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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 175 out of 8,753

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VAERS ID: 1795217 (history)  
Form: Version 2.0  
Age: 39.0  
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 / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS - / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Asthenia, Chills, Diarrhoea, Dysgeusia, Extra dose administered, Insomnia, Maternal exposure during breast feeding, Migraine, Nervousness, Pain, Photopsia, Pyrexia, Tremor, Vaccine positive rechallenge, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Retinal disorders (narrow), Neonatal exposures via breast milk (narrow), Noninfectious diarrhoea (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: same symptoms, but less intense and faster recovery after 2nd Pfizer COVID-19
Other Medications: post-natal vitamins, Omega 3 supplement
Current Illness: Had COVID-19 - positive test on 08/06/2021;
Preexisting Conditions: None
Allergies: NKDA; bee sting venom
Diagnostic Lab Data: No work up done. Stayed at home to convalesce. Pt is mostly recovered, by some symptoms persist - see above.
CDC Split Type:

Write-up: 10/14/21 at 10:30pm: body aches, unable to sleep, by 1am violent body chills and shakes (subjective fever), teeth chattering, feeling anxious and shaky; by 2:30am vomiting, diarrhea, migraine HA (when closed eyes, saw flashing), metal taste when not vomiting, felt very weak. Vomiting resolved by 5-6 am on 10/15/21, but the rest of the symptoms persisted throughout the weekend. As of today, still feels shaky and week, anxious, with periods of body chills/shakes. Patient was breast feeding during the time she received the third dose and with both of the prior Pfizer vaccine doses. The child had no symptoms after the first one, sick (fussy, crying, fever, decreased appetite) after second dose, and no symptoms after third dose.


VAERS ID: 1795242 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-18
Onset:2021-10-14
   Days after vaccination:238
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

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

Write-up: breakthrough COVID-19 case


VAERS ID: 1795280 (history)  
Form: Version 2.0  
Age: 64.0  
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 FF8839 / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Dry skin, Feeling hot, Nodule, Pain, Pyrexia, Rash macular, Retching, Skin warm, Swelling, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Only mild fever and chills with first 2 doses
Other Medications: Lisinopril 40mg
Current Illness: None
Preexisting Conditions: High blood pressure
Allergies: Zantac, Cipro, Levofloxacin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: First night - fever, extreme chills, achy body, arm had large knot and was hot to touch. Second night feverish, throwing up multiple times, dry heaves multiple times - face got extremely hot and woke up with large red splotches on my face that looked like sunburn spots (but they were dried and swollen)


VAERS ID: 1795303 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Kansas  
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 (JANSSEN)) / JANSSEN 1822809 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dysphagia, Eye pain, Headache, Impaired work ability, Oropharyngeal pain, Pain, Pharyngeal contusion, Photophobia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (broad), Corneal disorders (broad), Retinal 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 stated that on Thursday night, October 14th, that she started having a headache and that the headache carried over into Friday the 15th. Pt stated that the headache got worse on Friday and that it was a shooting pain behind her eye and that the bright lights at work were making it worse like she needed to wear sunglasses or leave. She ended up leaving work early afternoon. Pt stated that night (Friday October 15th) that she was eating dinner (enchiladas) and she went to swallow her food and it got stuck. Pt stated that during the time the food got stuck she could still breath and wasn''t choking. Pt stated it took 6-7 minutes to get the food to go down and she tried to remain calm. Didn''t go to the ER because she didn''t feel like it was an emergency. Pt stated that she didn''t eat anymore and just drank hot water and that the next day her throat was sore like it was bruised but that the headache had gone away. She stated that she has been able to swallow fine since and today (Monday October 18th) is feeling better. Instructed pt to talk with her doctor and let them know what happened, pt verbally understood and stated she was seeing him today.


VAERS ID: 1795311 (history)  
Form: Version 2.0  
Age: 49.0  
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 FH 8020 / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Extra dose administered, Fatigue, Hypomenorrhoea, Nausea, Pain, Palpitations
SMQs:, Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Fertility 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: on file after COVID #1, COVID #2
Other Medications: lexapro 5mg
Current Illness: not applicable
Preexisting Conditions: not applicable
Allergies: nkda
Diagnostic Lab Data: not applicable
CDC Split Type:

Write-up: fatigue, all-over body aches, nausea starting about 12 hours after x 24 hours, intermittent heart palpations x 3-4 days; light menstrual period beginning, continues


VAERS ID: 1795322 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-28
Onset:2021-10-14
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 3 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had a positive COVID-19 PCR on 10/14/2021 after receiving three doses of Pfizer vaccine


VAERS ID: 1795356 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Maryland  
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 - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Headache, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Cold sx after first vaccine 9/25/2021
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nausea, Muscle Pain, Headache


VAERS ID: 1795392 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Arizona  
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 301358A / 3 - / -

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

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

Write-up: Tachycardia, resting HR approximately 112, started at 11am and continued for next 36 hours.


VAERS ID: 1795406 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Tennessee  
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 (MODERNA)) / MODERNA 047C21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac flutter, Chest discomfort, Dyspnoea, Headache, Nausea, Sinus congestion
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Blood Pressure meds and Thyroid meds. Multi Vitamin and glocosamine.
Current Illness: none
Preexisting Conditions: high blood pressure
Allergies: latex, sulfa drugs and some anti biotics
Diagnostic Lab Data:
CDC Split Type:

Write-up: On second day I started having tightness in my chest and trouble breathing with heart flutter. I could not lay down to sleep, Had to sleep in chair for 2 days. Horrible headache, clogged sinus and nausea. Put ice pack on my head off and on for a couple of days. Trouble breathing lasted 4 days and I still have headache and clogged sinus.


VAERS ID: 1795423 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Tennessee  
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 301358A / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Injection site discomfort, Pain in extremity, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol inhaler nuvaring
Current Illness: None
Preexisting Conditions: exercise induced asthma
Allergies: insects: anaphylactic reaction to yellow jacket or hornets
Diagnostic Lab Data:
CDC Split Type:

Write-up: pins and needles sensation from left mid-upper arm to fingers (rated 3/10) that began the morning after receiving her 2nd dose of COVID-19 vaccination (Pfizer). intermittent aching at dorsal side of right forearm just distal to elbow and at radial aspect of right wrist rated 5/10 on pain scale. Denies any limitations in ROM or weakness. intermittent tingling in left upper thigh anterolateral and anterior shin just distal to knee. No treatment will follow up to be evaluated in 1 week from 10/18/2021


VAERS ID: 1795489 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-06-16
Onset:2021-10-14
   Days after vaccination:120
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood creatinine increased, COVID-19, Chills, Dialysis, Hypokalaemia, Intensive care, Malaise
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Retroperitoneal fibrosis (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Hypokalaemia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Hospitalized COVID-19 Infection admitted to the hospital internal medicine service in the context of chills and malaise over 3 days. His creatinine was found to be 12 and he was also hypokalemic. He is being admitted to the CICU for dialysis needs


VAERS ID: 1795562 (history)  
Form: Version 2.0  
Age: 59.0  
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 FH8027 / 2 LA / IM

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

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

Write-up: patient received the shot one week before actual date actual date 10/21/21 pt received the shot 10/14/2021


VAERS ID: 1795763 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
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 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Atrial fibrillation, Condition aggravated, Electrocardiogram abnormal, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Cardiomyopathy (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Alfuzosin 10 mg Lasix 40mg Potassium Chloride 20mEq Sertraline 25mg Eliquis 5mg Diltiazem ER 180mg
Current Illness:
Preexisting Conditions: afib, hypokalemia, history of PE, embolism and thrombosis BLE, CKD stage 3, MDD, HF, edema, intervertebral disc disorder thoracic/lumbar, BPH
Allergies: No known allergies
Diagnostic Lab Data: EKG
CDC Split Type:

Write-up: Elevated heart rate, seen at hospital, EKG done, shows afib (has history), states vaccine reaction.


VAERS ID: 1795776 (history)  
Form: Version 2.0  
Age: 57.0  
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 (MODERNA)) / MODERNA 007C214 / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR - / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, Chills, Fatigue, Myalgia, Pain, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: Eliquis, lamictal, lamotrogene, gabapentin, chlorozoxazone, b-12, iron, d-3
Current Illness: N/A
Preexisting Conditions: Lupus, Back, knee, and hip pain Prothrombin factor 2
Allergies: Reglan, bupronephine,
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fever, chills, vomiting, stomach pain, general pain and muscle pain, fatigue


VAERS ID: 1795969 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-29
Onset:2021-10-14
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Feeling abnormal, Flushing, Injection site pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 09/29/2021
Other Medications: Wellburtin XL 150mg
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pain at the injection site. Fever, Fatigue, Flushing sensations, brain fog.


VAERS ID: 1795987 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Washington  
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 CW0180 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Headache, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (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: Sertraline, Clonodine
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, nausea, headache, light headed, muscle aches for 5 days.


VAERS ID: 1796166 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Pennsylvania  
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 - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Facial pain, Immediate post-injection reaction, Oropharyngeal pain, Pain, Pain in jaw, Secretion discharge, Sneezing, Trismus
SMQs:, Anaphylactic reaction (broad), Dystonia (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Glaucoma (broad), Osteonecrosis (broad), Hypersensitivity (narrow)

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

Write-up: Immediately after receiving the shot my jaw began to feel tight as if I was beginning to get lock jaw. 2 hours after my right side of my jaw only began to hurt with a dull achy pulsating pain similar to a cavity but the entire right side of my face. Pain is a 6/10. Relieved with NSAID and hot compress temporarily. The next day I had a sore throat, began coughing and sneezing and producing too much mucous. These symptoms are still persisting but are getting slightly better other than the jaw pain that I experience at least once a day for at least half an hour each time. The right sided jaw pain emerges every night when I lie in bed to go to sleep.


VAERS ID: 1796173 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Colorado  
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 (MODERNA)) / MODERNA 091D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Impaired work ability, Injection site haemorrhage, Malaise, Mobility decreased, Pain, Pain in extremity, Pyrexia
SMQs:, Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported bleeding at injection site at time of vaccine. As evening went on, she began to feel arm pain, felt sick and achy, feverish, and said body felt on fire. Took acetaminophen and iced shoulder. Bump developed on arm where shot was administered. Had arm pain and was hard to lift her arm the following day. She had to leave work and go home to rest.


VAERS ID: 1796514 (history)  
Form: Version 2.0  
Age: 59.0  
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 FH8027 / 2 LA / IM

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

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

Write-up: Patient got second dose two weeks after initial dose.


VAERS ID: 1797112 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Illinois  
Vaccinated:0000-00-00
Onset:2021-10-14
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dysphagia, Headache, Nausea, Pain, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211028518

Write-up: CAN''T EAT ANYTHING; BODY IS SORE; NAUSEA; VOMITING; HEADACHE; This spontaneous report received from a patient concerned a 43 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1822811, expiry: 20-MAR-2022) dose was not reported, administered on 13-OCT-2021 for prophylactic vaccination. No concomitant medications were reported. On 14-OCT-2021, the patient experienced can''t eat anything. On 14-OCT-2021, the patient experienced body is sore. On 14-OCT-2021, the patient experienced nausea. On 14-OCT-2021, the patient experienced vomiting. On 14-OCT-2021, the patient experienced headache. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the nausea, vomiting, can''t eat anything, body is sore and headache was not reported. This report was non-serious.


VAERS ID: 1797454 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Maryland  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 2 - / OT

Administered by: Unknown       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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: 2 patients received expired moderna covid-19 vaccine/Expired vaccine used; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (2 patients received expired moderna covid-19 vaccine/Expired vaccine used) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 050E21A) for COVID-19 vaccination. No Medical History information was reported. On 14-Oct-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 14-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (2 patients received expired moderna covid-19 vaccine/Expired vaccine used). On 14-Oct-2021, EXPIRED PRODUCT ADMINISTERED (2 patients received expired moderna covid-19 vaccine/Expired vaccine used) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications was reported. Treatment medications was not provided. Most recent FOLLOW-UP information incorporated above includes: On 15-Oct-2021: follow-up document Includes no new information


VAERS ID: 1797667 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Unevaluable event
SMQs:

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

Write-up: na


VAERS ID: 1797691 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Unevaluable event
SMQs:

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

Write-up: N/A


VAERS ID: 1797789 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Pravastatin 40 mg Tablet
Current Illness: None
Preexisting Conditions: High cholesterol
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient came in Oct. 14, 2021 at around 2:00 pm for his 2nd Pfizer vaccine. The patient was perfectly fine after receiving the shot and left the pharmacy with no problem. However, patient''s wife called the next morning and told us that he was taken to the ER last night bc he woke up covered in sweats, had rapid heart beat, and eventually passed out at home. According to her, patient has no underlying condition and the ER concluded that it must be from the vaccine and reported the incident to VAERS.


VAERS ID: 1797799 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-09
Onset:2021-10-14
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19 pneumonia, Dyspnoea, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH/CHRONIC CONDITIONS INCLUDE ASTHMA, COPD, OSA, HTN, DM2
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: THIS CASE MEETS CRITERIA FOR VACCINE BREAKTHROUGH REVIEW. SXS INCLUDE WORSENING SOB. WAS PREVIOUSLY ADMITTED FOR COVID PNA.


VAERS ID: 1797826 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-14
Onset:2021-10-14
   Days after vaccination:242
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asymptomatic COVID-19, Delivery, Exposure during pregnancy, Vaccine breakthrough infection
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Normal pregnancy conditions and outcomes (narrow), COVID-19 (narrow)

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

Write-up: This case meet criteria for vaccine breakthrough review. Patient was admitted , is asymptomatic for COVID symptoms. Per chart review, may have been symptomatic ~1 month prior. Patient delivered on 10/15/21.


VAERS ID: 1797888 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-08
Onset:2021-10-14
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: fever chills, severe pain after booster


VAERS ID: 1797894 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-08
Onset:2021-10-14
   Days after vaccination:189
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 2 - / -

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

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

Write-up: Pt admitted to rehab for strengthening after being in the hospital. Has history of ESRD and on dialysis. Exposed to COVID and tested positive.


VAERS ID: 1797916 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-10
Onset:2021-10-14
   Days after vaccination:218
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 - / -

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

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

Write-up: Pt admitted with acute appendicitis that was treated non-operatively due to COVID positive status.


VAERS ID: 1798027 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-10-12
Onset:2021-10-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chest X-ray, Chest discomfort, Chills, Electrocardiogram, Fatigue, Headache, Injection site pruritus, Musculoskeletal stiffness, Myocardial necrosis marker, Neck pain, Palpitations, Pruritus
SMQs:, Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Benadryl prn, ibuprofen prn taken upon onset of symptoms, but not prior to.
Current Illness: Chronic lower back pain.
Preexisting Conditions: Lower back pain, s/p laminectomy yrs ago.
Allergies: Percocet (itching)
Diagnostic Lab Data: EKG at Urgent Care 10/15/2021. EKG, CXR, & Cardiac enzymes in ED 10/15/2021. PCP eval 10/18/2021.
CDC Split Type:

Write-up: 10/13/2021 chills, headache; 10/14/2021 severe neck pain and stiffness, chest discomfort with intermittent palpitations lasting for hours, generalized itching, fatigue; 10/15/2021 localized itching below site itching.


VAERS ID: 1798069 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-10-08
Onset:2021-10-14
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / IM

Administered by: Military       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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NKA, NKDA
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: 6 days post vaccination pt reports lymphadenopathy in left auxiliary space that is tender to palpation.


VAERS ID: 1798075 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-20
Onset:2021-10-14
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 - / -

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

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

Write-up: HOSPITALIZED WITH COVID-19 BREAKTHROUGH CASE


VAERS ID: 1798081 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-11
Onset:2021-10-14
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (AFLURIA QUADRIVALENT) / SEQIRUS, INC. - / 1 LA / IM

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

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

Write-up: Patient reports getting both vaccines in same arm on 10/11/2021. Patient reports needing to go to the hospital on 10/14/2021 due to increased heart rate, chest pain, and difficulty breathing.


VAERS ID: 1798105 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Blood test, Chest pain, Chills, Condition aggravated, Dizziness, Dyspnoea, Electrocardiogram, Fatigue, Myalgia, Nausea, Pyrexia, Throat irritation, X-ray
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (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? Yes
Hospitalized? No
Previous Vaccinations: Covid-19 Pfizer
Other Medications:
Current Illness: Slight reaction to first Covid-19 Pfizer shot: difficulty breathing, dizziness, blurred vision, nausea, vomiting, swollen lymph nodes, bloody nose, sore joints and muscles, headache
Preexisting Conditions: Very mild regurgitating valves (aorta, tricuspid, pulmonary) and slightly enlarged ascending aorta
Allergies: Contrast dye, pecans, hickory, walnut, corn, dogs, cats, horses, roaches, mold, dust, grass in yards
Diagnostic Lab Data: Emergency Department- 10/15/2021 because I was still running a fever and having difficulty breathing X-ray Bloodwork EKG Breathing treatment
CDC Split Type:

Write-up: Difficulty Breathing Dizziness Nausea Chest pain Itchy throat Pain in joints and muscles Fatigue Fever 101+ Chills


VAERS ID: 1798158 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amitriptyline (ELAVIL) 25 MG tablet Take 1 tablet by mouth nightly as needed for Sleep. atorvastatin (LIPITOR) 10 MG tablet Take 1 tablet by mouth nightly. clobetasol (TEMOVATE) 0.05 % ointment Apply topically 2 (two) times daily to affect
Current Illness: Essential hypertension - Primary ICD-10-CM: I10 ICD-9-CM: 401.9 Type 2 diabetes mellitus with hyperlipidemia (CMS/HCC) ICD-10-CM: E11.69, E78.5 ICD-9-CM: 250.80, 272.4 Class 1 obesity due to excess calories without serious comorbidity with body mass index (BMI) of 33.0 to 33.9 in adult ICD-10-CM: E66.09, Z68.33 ICD-9-CM: 278.00, V85.33
Preexisting Conditions: HTN (hypertension) Reactive airway disease GERD without esophagitis Thyroid nodule Type 2 diabetes mellitus with hyperlipidemia (CMS/HCC) Tear of medial meniscus of left knee Primary osteoarthritis of left knee Vitamin D deficiency Hyperlipidemia LDL goal Primary insomnia
Allergies: Metformin Metoprolol
Diagnostic Lab Data: Pt was monitored for 30 minutes, vital signs taken (normal), injection site was inspected (normal) Pt had no complaints
CDC Split Type:

Write-up: pt was given the Pfizer COVID vaccine when she had already received both of the moderna vaccines. NO issues reported, pt had no complaints when discharged.


VAERS ID: 1798196 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185H / 3 RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 2 RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Bedridden, Chills, Diarrhoea, Fatigue, Headache, Lymphadenopathy, Myalgia, Pyrexia, SARS-CoV-2 test negative, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: seasonal allergies to flower
Diagnostic Lab Data: Covid-19 Test- Negative
CDC Split Type: vsafe

Write-up: Dose1- Fatigue and headache Dose2-fever of 103, headache, vomiting and diarrhea , fatigue, joint and muscle pain. Patient was in bed for 2days following the vaccine Dose3- fever of 103, headache, diarrhea , fatigue, joint and muscle pain Patient was in bed for 2days following the vaccine, chills Large lump under your right arm-size of avocado-Dose 3


VAERS ID: 1798203 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-07
Onset:2021-10-14
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Headache, Nasal congestion, Odynophagia, Oropharyngeal pain, Pain, Pyrexia, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test negative
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: flu shot- 2019/ November, I was sick for a couple of months after that. It was terrible.
Other Medications: Adderall 30 mg od levothyroxine 112 mcg od vitamin D geriatric supplement complete vitamin and mineral Sudafed od Zyrtec od Zantac od
Current Illness: no
Preexisting Conditions: Hashimoto chronic thyroiditis anxiety depression ADHD
Allergies: no
Diagnostic Lab Data: COVID-19 test-negative
CDC Split Type: vsafe

Write-up: A week after the vaccination, 10/14/2021, I woke up with a slight fever and my whole body hurt. I was really congested, my head was pounding and one nostril was running and the other was stuffed up. I had a really sore throat, it felt like I was swallowing glass. My symptoms just let up today, 10, 19, 2021, I just finished my z-pack that my doctor called in on 10/14/2021. Also on 10/14/2021- I did a hospital COVID-19 test through the hospital drive thru and the results were negative.


VAERS ID: 1798204 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 3 LA / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH DJ7720 / 1 RA / IM

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

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

Write-up: Patient states continued pain from vaccinations, she states the vaccinator had given the vaccine "too high" on her arm and after one week of continued pain/discomfort it was notated. Patient has seen provider and no treatment course has been decided on yet.


VAERS ID: 1798220 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-13
Onset:2021-10-14
   Days after vaccination:184
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 1 LA / IM

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

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

Write-up: Pt received Pfizer x2. Pt tested COVID + on 10/14/21 and admitted to hospital for COVID on 10/14/2021. Pt receiving remdesivir and dexamethasone.


VAERS ID: 1798249 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-03
Onset:2021-10-14
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Bell's palsy, Facial paralysis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (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: Prozac 20mg
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Urgent care and ENT
CDC Split Type:

Write-up: Woke up with half my face paralyzed, was diagonal with Bells Palsy on my left side


VAERS ID: 1798275 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-17
Onset:2021-10-14
   Days after vaccination:150
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Positive covid test and symptoms


VAERS ID: 1798297 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-02-09
Onset:2021-10-14
   Days after vaccination:247
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Bronchial wall thickening, COVID-19, Cardiomegaly, Cerebrovascular accident, Chest X-ray abnormal, Lung infiltration, Magnetic resonance imaging head abnormal, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Cardiac failure (broad), Interstitial lung disease (narrow), 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), Cardiomyopathy (broad), Eosinophilic pneumonia (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: miralax, vit D, APAp, allopurinol, ASA, atorvastatin, coreg, amaryl, irbesartan, metformin, robaxin, zaroxolyn, K-dur, torsemide
Current Illness: no
Preexisting Conditions: CHF, CKD, DM, OSA, OA, gout, stenosis of spinal canal, DDD, HTN, HLD, morbid obesity, OSA, venous insufficiency
Allergies: lisinopril
Diagnostic Lab Data: PCR + 10/14/2021, Imaging: CXR with perihilar interstitial thickening/infiltrates, cardiomegaly, MRI brain 10/15 Acute Right Cerebellar Stroke
CDC Split Type:

Write-up: breakthrough covid + w/ acute CVA


VAERS ID: 1798298 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-08
Onset:2021-10-14
   Days after vaccination:220
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006821A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Encephalopathy, Exposure to SARS-CoV-2, SARS-CoV-2 test positive, Tibia fracture
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Accidents and injuries (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

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

Write-up: Pt was in rehab unit recovering from a tibial plateau fracture. Was exposed to COVID and found to be COVID positive. Found to be mildly encephalopathic.


VAERS ID: 1798299 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Anaphylactic reaction, Eye swelling
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anaphylactic/anaphylactoid shock 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received covid and GlaxoSmithKline Fluarix quadrivalent Lot # 95Z42 at 8:40 and 8:45am. Was at dinner in a restaurant at 5:30PM when his eye was swelling noticeably. Went home and noted his opposite eye swelling, "felt like my eyes were exploding" Present to and ER where he reports being admitted and treated for anaphylactic reaction with IV steroids. He does report eating escargot and oysters.


VAERS ID: 1798315 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Extra dose administered, Hypoaesthesia, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow), 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: Acetaminophen 500 mg
Current Illness:
Preexisting Conditions:
Allergies: Ibrophen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Run from right side to left side at my back pain and my left hand Numbs and in pain. Back pain.


VAERS ID: 1798417 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / UN

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Chest X-ray, Dyspnoea, Interstitial lung disease, Pneumonia, Pulmonary alveolar haemorrhage, Pulmonary imaging procedure
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Interstitial lung disease (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amoxicillin, apixaban, aspirin, atorvastatin, cholecalciferol, docusate sodium, metoprolol succinate, mexiletine, vitamins A, C, E-zinc-copper, diclofenac sodium
Current Illness: CAD requiring CABG and possible chronic ILD
Preexisting Conditions: CAD requiring CABG and possible chronic ILD
Allergies: grapes and peaches
Diagnostic Lab Data: CXR, MRI of chest
CDC Split Type:

Write-up: Shortness of breath starting one day after vaccination, worsened over 4 days, admitted to ED 4 days post-vaccination, found to have acute hyperoxemic respiratory failure, treated with supplemental oxygen, albuterol/ipratroprium, methylprednisone, bactrim, CTX/doxy, diuretics., diagnostic work up includes ILD, DAH, pneumonia Work up and hospital stay not completed, outcome unknown at this time


VAERS ID: 1798426 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-01-13
Onset:2021-10-14
   Days after vaccination:274
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Headache, Nasal congestion, Oropharyngeal pain, Rhinorrhoea, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Complaint of sore/scratchy throat, headache, and runny nose/congestion


VAERS ID: 1798430 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-05-31
Onset:2021-10-14
   Days after vaccination:136
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Echocardiogram abnormal, Inappropriate schedule of product administration, Pericardial drainage, Pericardial effusion, Pericarditis, Pruritus
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zoloft
Current Illness: pruritis, etiology unknown, work up in progress. large pericardial effusion was an incidental finding on ECHO as part of her work up. Pt received Pfizer vaccine April/May and then July, symptoms began May.
Preexisting Conditions: depression/anxiety
Allergies: cat dander
Diagnostic Lab Data: 10/15/21 ECHO Pericardium, extracardiac: A large pericardial effusion is identified circumferential to the heart, measuring up to 2.5 cm along the LV apex. There is an accentuated RV systolcic contraction without diastolic inversion/collapse. The IVC is normal in size and has normal respirophasic changes. Patient is normotensive with normal heart rate. No findings to suggest tamponade physiology but low pressure pretamponade physiology may be developing with a small degree of right atrial inversion (Clip#40) and significant inflow variation across the tricuspid valve.
CDC Split Type:

Write-up: Pt developed pruritis in May, etiology unknown, work up in progress. Large pericardial effusion was an incidental finding on ECHO as part of her work up. Pt received Pfizer vaccine April/May and then July. Pt underwent pericardiocentesis 10/18/21 with removal of 410 ml fluid. Pt discharged 10/19/21 on indomethacin 50 mg three times daily and colchicine 0.6 mg twice daily for 3 months for pericarditis.


VAERS ID: 1798440 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-12
Onset:2021-10-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK UN / -

Administered by: Private       Purchased by: ?
Symptoms: Blindness unilateral, Computerised tomogram head, Retinal artery occlusion, Ultrasound Doppler
SMQs:, Embolic and thrombotic events, arterial (narrow), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluoxetine, losartan, metoprolol ER, vitamin D
Current Illness: None
Preexisting Conditions: Tobacco use HTN Emphysema
Allergies: NKDA
Diagnostic Lab Data: 10/14/21 Ophthalmologist consult, ER visit with CT of the brain and carotid ultrasound
CDC Split Type:

Write-up: Unknown lot number, immunization given at the hospital clinic. Booster immunization received 10/12/2021. Pt woke up on 10/14/21 with blindness of left eye. Diagnosed with central retinal artery occlusion.


VAERS ID: 1798456 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-27
Onset:2021-10-14
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Blood test, Computerised tomogram head, Dizziness, Dyspnoea, Electroencephalogram, Feeling abnormal, Magnetic resonance imaging, Seizure like phenomena, Speech disorder
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data: CT of the head. MRI, EEG, blood work. 10/14/21-10/18/21.
CDC Split Type:

Write-up: Severe dizziness, difficulty speaking, seizure like movements, weakness, brain fog, difficulty breathing


VAERS ID: 1798486 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-01-12
Onset:2021-10-14
   Days after vaccination:275
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Nasal congestion, Oropharyngeal pain, Rhinorrhoea, SARS-CoV-2 test positive, Throat irritation
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Complaint of cough, sore/scratchy throat, and runny nose/congestion,


VAERS ID: 1798507 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-10-11
Onset:2021-10-14
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004H21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Dizziness, Dyspnoea, Heart rate increased, Hypersensitivity, Injection site pain, Nausea, Paraesthesia, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

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

Write-up: 1st Day on October 11th, 2021 I only had a sore arm. No side effects besides the sore arm where the Moderna Shot was injected in my right arm from October 11th until on October 14th in the middle of the night around 9 P.M. I felt lightheaded, nauseous, felt like I couldn''t breathe and started vomiting for no apparent reason for almost 1 hour. I felt a tingling sensation all around my body and had to take a liquid form of Benadryl to help ease the severe side effects as I was having an allergy reaction. I didn''t eat anything different in the course of time before or after this event on October 14th took place around 9 P.M. After the events of October 14th, I felt fine up until October 17th and then October 18th where I felt worse side effects. I suddenly had a severe fever on October 17th that appeared around 10 P.M. in the night and my heart was beating very fast, I also vomited and had diarrhea for several hours in the night I had to get up from my bed to use the bathroom and then go back to sleep. The next day on October 18th around 7:00 P.M. my heart was beating very fast and I felt like I was going to faint and then had a severe fever once again that now on October 19th in the morning disappeared.


VAERS ID: 1799147 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Chills, Diarrhoea, Fatigue, Flatulence, Headache, Injection site pain, Insomnia, Nausea, Oropharyngeal pain, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Blood work done 10/19/2021. No results yet.
CDC Split Type:

Write-up: No symptoms of any kind before the injection. The first night experienced chills, injection sight pain, body aches, nausea. Over night, difficult to sleep, ache in lower back, arm and all over. Next morning, aching all over, fever, gas pains in abdomen. severe diarrhea throughout the day. That evening, severe sore throat, fatigue, fever, headache. Still having lingering sore throat. Fatigue is not as bad.


VAERS ID: 1800746 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-24
Onset:2021-10-14
   Days after vaccination:204
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: Positive Covid test on 10/19/2021
CDC Split Type:

Write-up: Positive Covid test on 10/19/2021


VAERS ID: 1800810 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 07621A / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dyspnoea, Headache, Insomnia, 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? 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 has chills, headaches, body aches, trouble breathing, insomnia,


VAERS ID: 1800819 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Balance disorder, Erythema, Migraine, Muscular weakness, Pain, Swelling
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient email reads, " area is reddened swollen with some pain. My legs feel wobbly and weak at times. In addition she has a migraine that her regular medication is not helping. Attempted to follow up with email employee not responding to call or email.


VAERS ID: 1800860 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL301358S / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Pain, Pyrexia, Urinary incontinence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Same reaction just not as bad. Lasted 12 hours. Age 62.
Other Medications:
Current Illness:
Preexisting Conditions: Multiple Sclerosis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, loss of bladder control, equal liberlim, major body aches.


VAERS ID: 1800894 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Axillary pain, Headache, Myalgia, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Emergen-C; Caltrate
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Gantrisin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Armpit pain shooting into body on left armpit and left side of body. Headache, fever, joint and muscle pain.


VAERS ID: 1800904 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-12
Onset:2021-10-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Rash papular, Rash pruritic, Skin warm
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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: fish oil, norco, fenofibrate, praluent, lisinopril, pantoprazol, metoprolol ER, gabapentin, metformin
Current Illness: none
Preexisting Conditions: diabetes, hypertension
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Warm, raised, itchy rash appeared 2 days after vaccination. The rash is a couple inches wide and 3 to 4 inches long. The patient had no reaction with the first 2 shots.


VAERS ID: 1800953 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-08
Onset:2021-10-14
   Days after vaccination:189
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 LA / IM

Administered by: Public       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 Positive for Covid.


VAERS ID: 1800969 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 4 LA / IM

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

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

Write-up: Patient received more than the recommended number of Pfizer COVID-19 vaccine doses. In total they received four doses of the vaccine.


VAERS ID: 1801006 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (AFLURIA QUADRIVALENT) / SEQIRUS, INC. - / 1 LA / ID

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Extra dose administered, Headache, Lymphadenopathy, Malaise
SMQs:, Arthritis (broad), Medication errors (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: COVID Pfizer 2nd dose
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Sulfa Medications MSo4
Diagnostic Lab Data:
CDC Split Type:

Write-up: swollen lymph nodes, headache, sore joints, malaise


VAERS ID: 1801016 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness, Cold sweat, Headache, Loss of consciousness, Pyrexia
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt.''s Mother states that after receiving the 2nd dose of Phizer 10/13/2021, started experiencing symptoms 10/14/2021 of fever, cold-sweats, loss of consciousness, and loss of vision. Came to with headache and fever, 10/14/2021 Primary visit with recommendations of Ibuprofen for fever and no Follow-Up of "Booster". Symptoms have subsided.


VAERS ID: 1801230 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-29
Onset:2021-10-14
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Dyspnoea exertional, Fatigue, Immediate post-injection reaction, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: Immediately after receiving the vaccine, I experienced severe left arm pain for a total of 3 days which was relieved only after taking Ibuprofen. About a week later, I started noticing that I would become very tired and short of breath after going up 4 flights of stairs (which I normally do several times a day during work). For the past week, I have been feeling more fatigued and short of breath. I was completely normal before receiving the vaccine and nothing has changed in my diet or daily routine.


VAERS ID: 1801236 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-08
Onset:2021-10-14
   Days after vaccination:189
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Laboratory test abnormal
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? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol, verapamil, triaminolone, sumatriptan, sucralfate, simvastin, sertraline, prednisone, multivitamin, synthroid, albuterol, lioresal, b complex, estradiol, amitriptyline
Current Illness:
Preexisting Conditions: COPD, CAD, PAF, A fib, hypotension, Hypothyroidism,
Allergies:
Diagnostic Lab Data: Swabbed pos on admission 10.14.21
CDC Split Type:

Write-up: SOB


VAERS ID: 1801300 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Chest discomfort, Chest pain, Computerised tomogram, Contusion, Dyspnoea, Eye pain, Fibrin D dimer increased, Headache, Inflammation, Injection site bruising, Pain
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Bronchitis
Preexisting Conditions: Tachycardia, Fibromyalgia , Migraines
Allergies: cipro, Codine
Diagnostic Lab Data: hospital My d dimer is evaluated , ct scan of chest was clear on monday night 10/18/2021 ER ask for me to follow up with my doctor
CDC Split Type:

Write-up: Inflammation , bruising on my left arm and also right legs , SOB , chest pressure and pain , body aches and weakness , headache and eye pain


VAERS ID: 1801315 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-10-12
Onset:2021-10-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site erythema, Injection site pain, Injection site pruritus, Injection site swelling, Pain, Pruritus
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), 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? 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: Itching at Injection Site-Medium, Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Systemic: Allergic: Itch Generalized-Medium, Additional Details: Patient has a mark on arm; is worried that it will scar. She began noticing itching 2 days after dose. Has been intching and painful since then


VAERS ID: 1801472 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-27
Onset:2021-10-14
   Days after vaccination:140
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1801561 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 182209 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Fall
SMQs:, Accidents and injuries (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 per client
Current Illness:
Preexisting Conditions:
Allergies: None per client
Diagnostic Lab Data:
CDC Split Type:

Write-up: client was siting in the monitoring section and stated he felt fine and then as monitor walked away he fell taking the chair with him. He came around and asked in a strong regular voice what happen. BP 120/72. Placed on back with legs raised. EMS came assess felt his head and gave in instructions for a headache and if had blurred vision and other signs to go to the urgent or ED for evaluation for concussion. Client had decline going to the hospital.


VAERS ID: 1801595 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Breast pain, Extra dose administered, Lymphadenopathy, Pain
SMQs:, Lipodystrophy (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient reports that immediately after receiving her Pfizer booster shot, she felt a sharp pain that radiated from her underarm to her breast. Reports that lymph nodes on same side of neck and area under her arm became swollen. Reports that symptoms lasted for 4 days but did not prohibit her from working. Denies fever.


VAERS ID: 1801606 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Pain in extremity, Sciatica
SMQs:, Retroperitoneal fibrosis (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: Doctor''s prescriptions: metformin 500mg/2xday, lisinopril sodium 40mg/1xday, amlodipine 5mg/1xday, atorvastatin 20mg/1xday, timolol .5%/1 drop per eye Vitamin D 4000 unit/day, Vitamin b12 1000mg/day Alavert
Current Illness: No
Preexisting Conditions: Diabetic, Chronic kidney disease, High blood pressure, high cholesterol (taken care of by medication), MS
Allergies: Penicillin, Neurontin, alcohol
Diagnostic Lab Data: No
CDC Split Type: vsafe

Write-up: On Thursday night I started having pain on my upper thigh On Friday it went down the inside of e leg. By Saturday it was sciatica patterned pain that goes down my leg and my back. On Sunday it went done both he inside and outside of my right leg. Took Tylenol to help me sleep. I knew I had an appointment on Tuesday. My doctor was unsure if it was related to the vaccine at all because I do have a bad back. It has gotten better. It is at a point where it is noticeable if I take a step wrong but it is going away. I expect in a week it will be completely gone. I am also doing stretching exercises and using heat and ice.


VAERS ID: 1801822 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / UNK RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Extra dose administered, Fatigue, Headache, Lymphadenopathy, Myalgia, Nausea, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Medication errors (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: Covid vaccine #2
Other Medications: Celexa, Lyrica, Hydroxyzine, Montelukast, multivitamin, fish-oil
Current Illness: No illnesses
Preexisting Conditions: IBS/ UC/ anal fissures
Allergies: Codeine, bananas, watermelon,
Diagnostic Lab Data: Almost, went to the hospital due to the adverse side effects
CDC Split Type:

Write-up: Lymph nodes (right arm pit) swollen. Extreme fatigue, entire body pain (muscles and joints), extreme nausea, and headache. Every muscle in my body hurt or throbbed.


VAERS ID: 1801828 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood pressure decreased, Pallor, Tinnitus, Vision blurred
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: The patient became pale with blurred vision. The patient remained alert and oriented. The patient''s blood pressure had dropped and he began having ringing in his ears. The patient was assisted to the medical cot and given some water. The patient''s color improved, his vision improved and the ringing subsided. The patient''s vitals were continuously monitored for the 9 minutes it took him to fully recover and his vitals to return to normal. We continued to monitor the patient for an additional 15 minutes without complication or further change.


VAERS ID: 1801950 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-11
Onset:2021-10-14
   Days after vaccination:245
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

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

Write-up: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1802414 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-08
Onset:2021-10-14
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site rash, Injection site swelling, Rash, Skin discolouration
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient received Moderna vaccination on 10/8/21. She stated that she had a rash/swelling in the injection site and rash on one side of the neck on 10/14/21. It is now subsided and done, but the rash has left some dark spots on the skin.


VAERS ID: 1802565 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site infection, Injection site swelling, Skin warm
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Patient called and stated had given her a vaccine that led to a site infection. Following vaccination, patient arm was warm to the touch and had a bump near the site. Patient described that she couldnt remember if used an alcohol swab, and she felt that the dose administration site was lower than it shouldve been. Upon watching tape, correctly administered vaccine using an alcohol swab, and injecting in the proper area. After speaking to the patient again, she said that she was not upset or trying to get anyone in trouble, she just wanted to let us know what happened so that we could investigate. She stated that Dr gave her an antibiotic for cephalexin, and she has taken 3 doses so far, and site of injection is already feeling better.


VAERS ID: 1802569 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Haematochezia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (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: Claritin - 10 mg, Calcium Citrate - 1000 mg, Vitamin D3 - 4000 IU, Magnesium - 200 mg, Kirkland Super B-Complex, Omega-Q Omega 3 fatty acids - 530 mg & Coenzyme Q10 - 20 mg, Zinc - 23 mg & Echinacea purourea - 20 mg, Dr. formulated Probioti
Current Illness: none
Preexisting Conditions: Osteoporesis
Allergies: none
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Bowel movement the morning after the vaccine - about 24 hours later- was a fairly bright red - very unusual color. Wiping afterward revealed bright red blood on tissue. Did not continue to bleed and subsequent bowel movements were normal.


VAERS ID: 1802581 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-30
Onset:2021-10-14
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Menstrual disorder
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: Effexor
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Unexpected menstruation- menstruated twice in course of a 2 week period.


VAERS ID: 1802760 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: COVID19 Vaccine Clinic appointment only. CDC screening form completed. No medication indicated on form that was questioned for.
Current Illness: COVID19 Vaccine Clinic appointment only. CDC screening form completed. No illnesses indicated on form that was questioned for.
Preexisting Conditions: COVID19 Vaccine Clinic appointment only. CDC screening form completed. No long-standing health conditions indicated on form that was questioned for.
Allergies: COVID19 Vaccine Clinic appointment only. CDC screening form completed. No allergies indicated on form that was questioned for.
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Vaccine Error. Patient only 17 and not eligible for Moderna vaccine. No know adverse outcomes at this time. Vaccine error discovered by auditor at the end of the day at 5pm. Notified CMO. Attempts began to contact patient of vaccine error. Please advise if patient should get Moderna or Pfizer as 2nd vaccine.


VAERS ID: 1803818 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-12
Onset:2021-10-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

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

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

Write-up: I have not gotten my period since I was vaccinated, it was scheduled to come two days later and I still have not received it and I am not pregnant, and my period has never been more than a day late, it is now 7 days late.


VAERS ID: 1804035 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-21
Onset:2021-10-14
   Days after vaccination:207
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1804046 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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: Junel 25 birth control
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Muscle aches and fever, 100.3.


VAERS ID: 1804049 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Dyspnoea, Fatigue
SMQs:, Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

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

Write-up: Severe lower back pain, still persistent a week later. Breathing feels short. Tiredness even after 1 week after the shot


VAERS ID: 1804158 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-08
Onset:2021-10-14
   Days after vaccination:248
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1804165 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / UNK LA / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Feeling abnormal, Inappropriate schedule of product administration, Injection site pain, Muscular weakness, Poor quality sleep, Wrong product administered
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Depression (excl suicide and self injury) (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Apri birth control
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None. I called my doctor office?s 24/7 emergency line to confirm that receiving a third shot when I did would be okay. I received my second dose of the Pfizer vaccine on April 23, 2021, so this third shot I received was at about 5 months later, which is less than the recommended 6 mo booster shot waiting period.
CDC Split Type:

Write-up: I went into pharmacy for an annual flu shot, however Pharmacy incorrectly injected me with the Pfizer vaccine. That is the main treatment I am reporting, that Pharmacy gave me the wrong shot. I believe the administrator was a pharmacy tech. To date, a week later, I still have no additional information from them because they have refused to give me any information beyond a scan of the supposed lot number I was given - no follow up on dosage given, or any official record from them. I also have no confirmation they have reported this mistake to the appropriate authorities. The only record I have is the incorrect confirmation of a flu shot ( that I was not given, and they still have not corrected my records). The day after my shot, I slept poorly and woke at 3 am. When I checked my temperature at 7:30 am, I had a 99.9 low grade fever, and felt very poorly. I continued to have a fever until the next morning. I also had a sore arm at the injection site, but also developed a very weak forearm and hand around 24 hours after my shot, but that also went away Sunday morning.


VAERS ID: 1804187 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dysphonia, Fatigue, Pain in extremity, Respiration abnormal, Speech disorder, Throat irritation
SMQs:, Dementia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Client vaccinated with Janssen COVID vaccine at 9:50 without incident. Known severe allergies to banana. 15 minutes later when he was about to leave area he complained of his throat itching and was making loud, hoarse raspy breathing sound and rubbing his left hear. He was unable to speak a complete, clear sentence. NP listened to his lungs. Lungs clear and okayed administration of IM Benadryl which was given by charge nurse. Within 2 -3 minutes felt fine, quit horsey noise and could talk again. Left area and went back at 10:45 am. 1:45 pm - visited patient again who felt fine except for being tired and having a sore arm.


VAERS ID: 1804190 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blister, Feeling abnormal, Gait disturbance, Herpes zoster, Pain, Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Severe cutaneous adverse reactions (broad), Angioedema (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril, Eliquis, Levothyroxine, Amlodipine, Metoprolol, Losartan, Metformin, Atorvastatin, Alendronate
Current Illness: None
Preexisting Conditions: Diabetes
Allergies: None
Diagnostic Lab Data: None
CDC Split Type: vsafe

Write-up: The next day my mom started having a lot of pain on her right arm. Then she got a blister in her index finger. I thought it was a mosquito bite so I gave her Benadryl. She had a flight to visit my sister and the next day she woke up with her hand full of blisters. They took her to urgent care and they said it was an allergic reaction. The next day she was feeling very bad so they took her to the ER. I was on the phone with the doctor and he said she has shingles. He gave her some medications because the pain was very intense. They sent her home. Today she woke up feeling worse. My sister says she does not want to move, she is dragging her feet when she walks. But she slept fine and ate fine. Now her hand is swollen and has blisters up to her elbow.


VAERS ID: 1804261 (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: 2021-10-21
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: None
Preexisting Conditions: Obesity
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Staff administered 0.3 ml of vaccine from a vial that had set out for 21 hours. When it was identified that vial was expired, staff brought to my attention. Reviewed event with Clinic Director and Covid Vaccine Coordinator. Manufacturer guidance supported that a repeated dose may be given immediately in the opposite arm. Staff notified patient of error and patient was agreeable to receiving a second injection.


VAERS ID: 1804263 (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: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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:
CDC Split Type:

Write-up: When it was determined that staff had administered 0.3 ml of vaccine from a mixture of 0.8 ml diluent volume vs 1.8 diluent volume, I reviewed event with Clinic Director. Clinic Director and Covid Vaccine Coordinator contacted Pfizer and was advised patient should be notified of event. Patient was to be advised that he might experience increased soreness at injection site and should return for scheduled 2nd dose. Patient was notified on October 15, 2021 at 1:16 pm. Patient reported no unusual side effects. Patient was reminded of upcoming appointment for second dose.


VAERS ID: 1804265 (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: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: When it was determined that staff had administered 0.3 ml of vaccine from a mixture of 0.8 ml diluent volume vs 1.8 diluent volume, I reviewed event with Clinic Director. Clinic Director and Covid Vaccine Coordinator contacted Pfizer and was advised patient should be notified of event. Patient was to be advised that he might experience increased soreness at injection site and should return for scheduled 2nd dose. Patient was notified on October 15, 2021 at 1:16 pm. Patient reported no unusual side effects. Patient was reminded of upcoming appointment for second dose.


VAERS ID: 1804273 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Approx 45
Other Medications: Levothryrozin, Atenolol, Nifedipine ER, Hydrochlorothiazide (HCTZ), potassium Chloride Micro ER, Allegra, Acetaminophen PM 1/2 tab, Multivitamin.
Current Illness: None
Preexisting Conditions: Hypothyroid ( Hoshimotos), Hypertension, only have one kidney - Genetic.
Allergies: NKA
Diagnostic Lab Data: None, but requested a Measles test. Not yet done.
CDC Split Type:

Write-up: Broke out in hives/rash which continued to spread from face down my body,. Thick red swollen layer. Receive injection of steroids and 7 day course of oral steroids. Told to continue using Benadryl and Allegra. Another type of rash formed which resulted in me going to a dermatologist they next day. Stated they believe vaccine triggered a Shingles flare up and prescribed 7 day course of ValACYclovir 1 gr 3 x day. Was uncertain of what the third rash I have is. Face rash is improving but other two rashes are continuing to spread and are extremely painful and itch.


VAERS ID: 1804322 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Glassy eyes, Hyperhidrosis, Pallor, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: kPatient received first dose of Pfizer vaccine 0.3ml L deltoid in seated postion. Within first 3 minutes following vaccine, patient reported dizziness, and presented with diaphoresis, pallor, and glassy, unfocused eyes. Patient was transported to sick bay stetcher area with wheelchair and assisted into supine position, hob elevated 45 degrees. Patient remained conscious and verbal throughout. B/P was recorded via electronic monitor with large adult cuff. Readings as follows: 18:57- 67/40 18:58- 69/40 19:00- 78/44 17:01- 98/66 17:03- 109/74 Patient was provided water, juice, and crackers (all consumed without issue). after 30 minute observation, patient was free to leave, demonstrated Alert+Oriented x4 LOC, skin and lip color WNL, and stated, "That just happens with medical stuff. I get like that. I feel fine now though." Patient accompanied by spouse. Patient advised to request follow-up doses in supine position in future.


VAERS ID: 1804340 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-12
Onset:2021-10-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Fatigue, Inappropriate schedule of product administration, Influenza like illness, Malaise, Respiratory tract congestion
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: Levothyroxine, Montelukast
Current Illness: None
Preexisting Conditions: Hypo-thyroid
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: I have felt fatiqued, run down and genrally not well since receiving the Covid booster and flu shot 9 days ago. Some abnormal chest congestion. Feel "fluish". No fever.


VAERS ID: 1804344 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 1 LA / IM

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

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

Write-up: Patient given first dose of COVID-19 vaccine at 11:04am. Vial being stored in refrigerator had DO NOT USE BEYOND date of 10/14/21 at 0700 am. Manufacturer (Pfizer) contacted and stated that they have off-label studies showing physical properties of vaccine are unchanged for 32 days. Medical director consulted and does not advise re-administering vaccine.


VAERS ID: 1804355 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 2 LA / IM

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

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

Write-up: Patient given second dose of COVID-19 vaccine at 10:16 am. Vial being stored in refrigerator had DO NOT USE BEYOND date of 10/14/21 at 0700 am. Manufacturer (Pfizer) contacted and stated that they have off-label studies showing physical properties of vaccine are unchanged for 32 days. Medical director consulted and does not advise re-administering vaccine.


VAERS ID: 1804362 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 2 LA / IM

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

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

Write-up: Patient given second dose of COVID-19 vaccine at 9:41am. Vial being stored in refrigerator had DO NOT USE BEYOND date of 10/14/21 at 0700 am. Manufacturer (Pfizer) contacted and stated that they have off-label studies showing physical properties of vaccine are unchanged for 32 days. Medical director consulted and does not advise re-administering vaccine.


VAERS ID: 1804378 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain upper, Chills, Diarrhoea, Dizziness, Headache, Pain, Pain in extremity, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine
Other Medications: Gabapentin; hydrocortisone
Current Illness:
Preexisting Conditions: Addison''s disease; hypo-thyroid; fibromyalgia; multiple myloma
Allergies: Sulfur; CIPRO; codeine; TOPAMAX; FLAGYL
Diagnostic Lab Data:
CDC Split Type: vsafe

Write-up: Pain in left vaccine arm, dizzy spells, chills, fever, diarrhea, headaches, stomach and body pain.


VAERS ID: 1804454 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / UNK LA / IM

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

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

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


VAERS ID: 1804503 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-09-28
Onset:2021-10-14
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 3 RA / SYR

Administered by: Military       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Dysgeusia, Dyspnoea, Fatigue, Feeling cold, Pyrexia, SARS-CoV-2 test positive, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: Scoliosis, heart issue
Allergies: codeine, Percocet
Diagnostic Lab Data: Covid-19 test
CDC Split Type: vsafe

Write-up: I had a really bad cough. Worst then a cold. I had a difficulty breathing. Everything tasted salty. I had chills that I began to shake. I was really cold. I have a fever of a 103. I went to the ER. They did a Covid-19 test, which came back positive. I am very fatigue.


VAERS ID: 1804517 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Eliquis, Gabapentin, Lopressor, Zoloft, Zocor, Hytrin, Cordarone, D3, Iron, Loratadine, magnesium,
Current Illness: Unknown
Preexisting Conditions: Paroxysmal A Fib, HTN, Cancer of prostate, CAD, Hyperlipid, Chronic A Fib, OSA
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient received booster injection from a vial that was out overnight- past the 6 hour time frame.


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