and gluten
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Immediately after receiving the shot at 10am, I felt flushed and had pain at injection site. this lasted for an hour or so and slowly faded into a dull aching in my arm and general fatigue throughout my body over the course of the next 8 hrs. I attempted to go for a walk after work about 6pm and noticed I was having irregular heartbeat with some rapid heart rate . I stopped walking because of these symptoms and drove home. I continued to feel tired with periodic rapid heart rate until bedtime. I got into bed about 10:15pm and by 10:30 pm I began a full onslaught of symptoms: I was flushed, fever of 102 F, I was sweating and shaking uncontrollably with chills and constant teeth chattering. I sweat through 2 frozen ice packs, had extreme dizziness when sitting up, weakness in arms and hands and legs. I could not take myself to toilet, needed assistance with transferring, toileting and drinking a glass of water. My neck and temples were throbbing in the veins causing a tremendous headache. I could not sleep but was afraid to take any medication for how it might react . My husband assisted me in getting water every 30 mins or so. The chills/shaking lasted until about 4 am. At 630am I had to get up for work, so I took OTC ibuprofen which did help my headache. My fever dropped down to 99 F as well by mid day on 10/15. Over the last three days I continue to hover about 1 degree above regular body temperature and still feel very fatigued with a headache that only subsides with routine dosing of ibuprofen. Most concerning, I am continuing to have cycles of irregular heart beat with rapid heart beat and the sensation of a "skipped beat".


VAERS ID: 1794942 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 RA / IM

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

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

Write-up: Patient was administered dose from vial that was expired due to being punctured and un-refrigerated for 21 hours.


VAERS ID: 1794967 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chills, Cough, Dyspnoea, Fatigue, Pyrexia, SARS-CoV-2 test negative, Sneezing
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: lamictal, oral birth control
Current Illness:
Preexisting Conditions: depression, pmdd, endometriosis
Allergies: latex
Diagnostic Lab Data: Negative covid test, administered 10/16
CDC Split Type:

Write-up: 9 hours after injection, all-over body exhaustion 10 hours after injection, convulsion-like chills & fever of 103.9 24 hours after injection, pressure on chest (like someone firmly pressing a hand into the center of my chest, affecting my breathing) and a cough develop 48 hours after injection, non-stop sneezing develops


VAERS ID: 1794999 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: No reported issues with vaccination. Patient received Pfizer BioNTech instead of Moderna as second dose. Patient did not have vaccine card, has dementia (not known by pharmacy in advance), and wife left him alone at the pharmacy for the vaccination. Wife called the next day to inform the pharmacy that the incorrect dose was received.


VAERS ID: 1795008 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-05
Onset:2021-10-14
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 2 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 3 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: Diabetes
Allergies: No known allergies
Diagnostic Lab Data: COVID-19 test
CDC Split Type:

Write-up: Patient hospitalized 10/14/21 for COVID-19 after being vaccinated


VAERS ID: 1795018 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-03-26
Onset:2021-10-14
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 1 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 2 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril, Pregabalin, Meclizine, Glipizide, Metformin
Current Illness: unknown
Preexisting Conditions: Diabetes, hypertension, neuropathy, hearing loss
Allergies: Iodine, ibuprofen
Diagnostic Lab Data: Positive COVID-19 test
CDC Split Type:

Write-up: Patient hospitalized with COVID-19 after being vaccinated.


VAERS ID: 1795042 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Genital pain, Muscle spasms, Pain, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Dystonia (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (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: No medications
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Generalized aches in upper body, Pinching/growing pain sensation in legs. Discomfort in thighs/feet, calves/shins, genital tract. It comes and goes. Cramping/burning in lower legs later in the day this happens and walking around helps with the pains/discomfort. It all started Thurs 10/14 around noon. The symptoms come and go and have since Thursday. Pt did start on a baby aspirin.


VAERS ID: 1795085 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: birth control
Current Illness: no
Preexisting Conditions: had COVID in Aug 2021 and anxiety
Allergies: no
Diagnostic Lab Data: no
CDC Split Type:

Write-up: Experiencing shortness of breath, chest pain, and pressure. Also feeling of nausea.


VAERS ID: 1795152 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / IM

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

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

Write-up: Administered 0.3 ml of vaccine from a vial that had been punctured 21 hours prior. Staff member made an error of not checking status of open vial.


VAERS ID: 1795162 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 RA / IM

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

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

Write-up: When she was driving home after her vaccination, she started feeling like her lips and tongue were swollen all the way up to her nose. It lasted about 20minutes then it went away and didn?t comeback anymore. Denies any other accompanying symptoms.


VAERS ID: 1795184 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Anxiety, Asthenia, Dyspnoea, Flushing, Tachycardia
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Hypoglycaemia (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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: report of feeling of impending doom, flushing, weakness, tachycardia, and shortness of breath


VAERS ID: 1795191 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adverse reaction, Diarrhoea, Fatigue, Headache, Impaired work ability, Nausea, Pain, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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: Amolodephene, Premarin, vitamins E and D and iron, neurotin, oxymorophine, Percocet
Current Illness: High blood pressure, high cholesterol, stomach ulcer, arthritis
Preexisting Conditions: High blood pressure, high cholesterol, arthritis
Allergies: Soma, reclast, penicillin, erothomycian, sulfur drugs, multivitamin, atoravastin
Diagnostic Lab Data: None, didn?t think I could leave my house, couldn?t work very much on Friday 10/15/2022 actually worked less than 2 hours of my 8 hour shift, on 10/18/2021 could not work due to the adverse reaction. I make $15 per hour, so this has cost me. I am notifying the pharmacy today.
CDC Split Type:

Write-up: Evening after injection, 6:00 pm on 10/14/2021, body aches and headache, 10/15/2021 7:00 a.m. very fatigued, nausea and vomiting and then terrible diarrhea, the nausea, headaches and diarrhea and fatigue continued on 10/16/2021 and 10/17/2021. Have taken zofran and over the counter anti-diarrhea meds on each of the days that symptoms were present. 10/18/2021 still fatigued, nauseated and some diarrhea as well as headaches continue but a little less severe at 1:15 p.m.


VAERS ID: 1795215 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Diarrhoea, Extra dose administered, Fatigue, Headache, Inflammation, Injection site pain, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), 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: Plavix, Losartan, Iron Pill, Hydrochlorothiazide
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt. states that after receiving the 3rd Booster of Phizer 10/13/2021, started experiencing symptoms 10/14/2021 of pain at the injection site, inflammation of heart wall (self-diagnosed), fatigue, muscle pain, nausea, joint pain, loose stool, and headache. Symptoms have subsided.


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