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

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



Case Details (Reverse Sorted by Onset Date)

This is page 176 out of 3,232

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VAERS ID: 1292919 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-28
Onset:2021-05-03
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Facial paralysis, Headache
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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NAPROXEN
Current Illness: UNKNOWN
Preexisting Conditions: UNCONTROLLED HTN AND DM2
Allergies: NONE
Diagnostic Lab Data: ADMITTED 5/3/21
CDC Split Type:

Write-up: PATIENT PRESENTED TO THE ER HERE AT THE HOSPITAL WITH RIGHT MOUTH DROOP; WAS EXPEREINCING SEVERE HEADING STARTING THE NIGHT AFTER RECEIVING 2ND DOSE OF MODERNA VACCINE.


VAERS ID: 1293009 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-04-20
Onset:2021-05-03
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cerebral venous sinus thrombosis, Computerised tomogram head abnormal, Headache, Hemianopia homonymous, Hemiparesis, Laboratory test normal, Neurologic neglect syndrome
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Noninfectious encephalitis (broad), Optic nerve disorders (broad), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Timolol maleate 0.5% ophthalmic solution 1 drop
Current Illness:
Preexisting Conditions: Glaucoma, migraines
Allergies: Penicillin
Diagnostic Lab Data: Patient was admitted to hospital on 5/5 and has had several head CTs confirming CVST. She has also had significant lab workup for an underlying etiology that thus far have all been negative.
CDC Split Type:

Write-up: Patient got her second dose of the Pfizer vaccine on 4/20 and started to feel a headache come on and believed it was due to a migraine. On 5/1 she went to her local ED and was given migraine treatment. She continued to have worse headaches and developed subsequent L homonomous hemianopsia, L sided weakness, and L sided neglect. She presented to the ED on 5/5 and was found to have cerebral venous sinus thrombosis confirmed by head CT. Other risk factors include active COVID-19 infection (unknown at time of vaccine administration) and OCP usage.


VAERS ID: 1293023 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Epistaxis, Fatigue, Feeling abnormal, Headache, Rash
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Dementia (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: Flonase, One a day Women''s daily vitamin
Current Illness: n/a
Preexisting Conditions: uveitis
Allergies: Tree Nut
Diagnostic Lab Data: n/a yet
CDC Split Type:

Write-up: nose bleed for 45 minutes day of (25 minutes after shot) fatigue brain fog Bad headache that lasted days (still have it while filling out this report 3 days later) rashes in random places all over my body develped 2 days later


VAERS ID: 1293208 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-02
Onset:2021-05-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Decreased appetite, Exposure during pregnancy, Fatigue, Headache, Nausea, Pain, Pain in extremity
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), 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: Prenatal vitamins
Current Illness: None
Preexisting Conditions: None
Allergies: Amoxicillin and azithromycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Currently pregnant - due date 11/08/21 Sore arm, fatigue, nausea, lack of appetite, chills, headache and body aches No treatment, rested


VAERS ID: 1293230 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-04-07
Onset:2021-05-03
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN N/A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Deep vein thrombosis, Erythema, Heparin-induced thrombocytopenia test positive, Peripheral swelling, Pulmonary embolism, Subclavian vein thrombosis
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received J&J covid vaccine on 4/7/2021. Patient presented to the ED on 5/3 for right arm swelling with redness. Patient was found to have proximal right upper extremity DVT extending to right subclavian vein along with bilateral PE in the ED. The provider noted the patient had no risk factors other than receiving the vaccine, requested a hematology/oncology consult for evaluation hypercoagulable , patient started on bivalirudin while HIT work-up completed plan to transfer to oral anticoagulation upon discharge.


VAERS ID: 1293280 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-02
Onset:2021-05-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Blindness, Blood test, Chest pain, Chills, Computerised tomogram, Dysgeusia, Fatigue, Headache, Joint range of motion decreased, Magnetic resonance imaging, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Retinal 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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Levothyyroxine
Current Illness: None
Preexisting Conditions:
Allergies: Shellfish
Diagnostic Lab Data: Blood draws , ct and mri all on 5/4 Lab draws on 5/5
CDC Split Type:

Write-up: Metal taste in mouth immediately then burning theough chest and abdomen on forst day. Could lift arm by second day, extreme fever chills and fatigue monday, hospitalizationon tuesday due to extreme headache and vision loss


VAERS ID: 1293292 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 00C521A / 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? 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: Vaccine administered to patient less than 18 years old. Guardian present at time of administration. Consent obtained verbally and in writing prior to administration.


VAERS ID: 1293354 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Blood sodium decreased, Dizziness, Headache, Hypotension, Myalgia, Neck pain, Thinking abnormal, Throat irritation, Vitamin B12 deficiency
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hyponatraemia/SIADH (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Chronic kidney disease (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin, Vitamin D.
Current Illness: Low blood pressure, low sodium
Preexisting Conditions: None known
Allergies: None known
Diagnostic Lab Data: My blood pressure had dropped from 104/60 to 70/52, or thereabouts, best as I can recall, which was why I felt faint, I was told. I was diagnosed with a sodium and Vitamin B12 deficiency.
CDC Split Type:

Write-up: I felt faint and dizzy, as though I was about to faint. I was unable to think clearly. After arriving at the ER, my symptoms graduated to achy muscles, pounding headache, neck aching, odd throat sensation, etc.


VAERS ID: 1293877 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Hypoaesthesia, Pallor, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)

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

Write-up: Dizziness, tingling/numbness of bilateral hands, pale. Vitals wnl. Water given.


VAERS ID: 1293926 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-05
Onset:2021-05-03
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / N/A UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Carotid artery thrombosis, Cerebral artery thrombosis, Cerebral mass effect, Cerebrovascular accident, Rhabdomyolysis, Ultrasound Doppler, Ultrasound Doppler abnormal
SMQs:, Rhabdomyolysis/myopathy (narrow), Neuroleptic malignant syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)

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

Write-up: Patient presented 3-4 weeks after receiving the Janssen COVID vaccine with right MCA stroke with mass effect, mild midline shift and right MCA thrombus. Carotid ultrasound showed thrombosis of the right common and internal carotid arteries and right carotid siphon. She was found down, last seen normal 2 days prior to admission. She was not a candidate for tPA given the delayed presentation and unlikely to benefit from thrombus extraction. She was treated with aspirin and atorvastatin and treated for rhabdomyolysis. Patient is currently still admitted to the hospital but transitioning to comfort focused care.


VAERS ID: 1294014 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:2021-05-03
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816022 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Paraesthesia, Rash erythematous, Skin warm
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: The patient had no known allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210503852

Write-up: WARM TO TOUCH; TINGLING A LITTLE; RED RASH MEASURING ABOUT 3 INCHES; This spontaneous report received from a pharmacist concerned a 31 year old female. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included the patient had no known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, and batch number: 1816022 expiry: 01-JUL-2021) dose was not reported, administered on 03-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 03-MAY-2021, the subject experienced warm to touch. On 03-MAY-2021, the subject experienced tingling a little. On 03-MAY-2021, the subject experienced red rash measuring about 3 inches. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the red rash measuring about 3 inches, warm to touch and tingling a little was not reported. This report was non-serious.


VAERS ID: 1294029 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Michigan  
Vaccinated:0000-00-00
Onset:2021-05-03
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arthritis (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: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210505287

Write-up: JOINT PAIN; FEVER; GENERAL FATIGUE; This spontaneous report received from a patient concerned a male of unspecified age. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported and batch number: 1802068 expiry: UNKNOWN) dose was not reported, administered on 03-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 03-MAY-2021, the subject experienced joint pain. On 03-MAY-2021, the subject experienced fever. On 03-MAY-2021, the subject experienced general fatigue. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from fever, joint pain, and general fatigue. This report was non-serious.


VAERS ID: 1294030 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Massachusetts  
Vaccinated:0000-00-00
Onset:2021-05-03
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 2058A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood glucose increased, Flushing, Pyrexia
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: METFORMIN; GLICLAZIDE; LIPITOR; METOPROLOL
Current Illness: Type II diabetes mellitus
Preexisting Conditions: Medical History/Concurrent Conditions: Clot blood (Patient was taking anticoagulants.); Comments: Patient had no known allergies and taking lit of anticoagulants for type II diabetes mellitus.
Allergies:
Diagnostic Lab Data: Test Date: 20210503; Test Name: Blood sugar increased; Result Unstructured Data: Quite high
CDC Split Type: USJNJFOC20210505293

Write-up: HIGH SUGAR LEVELS POST VACCINATION; FLUSH FEELING ON FACE; FELT LIKE FEVERISH; This spontaneous report received from a patient concerned a male of unspecified age. The patient''s height, and weight were not reported. The patient''s past medical history included 5 blood clots, and concurrent conditions included type 2 diabetes, and other pre-existing medical conditions included patient had no known allergies and taking lit of anticoagulants for type ii diabetes mellitus. The patient received covid-19 vaccine (suspension for injection, route of admin not reported and batch number: 2058A21A expiry: UNKNOWN) dose was not reported, administered on 03-MAY-2021 for prophylactic vaccination. Concomitant medications included gliclazide for type 2 diabetes, metformin for type 2 diabetes, atorvastatin calcium, and metoprolol. On 03-MAY-2021, the subject experienced high sugar levels post vaccination. On 03-MAY-2021, the subject experienced flush feeling on face. On 03-MAY-2021, the subject experienced felt like feverish. Laboratory data included: Blood sugar increased (NR: not provided) Quite high. The action taken with covid-19 vaccine was not applicable. The patient had not recovered from high sugar levels post vaccination, and the outcome of felt like feverish and flush feeling on face was not reported. This report was non-serious.


VAERS ID: 1294033 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Virginia  
Vaccinated:0000-00-00
Onset:2021-05-03
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Heart rate, Heart rate increased, Insomnia, Pain, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BENADRYL [DIPHENHYDRAMINE HYDROCHLORIDE]
Current Illness: Abstains from alcohol; Drug allergy (Allergy to Caines class of medications.); Non-smoker
Preexisting Conditions: Comments: Patient had no significant medical history.
Allergies:
Diagnostic Lab Data: Test Date: 20210504; Test Name: Heart rate; Result Unstructured Data: 110 bpm; Test Date: 20210504; Test Name: Heart rate; Result Unstructured Data: 105-120 bpm
CDC Split Type: USJNJFOC20210505775

Write-up: PAIN IN ARM; ELEVATED HEART RATE; FEVER; BODY ACHES; DIFFICULTY SLEEPING; This spontaneous report received from a pharmacist concerned an 18 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included non-smoker, non-alcoholic, and drug allergy, and other pre-existing medical conditions included patient had no significant medical history. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 03-MAY-2021 14:00 for prophylactic vaccination. The batch number was not reported and has been requested. Concomitant medications included diphenhydramine hydrochloride. On 03-MAY-2021, the subject experienced body aches. On 03-MAY-2021, the subject experienced difficulty sleeping. On 03-MAY-2021, the subject experienced fever. On 04-MAY-2021, Laboratory data included: Heart rate (NR: not provided) 105-120 bpm, 110 bpm. On 04-MAY-2021 02:00, the subject experienced elevated heart rate. On 04-MAY-2021 02:30, treatment medications included: paracetamol. On an unspecified date, the subject experienced pain in arm. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from difficulty sleeping on MAY-2021, was recovering from body aches, had not recovered from elevated heart rate, and the outcome of fever and pain in arm was not reported. This report was non-serious.


VAERS ID: 1294034 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:2021-05-03
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Feeling cold, Headache, Hyperhidrosis, Influenza like illness, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Alcohol use; Allergic reaction to antibiotics; Non-smoker; Prothrombin mutation G20210A
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210506415

Write-up: FEVERISH AND FEVER LIKE SYMPTOMS; SHAKING; SWEATING; FELT COLD; POUNDING HEADACHE; FELT TIRED; This spontaneous report received from a patient concerned a 22 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included prothrombin gene mutation - increased risk for blood clot (predisposition), amoxicillin allergy, occasional alcohol use, and non-smoker. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 205A21A expiry: UNKNOWN) .5 ml, administered on 03-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 03-MAY-2021, the subject experienced feverish and fever like symptoms. On 03-MAY-2021, the subject experienced shaking. On 03-MAY-2021, the subject experienced sweating. On 03-MAY-2021, the subject experienced felt cold. On 03-MAY-2021, the subject experienced pounding headache. On 03-MAY-2021, the subject experienced felt tired. Treatment medications included: ibuprofen. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from feverish and fever like symptoms, shaking, sweating, felt cold, pounding headache, and felt tired on 04-MAY-2021. This report was non-serious.


VAERS ID: 1294039 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Florida  
Vaccinated:0000-00-00
Onset:2021-05-03
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chills, Headache, Insomnia, Pain, Pyrexia, SARS-CoV-2 test, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: The patient had no known allergies.
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Result Unstructured Data: Negative
CDC Split Type: USJNJFOC20210506677

Write-up: COULD NOT SLEEP AS TOSSING AND TURNING ALL NIGHT; BODY ACHES; BODY SHAKING; CHILLS AND SHIVERING; HEADACHE; FEVER; This spontaneous report received from a patient concerned a 33 year old male. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included the patient had no known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 042A21A, expiry: UNKNOWN) dose was not reported, administered on 03-MAY-2021 16:10 for prophylactic vaccination. No concomitant medications were reported. On 03-MAY-2021 23:30, the subject experienced could not sleep as tossing and turning all night. On 03-MAY-2021 23:30, the subject experienced body aches. On 03-MAY-2021 23:30, the subject experienced body shaking. On 03-MAY-2021 23:30, the subject experienced chills and shivering. On 03-MAY-2021 23:30, the subject experienced headache. On 03-MAY-2021 23:30, the subject experienced fever. Laboratory data (dates unspecified) included: COVID-19 virus test (NR: not provided) Negative. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from could not sleep as tossing and turning all night, body shaking, and chills and shivering on 04-MAY-2021, and had not recovered from fever, body aches, and headache. This report was non-serious.


VAERS ID: 1294041 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:2021-05-03
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: The patient had no known allergies.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210506741

Write-up: MEDICATION ERROR; PATIENT RECEIVED VACCINE OUT OF THE RECOMMENDED TEMPERATURE RANGE; This spontaneous report received from a pharmacist concerned a 22 year old female. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included the patient had no known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1808978 and expiry: 13-JUN-2021) dose was not reported, administered on 03-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 03-MAY-2021, the subject experienced medication error. On 03-MAY-2021, the subject experienced subject received vaccine out of the recommended temperature range. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the medication error and patient received vaccine out of the recommended temperature range was not reported. This report was non-serious.


VAERS ID: 1294139 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-01
Onset:2021-05-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Chills, Disorientation, Dizziness, Flushing, Head discomfort, Headache, Muscle spasms, Nausea, Paraesthesia, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Janssen COVID-19 Vaccine EUA Had typical reaction for 2 nights after shot (Severe headache, chills, fever, muscle cramps, etc), but chills, headache and nausea persisted. Currently (6 days after vaccine) I have feeling of pressure in head above left ear. Pressure accompanied by slight headache, dizziness, feeling flush, stomach pain, and tingling in right hand. These symptoms haven''t changed over last 4 days, and most pronounced is head pressure, dizziness, and general disorientation. Haven''t taken medication, just getting good rest and hydration, but symptoms aren''t lessening.


VAERS ID: 1294241 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 1 LA / IM

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

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

Write-up: no adverse events happened its age adminstration error


VAERS ID: 1294511 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-14
Onset:2021-05-03
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lamotragine Wellbutrin Zyrtec Trazodone Multivitamin
Current Illness: I had a mild viral infection the day I got my shot: sinus pain, dry cough. Negative COVID tests.
Preexisting Conditions: Asthma
Allergies: Erythromycin Nickel Dust mites
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Why I''m reporting: My period started May 3 and was unusually light and short. Otherwise, I was extremely exhausted and in bed for a week, though as mentioned, I did have a mild cold going into it. I also had a fever and chills, but I can''t say if it was the cold or shot. Since I was still ill after a week and a half, I visited Urgent Care to make sure it wasn''t COVID or bronchitis and got the all-clear.


VAERS ID: 1294756 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Unknown  
Location: Nevada  
Vaccinated:2021-04-01
Onset:2021-05-03
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Fatigue, Hypersomnia, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (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: Prednisone for asthma
Current Illness:
Preexisting Conditions: None
Allergies: Shellfish nuts
Diagnostic Lab Data: None
CDC Split Type:

Write-up: By the 3rd day after I staryed feeling chronic fatigue and had a fever. By day four, I couldn''t get out of bed. I literally slept for 40 of the next 48 hours waking up with fever and chills, but so week I didn''t want to get out of bed. After 2 days in bed I started to feel better and by the end of the 6 th of May I had fully recovered. I hope.


VAERS ID: 1295166 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Hypoaesthesia, Lethargy, Vital signs measurement
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Exhaustion / Lethargy-Medium, Systemic: Headache-Medium, Systemic: Numbness (specify: facial area, extremities)-Severe, Additional Details: Patient complained of numbness from starting from left side of face to right side from neck to mouth along with headache and fatigue. She is still experiencing some numbness in her chin and mouth. I advised her to follow up with her PCP. BP was 134/93.


VAERS ID: 1295307 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Chills, Computerised tomogram normal, Dyspnoea, Myalgia, Pain in extremity, Pyrexia, Ultrasound scan normal
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin
Current Illness: 0
Preexisting Conditions: No long term illnesses
Allergies: Pecans, seasonal allergies, penicillin
Diagnostic Lab Data: Ultra sounds and cat scan on 5/4 came back clear for any clotting.
CDC Split Type:

Write-up: A few hours after vaccination the fever started and muscle aches/chills also began. Around 10:00 P.M., pain in the right calf started and light pain in the left side of the chest with shortness of breath. Patient went to the ER and was hospitalized for 1 day.


VAERS ID: 1295449 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 2 LA / IM

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

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

Write-up: On 05/03/2021, client called with c/o "big red welps on arms, legs and stomach that are itching" states has taken benedryl but not working. Denies any difficulty breathing or swelling. Had Covid-19 vaccine on 05/03/2021 and 2 hours later the hives appeared. Instructed needs to see PCP since hives are widespread. Verbalizes understanding states will call and make appt.. 05/05/2021 Tried to call patient but had to leave voicemail.


VAERS ID: 1295494 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-07
Onset:2021-05-03
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Muscle twitching, Ocular discomfort
SMQs:, Dyskinesia (broad), Dystonia (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: amlodipine Lisinopril
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Quivering twitching of left eye.


VAERS ID: 1295617 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

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

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

Write-up: patient received an expired vaccine


VAERS ID: 1295641 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

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

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

Write-up: PATIENT RECEIVED EXPIRED DOSE OF VACCINE


VAERS ID: 1295649 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 1 LA / IM

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

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

Write-up: gave moderna to 17 year old


VAERS ID: 1295658 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Abdominal pain, Chills, Feeding disorder, Headache, Migraine, Nausea, Pain, Pyrexia, Rash, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Escitalopram 5mg Estradiol 0.5mg
Current Illness: None
Preexisting Conditions: None
Allergies: codene
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Severe body aches started approximately 8 hours after receiving vaccine. Took recommended dose of Naproxin, which only reduced pain slightly. Approximately 16 to 18 hours after receiving vaccine I had severe body aches, fever, chills, headache and nausea. Vomitting started 20 hours after vaccine and continued for 12 hours, approximately every hour. Could not keep water food, fluids or medicine down. Unable to eat food for 24 hours. Headache turned into migraine and had very uncomfortable stomach and abdominal cramping. Also developed severe rash on neck and both sides of chest and abdomen. Migraine and abdominal issues lasted another 12 hours approximately. At about 48 hours after migraine subsided, abdominal issues continued with nausea (no vomitting). Nausea and rash lasted an additional 24 hours.


VAERS ID: 1295847 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-05-02
Onset:2021-05-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Exposure during pregnancy, Peripheral swelling, Premature separation of placenta, Swelling, Tenderness, Varicose vein
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Pre-natal vitamins, OTC fish oil 9.5grams, OTC baby aspirin daily
Current Illness:
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: I experienced 24 hours after my vaccine, right thigh and leg swelling. On 04-27-2021, I was hospitalized due to varicose veins. My right thigh was red with some tenderness. I also had premature ruptured placenta at 28 weeks pregnant. To this day I still have the varicose veins.


VAERS ID: 1296033 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-05-02
Onset:2021-05-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Glossodynia, Hypoaesthesia oral
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)

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

Write-up: Numbness in lips and tongue, No swelling. Had tongue lesions also.


VAERS ID: 1296114 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-12
Onset:2021-05-03
   Days after vaccination:80
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Atrioventricular block, Bradycardia, Heart injury, Myocarditis, Myositis
SMQs:, Rhabdomyolysis/myopathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Accidents and injuries (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: atorvastatin, fexofenadine, metformin, metoprolol tartrate, multivitamin, nifedipine, olmesartan, omeprazole, tamsulosin, cephalexin, ferrous sulfate, hyoscyamine sulfate
Current Illness: None
Preexisting Conditions: high-grade urothelial carcinoma receiving pembrolizumab with most recent dose on 4/5/21, prostate cancer, hypertension, myocardial infarction, prediabetes, hyperlipidemia
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admit for heart block and asymptomatic bradycardia to 40 bpm, found to have acute myocardial injury concenring for NSTEMI vs myocarditis; suspected immune checkpoint inhibitor myocarditis/myositis w/ complete heart block. 1 of 3 patients with similar presentation within 1 month (2 received 2nd dose Moderna, 1 received Janssen)


VAERS ID: 1296528 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-10
Onset:2021-05-03
   Days after vaccination:54
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 UN / SYR

Administered by: Other       Purchased by: ?
Symptoms: Blindness, Computerised tomogram head abnormal, Ophthalmic scan, Retinal artery occlusion
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? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Cholesterol Meds. & blood pressure meds.
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: cat scan 4/4/21 Opthalmologist imaging 4/5/21
CDC Split Type:

Write-up: Blood clot in right eye resulting in permanent loss of vision.


VAERS ID: 1296816 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Mouth ulceration, Oral pain, Tongue ulceration
SMQs:, Severe cutaneous adverse reactions (broad), Systemic lupus erythematosus (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: Sertraline, Risperidone
Current Illness: seasonal allergies
Preexisting Conditions: anxiety
Allergies: None
Diagnostic Lab Data: went to the doctor around 5pm on May 4th. No test done or lab.
CDC Split Type:

Write-up: Sores or ulcers in the mouth. So painful it''s hard to eat and drink somewhat. Able to breath ok though. Saw a Doctor and they thought it was a virus maybe but it happened so close after his shot. Symptoms started on a Monday and as of Friday evening he is still having bumps appear in the mouth and under tongue.


VAERS ID: 1297066 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-04-24
Onset:2021-05-03
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bio-Identical HRT; Zn,Vit D,Gingko,Folic Acid,Biotin,l-lysine
Current Illness: None Known
Preexisting Conditions: None Known
Allergies: PCN; Doxycycline
Diagnostic Lab Data: None performed to date.
CDC Split Type:

Write-up: 1) Most significant reaction began 10 days after receiving vaccination. Itchiness primarily on back & buttocks w/a little on arms, legs, and abdomen. Red raised bumps appeared w/increased itchiness each day & continues to present (Day 4). Took one Benadryl on Day 4 w/slight but temporary relief. 2) Additional reactions prior to outbreak of rash include: a) swollen lymph glands on right side of neck two days post vaccine lasting for two days. and b) Left ear ache/pain on 4/28/21 lasting one day.


VAERS ID: 1297834 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-16
Onset:2021-05-03
   Days after vaccination:76
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 1 LA / IM

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

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

Write-up: This 82 year old female received the Covid shot on 2/16/21 and went to the ED on 5/3/21 and was admitted on 5/3/21 with the following diagnoses listed below. SIRS (systemic inflammatory response syndrome)


VAERS ID: 1297852 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Diarrhoea, Dyspnoea, Fatigue, Immediate post-injection reaction, Migraine, Pain, Pain in extremity, Pyrexia, Vision blurred, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: various vaccines throughout patients life, last flu shot in 2009 had patient hospitalized 3 times
Other Medications: none
Current Illness: none
Preexisting Conditions: anemia, PCOS, depression, anxiety, ADHD
Allergies: hops, bees, echinacea
Diagnostic Lab Data:
CDC Split Type:

Write-up: Immediate arm paining mild dizziness followed by 4+ days of extreme fatigue, mild difficulty breathing, fever, chills, body aches (pain level 5/6), difficulty focusing, vomiting, diarrhea, and an on & off migraine


VAERS ID: 1298816 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Arizona  
Vaccinated:0000-00-00
Onset:2021-05-03
Submitted: 0000-00-00
Entered: 2021-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Chills, Malaise, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Name: Body temperature; Result Unstructured Data: 102
CDC Split Type: USJNJFOC20210503800

Write-up: VOMITTING/CANNOT KEEP ANYTHING DOWN, IT KEEPS COMING BACK UP; CHILLS; MALAISE; FEVER 102; This spontaneous report received from a patient concerned a male of unspecified age. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 203A21A, and batch number: 203A21A expiry: UNKNOWN) dose was not reported, administered on 03-MAY-2021 10:30 for prophylactic vaccination. No concomitant medications were reported. On 03-MAY-2021, the subject experienced vomiting /cannot keep anything down, it keeps coming back up. On 03-MAY-2021, the subject experienced chills. On 03-MAY-2021, the subject experienced malaise. On 03-MAY-2021, the subject experienced fever 102. Treatment medications (dates unspecified) included: paracetamol. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from fever 102, malaise, vomiting/cannot keep anything down, it keeps coming back up, and chills. This report was non-serious.


VAERS ID: 1298822 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Michigan  
Vaccinated:0000-00-00
Onset:2021-05-03
Submitted: 0000-00-00
Entered: 2021-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210505310

Write-up: DIDN''T RECEIVE THE FULL DOSE; This spontaneous report received from a pharmacist concerned a patient of unspecified age and sex. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 204A21A expiry: UNKNOWN) dose was not reported, administered on 03-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 03-MAY-2021, the subject experienced didn''t receive the full dose. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of didn''t receive the full dose was not reported. This report was non-serious.


VAERS ID: 1298823 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Maryland  
Vaccinated:0000-00-00
Onset:2021-05-03
Submitted: 0000-00-00
Entered: 2021-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Gait disturbance, Influenza like illness, Pain
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 20210503; Test Name: Body temperature; Result Unstructured Data: 102 F
CDC Split Type: USJNJFOC20210505586

Write-up: ACHES; FLU-LIKE SYMPTOMS; HARD TO WALK; This spontaneous report received from a consumer concerned a 63 year old female. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 205A21A expiry: UNKNOWN) dose was not reported, administered on 03-MAY-2021 10:15 for prophylactic vaccination. No concomitant medications were reported. On 03-MAY-2021, the subject experienced aches. On 03-MAY-2021, the subject experienced flu-like symptoms. On 03-MAY-2021, the subject experienced hard to walk. Laboratory data included: Body temperature (NR: not provided) 102 F. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from aches, flu-like symptoms, and hard to walk. This report was non-serious.


VAERS ID: 1298829 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Oregon  
Vaccinated:0000-00-00
Onset:2021-05-03
Submitted: 0000-00-00
Entered: 2021-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, Back pain, Body temperature, Chills, Decreased appetite, Feeling of body temperature change, Headache, Hypersomnia, Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (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: NEXPLANON
Current Illness: Birth control
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 20210503; Test Name: Body temperature; Result Unstructured Data: 97 F; Test Date: 20210504; Test Name: Body temperature; Result Unstructured Data: 99 F
CDC Split Type: USJNJFOC20210506681

Write-up: LOSS OF APPETITE; VOMITING; SLEEPING; CHILLS; LOW FEVER; SEVERE HEADACHE; STOMACH PAIN ON RIGHT SIDE; BACK ACHE; BODY ACHES; HOT/COLD SENSATIONS; This spontaneous report received from a consumer concerned an 18 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included birth control. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 206A21A, and expiry: 23-JUN-2021) dose was not reported, administered on 03-MAY-2021 for prophylactic vaccination. Concomitant medications included etonogestrel for birth control. On 03-MAY-2021, the subject experienced stomach pain on right side. On 03-MAY-2021, the subject experienced back ache. On 03-MAY-2021, the subject experienced body aches. On 03-MAY-2021, the subject experienced hot/cold sensations. On 03-MAY-2021, the subject experienced chills. On 03-MAY-2021, the subject experienced sleeping. On 03-MAY-2021, the subject experienced low fever. On 03-MAY-2021, the subject experienced severe headache. Laboratory data included: Body temperature (NR: not provided) 97 F. Treatment medications included: ibuprofen. On 03-MAY-2021 05:00, the subject experienced vomiting. On 04-MAY-2021, the subject experienced loss of appetite. Laboratory data included: Body temperature (NR: not provided) 99 F. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from stomach pain on right side, severe headache, back ache, body aches, hot/cold sensations, chills, and vomiting, and the outcome of sleeping, low fever and loss of appetite was not reported. This report was non-serious.


VAERS ID: 1298855 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Florida  
Vaccinated:0000-00-00
Onset:2021-05-03
Submitted: 0000-00-00
Entered: 2021-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Back pain
SMQs:, Retroperitoneal fibrosis (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: Abstains from alcohol; Non-smoker
Preexisting Conditions: Comments: Patient had no known allergies. No drug abuse or illicit drug usage were found.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210509870

Write-up: MILD BACK PAIN; This spontaneous report received from a patient concerned an 18 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included non-alcoholic, and non-smoker, and other pre-existing medical conditions included patient had no known allergies. no drug abuse or illicit drug usage were found.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1808982, and expiry: UNKNOWN) dose was not reported, administered on 03-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 03-MAY-2021, the subject experienced mild back pain. Treatment medications (dates unspecified) included: ibuprofen. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from mild back pain. This report was non-serious.


VAERS ID: 1299536 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 UN / IM

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

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

Write-up: Error: Improper Storage (temperature)


VAERS ID: 1299657 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-18
Onset:2021-05-03
   Days after vaccination:105
Submitted: 0000-00-00
Entered: 2021-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Cerebrovascular accident, Computerised tomogram, Echocardiogram, Magnetic resonance imaging, NIH stroke scale score increased, Scan with contrast
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ibuprofen after the vaccination
Current Illness: Nons
Preexisting Conditions: Asthma
Allergies: Bee sting
Diagnostic Lab Data: Cat scan/Cat scan w/contrast, MRI/MRI w/contrast, Echo, TEE, blood work
CDC Split Type:

Write-up: Healthy 49 yo female with no genetic disposition, no high blood pressure, no high cholesterol, not diabetic, had a moderate to severe stroke with NIH stroke score of 19 upon admission to ER. TPA administered,


VAERS ID: 1300373 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-29
Onset:2021-05-03
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Blood creatine phosphokinase increased, Blood creatinine increased, Blood test normal, Computerised tomogram, Headache, Renal failure, Rhabdomyolysis
SMQs:, Rhabdomyolysis/myopathy (narrow), Acute renal failure (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: CK peaked at 60,000. Creat peaked at 2.86. Innumerable labs to determine other etiologies so far negative. A
CDC Split Type:

Write-up: Admitted to hospital with rhabdomyolysis and renal failure. Also reported severe headache and abd pain prompting CT scans.


VAERS ID: 1300454 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-10
Onset:2021-05-03
   Days after vaccination:54
Submitted: 0000-00-00
Entered: 2021-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cerebrovascular accident, Facial paralysis
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)

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

Write-up: This 65 year old female received the Pfizer Covid shot on 3/10/21 and went to the ED on 5/3/21 and was admitted on 5/3/21 with the following diagnoses listed below. I63.9 - Acute CVA (cerebrovascular accident) (CMS/HCC) FACIAL DROOP


VAERS ID: 1300613 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-04-11
Onset:2021-05-03
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Menstrual disorder, Muscle spasms, Pruritus, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Dystonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Red rash and itching on arms face and legs 3 weeks post vaccine, cramping in legs and unusual menstrual cycle


VAERS ID: 1300678 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Hypoaesthesia, Pallor, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)

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

Write-up: Dizziness, tingling/numbness of bilateral hands, pale. Vitals wnl. Water given.


VAERS ID: 1301659 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-21
Onset:2021-05-03
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Alanine aminotransferase normal, Blood creatinine normal, Brain natriuretic peptide normal, Dyspnoea, Full blood count normal, Troponin I normal, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall XR 20mg 24 hour SR cap Restasis 0.05% Opht gtt Refresh Tears Nabumetone (Relafen) 750mg a day Lidex cr?me topically Lexapro 20mg daily Trazodone 50mg qhs Omeprazole Mag 20mg CPDR SR cap daily
Current Illness: gastritis ADHD bilateral keratoconjunctivitis sicca insomnia depression contact dermatitis
Preexisting Conditions: gastritis ADHD bilateral keratoconjunctivitis sicca insomnia depression
Allergies: none
Diagnostic Lab Data: always 100% O2 sat Afebrile normotensive, Pulse normal did have audible wheezing BNP, Trponin I, ALT, Cr, CBC all normal
CDC Split Type:

Write-up: Got vaccine 4/21/21; local reaction started 5/3/21; developed new onset wheezing and SOB diagnosed 5/5/21, treated with prednisone, albuterol and epi injection.


VAERS ID: 1301674 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-12
Onset:2021-05-03
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026821A / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Appendicectomy, Blood test, Computerised tomogram, Urine analysis
SMQs:

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: PANTOPRAZOLE SOD DR 40 MG tab, 1 daily #723964 Gastritis PREMARIN .9 mg 1 daily 21 days. Then do not take for 7 days #721580 hormone MEDROXYPROGESTERONE 2.5mg tab , 1 daily # 271450113 hormone LEVOTHYROXINE 112 mcg tab. 1 daily #28506
Current Illness: None
Preexisting Conditions: Thyroid Depression Gastritis
Allergies: Maybe codeine
Diagnostic Lab Data: Blood, CT SCAN, urine 5/3/21
CDC Split Type:

Write-up: Emergengy Appendicitis surgery


VAERS ID: 1301694 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anaphylactic reaction, Dyspnoea, Erythema, Lymphadenopathy, Pruritus, Swelling face, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Severe anaphylaxis- Red on face and arm (hives/itching), severe shortness of breath, and severe swelling of face and under the arms.


VAERS ID: 1301772 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-05-03
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Injection site pruritus, Injection site swelling, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210511833

Write-up: ITCHING AT INJECTION SITE; HURTING RIGHT ARM; FATIGUE; SWELLING AT INJECTION SITE; This spontaneous report received from a patient concerned a 66 year old male. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) dose was not reported, administered on 21-APR-2021 for prophylactic vaccination. Batch number was not reported and has been requested. No concomitant medications were reported. On 03-MAY-2021, the subject experienced itching at injection site. On 03-MAY-2021, the subject experienced hurting right arm. On 03-MAY-2021, the subject experienced fatigue. On 03-MAY-2021, the subject experienced swelling at injection site. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the hurting right arm, fatigue, itching at injection site and swelling at injection site was not reported. This report was non-serious.


VAERS ID: 1301773 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-05-03
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chills, Limb discomfort, 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: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210512113

Write-up: ACHY; LEGS WERE LEAD; CHILLS; FEVER; This spontaneous report received from a patient via a company representative concerned a patient of unspecified age and sex. The patient''s weight, height, and medical history were not reported.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: unknown) dose was not reported, administered on 03-MAY-2021 for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On 03-MAY-2021, the subject experienced chills. On 03-MAY-2021, the subject experienced fever. On 04-MAY-2021, the subject experienced achy. On 04-MAY-2021, the subject experienced legs were lead. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the chills, fever, achy and legs were lead was not reported. This report was non-serious.


VAERS ID: 1301996 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-30
Onset:2021-05-03
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / -

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Feeling cold, Herpes zoster, Influenza like illness, Pain, Rash
SMQs:, Anaphylactic reaction (broad), 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Scoliosis
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shingles. Symptoms began 3 days after 2nd Moderna COVID vaccine. These included waves of chills sensation through left leg and groin lymph node areas, as well as fatigue, achiness, and general flu-like symptoms. 6 days later (5/9), the first sign of rash/blister broke out. My doctor performed a house visit to confirm shingles and prescribed ValACYclovir. I am on my 2nd day of this medication.


VAERS ID: 1302092 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-23
Onset:2021-05-03
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin c, Vitamin D, dexamethasone oral, gabapentin, olanzapine, ondansetron, prochlorperazine, zinc sulfate
Current Illness: cancer of tongue
Preexisting Conditions: Cancer of the tongue, receiving chemotherapy. Pt received his chemotherapy treatment on 4/20/21 - 3 days prior and then 4/27- 5 days post vaccination. He was receiving weekly cisplatin as a new start chemotherapy. Only 2 cycles were completed on patient.
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: 3 days after receiving the Covid vaccination, the patient tested positive for Covid. THe pt began to deteriorate and was admitted 10 days post vaccination and required oxygen support. Pt continued to experiences Covid pneumonia.


VAERS ID: 1302106 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-27
Onset:2021-05-03
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH WW0171 / UNK LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Cheilitis, Dry skin, Eye pruritus, Eye swelling, Eyelid rash, Fatigue, Malaise, Ocular hyperaemia, Pyrexia, Rash, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

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

Write-up: On 4/28 had fever of 100.7, joint pain, tired and sick. On 5/3 began having a reaction on chest, chin line, eyes, and lips. I have itchy bumps on these areas of my body and some sores on my chest. My eyes are itchy and have dry patches around the eye. They are also red and swollen.


VAERS ID: 1302349 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Body temperature increased, Dizziness, Headache, Paraesthesia
SMQs:, Peripheral neuropathy (broad), 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: Flu shot vaccine in late 2020 caused fever and headache for night of vaccination .
Other Medications: Men''s One a Day multivitamin Tolterodine
Current Illness:
Preexisting Conditions:
Allergies: kiwi fruit
Diagnostic Lab Data:
CDC Split Type:

Write-up: I felt lightheaded a few hours after receiving the vaccine. Around 5-6 hours after the vaccine I was running a high temperature, felt tingling in my thighs, and having a big headache every time I stood up. Persisted for day of vaccination and next day before passing.


VAERS ID: 1302471 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-04-01
Onset:2021-05-03
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cerebral venous sinus thrombosis, Confusional state, Dysarthria, Magnetic resonance imaging head abnormal
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Embolic and thrombotic events, venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: allopurinol 100 mg oral tablet 100 mg = 1 Tablet, Orally, Daily amLODIPine 5 mg oral tablet 5 mg = 1 Tablet, Orally, Daily aspirin 81 mg oral tablet, chewable 162 mg = 2 Tablet, Orally, Daily Co Q-10 100 mg oral capsule 100 mg = 1 Capsule,
Current Illness:
Preexisting Conditions: Hypertension, hypothyroidism, diabetes mellitus, obesity, distant history of hyperuricemia and microscopic hematuria, diverticulosis, colon polyps
Allergies: No known medication or food allergies
Diagnostic Lab Data: MRI Brain 05/03/2021 showing 3 cm segment thrombosis of the left superior anastomotic vein near the superior sagittal sinus. No corresponding hemorrhage or brain infarction.
CDC Split Type:

Write-up: Admitted 04/30/2021 for increasing slurred speech and confusion; previously admitted to outside facility 04/15/2021 through 04/19/2021 for similar symptoms


VAERS ID: 1302607 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-01
Onset:2021-05-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / -

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Blood potassium decreased, Decreased appetite, Dehydration, Depression, Laboratory test normal, Malaise, Myalgia, Nausea, Pyrexia, Sleep disorder, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (narrow), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (narrow), Hypokalaemia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Syncope
Allergies: None
Diagnostic Lab Data: Blood draw ran for labs on 5/3, normal except for some dehydration and low potassium
CDC Split Type:

Write-up: Low grade fever for two days until 5/3. Went to ER with severe nausea, muscle pains. Fainted in ER waiting room. Was extremely sick for three days with nausea, pain, low energy and side effects. Am still having leg muscle pain on 5/10 as well as low energy, being unable to sleep, no appetite, depression. Went to Urgent Care on 5/10, vitals are good


VAERS ID: 1302666 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-12
Onset:2021-05-03
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Herpes zoster
SMQs:, Opportunistic infections (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: nop
Current Illness: tooth infection
Preexisting Conditions: no
Allergies: penicilin
Diagnostic Lab Data: Doctors visual diagnostic
CDC Split Type:

Write-up: Herpes Zoster


VAERS ID: 1302713 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-28
Onset:2021-05-03
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 1 LA / SYR

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

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

Write-up: Swollen lymph nodes on left side neck and in left armpit


VAERS ID: 1302805 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-10
Onset:2021-05-03
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Armour 30 and 15 vitamins D, C, E, Mag, Calcium, B, Adrenal Su
Current Illness: none
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shingles


VAERS ID: 1302993 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 1 LA / IM

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

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

Write-up: Moderna administered under 18 year old


VAERS ID: 1303285 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-09
Onset:2021-05-03
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN Z01AZ1A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: COPD Fibromyalgia Type 2 Diabetes
Allergies: Norflex Ibuprofen
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 24 days after vaccine ringing in both ears. No treatment, still having ringing in both ears


VAERS ID: 1303381 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-23
Onset:2021-05-03
   Days after vaccination:69
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, Chest pain
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: This 92 year old white male received the Covid shot on 2/23/21 and went to the ED and admitted on 5/3/21 and again to ED and admitted on 5/5/21 with the following diagnoses listed below. I21.4 - NSTEMI (non-ST elevated myocardial infarction) (CMS/HCC) CHEST PAIN


VAERS ID: 1303915 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-04-07
Onset:2021-05-03
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood creatine phosphokinase normal, Cough, Dyspnoea, Electrocardiogram normal, Fibrin D dimer normal, Full blood count normal, Influenza virus test negative, Metabolic function test normal, Respiratory syncytial virus test negative, SARS-CoV-2 test negative, Troponin normal
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CBC, CMP, CPK, Troponin, D-Dimer, ECG all normal; Flu/RSV/Covid, negative; RE-EVALUATION & FINAL ASSESSMENT: 12:42 PM I have reevaluated the patient who reports feeling improved. Results were discussed with the patient and he verbalized understanding. The pt is stable for discharge, we discussed plan, and he is agreeable. Pt is comfortable going home. He will follow up with PCP for further evaluation as needed. Strict return precautions were given prior to discharge for any worsening
CDC Split Type:

Write-up: The patient is a 56 y.o. male who presents to the Emergency Department with cough and SOB for 2-3 days. The patient states he was vaccinated with the johnson and johnson COVID-19 vaccine two weeks ago. He denies any vomiting diarrhea, fevers, leg swelling, or chest pain. The patient additionally denies being around any sick contacts or any recent travel. The patient is a 56 y.o. male evaluated for cough and SOB for 2-3 days. Possibility of pneumonia. I have lower suspicion for PE, however his oxygen saturation is less than 94%, so we will obtain a D-dimer. I have lower suspicion for ACS. Will also check COVID swab to rule out COVID despite recent vaccination.


VAERS ID: 1303947 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-05-03
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Back pain, Blood pressure measurement, Heart rate, Heavy menstrual bleeding, Hyperhidrosis, Hypoaesthesia, Muscle spasms, Nausea, Pain, Paraesthesia, Paralysis
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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: Alcohol use (Occasioanl drinker.); Birth control; Non-smoker
Preexisting Conditions: Comments: The patient had no drug allergies nor illicit drug use.
Allergies:
Diagnostic Lab Data: Test Date: 20210503; Test Name: Heart rate; Result Unstructured Data: normal; Test Date: 20210503; Test Name: Blood pressure; Result Unstructured Data: normal
CDC Split Type: USJNJFOC20210511206

Write-up: BACK ACHE; MUSCLE SPASM; HEAVY DARK CLOTTY PERIOD; PARALYSIS; PINS AND NEEDLES SENSATION; NUMBING; SWEATS; SORENESS; NAUSEA; This spontaneous report received from a consumer concerned a 26 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included birth control implanted in arm that is old and needs to be taken out, alcohol user, and non smoker, and other pre-existing medical conditions included the patient had no drug allergies nor illicit drug use. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1808982, and batch number: 1808982 expiry: UNKNOWN) dose was not reported, 1 total, administered on 03-MAY-2021 at 09:00 on left arm for prophylactic vaccination. No concomitant medications were reported. On 3-May-2021 at 09:00, the patient was vaccinated. At 17:00, the patient had pain, nausea, sweats, and soreness. At 18:00, she had pins and needles sensation, numbing, and paralysis. Later, she had sweats. Paramedics had checked the patient blood pressure and heart rate and they were within normal limits. The patient was still experiencing backache, muscle spasm, pain and heavy dark clotty period which was unusual. The patient had birth control implanted in arm that was old and needed to be taken out. Laboratory data included: Blood pressure and Heart rate was found normal. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from soreness, back ache, muscle spasm, and heavy dark clotty period, and the outcome of nausea, sweats, pins and needles sensation, numbing and paralysis was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0 20210511206-COVID-19 VACCINE AD26.COV2.S- Paralysis. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).


VAERS ID: 1304166 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Neuralgia, Oral pain, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Nerve pain in head and teeth day of vaccination. Since that day, long painful lines like scratches on back; these keep recurring


VAERS ID: 1305487 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-01
Onset:2021-05-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Diarrhoea, Dizziness, Fatigue, Pain, Pyrexia, Tinnitus
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Birth control
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Assessed for potential ear or sinus infection on 5/7, came back negative.
CDC Split Type:

Write-up: First day fatigue, second day intense body aches, dizziness, and fever. Third day diarrhea and ringing in the ears. Pulsating tinnitus has continued on for two weeks with progression after other symptoms have subsided.


VAERS ID: 1305494 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hemiplegic migraine, Hypoaesthesia, Hypoaesthesia oral, Magnetic resonance imaging
SMQs:, Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine Vitamin d Vitamin b
Current Illness: No
Preexisting Conditions: EDS Fibromyalgia Hashimoto''s thyroiditis Hemiplegic migraine atypical rare variant
Allergies: Several
Diagnostic Lab Data: MRI
CDC Split Type:

Write-up: Within an hour half of my body went numb My tongue went numb and I was in the emergency room unable to speak with what appeared to be the worst hemiplegic migraine in my life. The feeling has not returned in my left hand side of my body or my tongue. I am told the second vaccine injection will be worse. Then I was misdiagnosed with muscular sclerosis after an MRI was done and damage was found to my brain. I could not be more angry


VAERS ID: 1306667 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: B12, 325 mg aspirin.
Current Illness: None.
Preexisting Conditions: None.
Allergies: None.
Diagnostic Lab Data: Had MRI that was negative.
CDC Split Type:

Write-up: He got his vaccine, was in the store at the meat counter and then had a visual effect as people were looking at him funny, and things went from black/white to black/gray/white and passed out (told he had a seizure and on film at the grocery store), then woke up in the back of the ambulance on the way to the hospital. In the hospital he was given an injection to slow his heart rate down, said that he drank a pot of coffee and then had another 16 oz coffee after that. He was not admitted, treated in the ER, fed him and was discharged home and then walked about 1/2 mile to his truck at the supermarket, and finished his shopping. He has been a little tired since then, has been taking it easy and not pushing himself too hard and not working too many hours.


VAERS ID: 1306809 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-04-29
Onset:2021-05-03
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (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: Client denies taking prescription medications, over-the-counter medications, dietary supplements, or herbal remedies at time of vaccination.
Current Illness: Client denies the presence of other illnesses at the time of vaccination and up to one month prior.
Preexisting Conditions: Client reports history of hypertension, smoking, obesity. Client denies other known chronic or long-standing health conditions.
Allergies: ACE inhibitors.
Diagnostic Lab Data: Client states that she has not visited any medical professionals or obtained any medical/laboratory tests prior to reporting to administering facility staff.
CDC Split Type:

Write-up: Client reports, "I got my vaccine on the 29th, and on the 3rd I found myself on the floor under my counter with a big bruise on my face. I had blood on my pillow in the other room where I may have bitten my lip, but I don''t remember anything about what happened. I''m worried I may have had a seizure, and I''ve never had seizures." Client denies any event preceding this one, and is unsure of duration of event. Purple and yellow hematoma noted to client''s orbit of right eye and to right cheek. Client denies ongoing signs or symptoms, at this time.


VAERS ID: 1306838 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-01
Onset:2021-05-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Mastitis, Physical examination
SMQs:, Functional lactation disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allopurinol 100mg, indomethacin 50mg prn, levothyroxine 50mcg, duloxetine 60mg fluocinonide 0.05% cream prn, naltrexone 50mg, lisinopril 10mg, quetiapine 100mg
Current Illness: alcoholism, bipolar disorder mixed, gout, hypertension, hyperlipidemia, hypothyroidism, prediabetes, Rheumatoid Arthritis
Preexisting Conditions: As above.
Allergies: None
Diagnostic Lab Data: Diagnosed by physical exam in the office 5/11/21, treated with oral antibiotics
CDC Split Type:

Write-up: right sided mastitis


VAERS ID: 1306981 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-01
Onset:2021-05-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood test, Campylobacter infection, Computerised tomogram, Guillain-Barre syndrome, Laboratory test, Lumbar puncture, Magnetic resonance imaging head, Magnetic resonance imaging spinal, Narcolepsy, Polymerase chain reaction
SMQs:, Peripheral neuropathy (narrow), Convulsions (broad), Guillain-Barre syndrome (narrow), Demyelination (narrow), Generalised convulsive seizures following immunisation (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vyvanse 30mg/d, children''s multivitamin chewable.
Current Illness: None
Preexisting Conditions: None
Allergies: Cats, ragweed.
Diagnostic Lab Data: Full blood and metabolic panel, GI PCR panel, CT scan, lumbar puncture, brain and spinal cord MRI. Tests & hospitalization ongoing.
CDC Split Type:

Write-up: Acute narcolepsy. Suspected Guillain-Barre Syndrome. Could be related to concurrent-onset campylobacter infection.


VAERS ID: 1307096 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-01-07
Onset:2021-05-03
   Days after vaccination:116
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 2 AR / IM

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

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

Write-up: PATIENT RECEIVED VACCINE IN JANUARY AND IS NOW COVID-19 POSITIVE


VAERS ID: 1307141 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-01
Onset:2021-05-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 UN / SYR

Administered by: Public       Purchased by: ?
Symptoms: Angiogram pulmonary normal, Chest pain, Cytomegalovirus test negative, Echocardiogram normal, Electrocardiogram ST segment elevation, Epstein-Barr virus antibody negative, Nausea, Pericarditis, Pyrexia, Troponin increased, Viral test
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: ECG: diffuse ST segment elevation consistent with pericarditis. Normal CT angiography of chest. Elevated troponin to 5.68 Echocardiogram normal PCR for coxsackievirus, EBV and CMV all negative
CDC Split Type:

Write-up: Fever and nausea beginning in the evening after administration, improved, then onset 2 days after administration of chest pain. Presented to emergency room and subsequently admitted with diagnosis of pericarditis. Symptoms resolved within a few hours of treatment with Colchicine


VAERS ID: 1307177 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-01
Onset:2021-05-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Bell's palsy, Facial paresis, SARS-CoV-2 test negative
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: Mild intermittent Asthma
Allergies: none
Diagnostic Lab Data: none, referred to Neuro, RP2-PCR negative
CDC Split Type:

Write-up: Bell''s palsy on left, Patient is a 17 year old male who presents to ED today for left sided facial weakness involving the face and forehead. Patient says he received the Pfizer vaccine for COVID19 this past Saturday. Two days later on Monday, he developed these symptoms. He arrives well appearing in NAD. He has weakness of the left face involving the forehead, difficulty raising eyebrow and closing left eye.


VAERS ID: 1307267 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose, Blood lactic acid, Chest X-ray normal, Confusional state, Decreased appetite, Dyspnoea, Feeling abnormal, Malaise, Mental status changes, Neutrophil count increased, Pneumonia, Pyrexia, Rash, Urine analysis, White blood cell count increased
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ? Allopurinol Oral : Tablet 300 mg, 1 TABLET DAILY ? Cardize
Current Illness: No known acute illnesses
Preexisting Conditions: COPD, Anemia Arrhythmia Atrial Fibrillation Atypical Chest Pain Back Pain Chronic Back Pain Congestive Heart Failure
Allergies: No known drug allergies
Diagnostic Lab Data: 5/3/21: Chest x-ray- no acute changes 5/3/21, Lactic acid: 1.98,5/3/21: U/A- trace of bacteria 5/3/21: CBC: WBCs elevated @ 12.1 & elevated neutrophils 5/3/21: CMP: glucos 5/3/21:
CDC Split Type:

Write-up: Presented to ED ~ 12 hours after receiving 2nd Covid vaccine. Chief Complaint: FEVER. (Pt had second COVID vaccine around noon. He presents via ambulance " feeling terrible" with fever, malaise. He is somewhat confused and uncomfortable here. Daughter in law here). No muscle aches, chest pain or cough. He has had loss of appetite. He has had dyspnea (chronic). He has had altered mental status (mild confusion). He has had skin rash (chronic LE). Pt was kept for observation x3. He was given IV fluids and a started 4.5 gm of Zosyn (Piperacillin Sod-Tazobactam So). Diagnosed with pneumonia - switched to oral augmentin at discharge. On home oxygen.


VAERS ID: 1307285 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Fatigue, Head discomfort, Headache, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: patient stated she took the vaccine on Monday 5/3/21 @930 and around 1pm patient stated she got home and just crashed (took a long nap). She felt very tired after the vaccine and on 5/5/21 she started feeling a lot of head pressure, light headed, blurry vision, and headache. No other c/o of symptoms.


VAERS ID: 1307350 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-16
Onset:2021-05-03
   Days after vaccination:76
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

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

Write-up: I21.4 - NSTEMI (non-ST elevated myocardial infarction)


VAERS ID: 1307538 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-30
Onset:2021-05-03
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 2 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LEXAPRO: IBEPROPHEN: SUBOXINE: BUSPROPHINE: GABAPETEN
Current Illness: NONE
Preexisting Conditions: NO
Allergies: NO
Diagnostic Lab Data: I AM GOING TO THE EAR DOCTOR ON MAY 27TH 2021
CDC Split Type:

Write-up: 24/7 RINGING IN BOTH OF MY EARS. I NEVER HAD ANY ISSUES AT ALL WITH MY EARS BEFORE THE VACINNE AND NOW I HAVE A CONTSTANT RINGING IN BOTH OF MY EARS. IT IS SO OVERWHELMING AND I AM BESIDES MYSELF


VAERS ID: 1307901 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-04-01
Onset:2021-05-03
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acoustic stimulation tests, Deafness
SMQs:, Hearing impairment (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 11th of May 2021 hearing tests
CDC Split Type:

Write-up: Hearing loss


VAERS ID: 1308234 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

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

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

Write-up: Headache about an hour after; chills and worsening headache around 6 PM into the night; took Tylenol around 7 PM for the headache, and it improved; chills and returning headache kept me up during the night and I probably had a fever as well; took temperature at 9:30 AM the following morning and had a fever of 100.3 F; napped until around 3 PM and felt better when I woke up (headache, chills, fever gone)


VAERS ID: 1308951 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Maryland  
Vaccinated:2020-04-26
Onset:2021-05-03
   Days after vaccination:372
Submitted: 0000-00-00
Entered: 2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: C-reactive protein increased, Cough, Fibrin D dimer increased, Hypoxia, Interleukin level increased, Pyrexia, SARS-CoV-2 antibody test, SARS-CoV-2 test negative, Serum ferritin increased, Thrombocytopenia
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acyclovir (ZOVIRAX) 200 MG capsule TAKE 1 CAPSULE DAILY 1/18/21 Yes azithromycin (ZITHROMAX) 250 MG tablet TAKE 1 TABLET 3 TIMES A WEEK 12/23/19 Yes donepezil (ARICEPT) 10 MG tablet Take 10 mg by mouth nightly. Yes fludrocortison
Current Illness: None
Preexisting Conditions: Lung transplant recipient Alzehimers
Allergies: atovaqone
Diagnostic Lab Data: SARS COV2 PCR negative NP swab x 3 5/7-5/10. Admitting inflammatory CRP $g 15 , Ferretin $g 1100, IL6 $g 50 and D dimer $g 5. Pt with mild thrombbocytopenia COVID IG G pending
CDC Split Type:

Write-up: pt with 1- of dry cough followed by fever to 102 on 5/7/21. Pt was not hypoxic on home but on arrival to ER had hypoxia, requiring high flow NC. condition has not improved despite treatment for bacterial infection, PE and atypical pathogens ( possible tick bite). Admitting inflammatory CRP $g 15 , Ferretin $g 1100, IL6 $g 50 and D dimer $g 5. Pt with mild thrombbocytopenia COVID IG G pending


VAERS ID: 1309183 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: North Carolina  
Vaccinated:0000-00-00
Onset:2021-05-03
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Poor quality product administered
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: Comments: The patient had no illness at the time of vaccination and no history of allergy to vaccine, drug or food.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210504849

Write-up: POOR QUALITY DRUG ADMINISTERED; This spontaneous report received from a health care professional concerned a 41 year old male. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included the patient had no illness at the time of vaccination and no history of allergy to vaccine, drug or food. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 203A21A, expiry: 23-JUN-2021) .5 ml, administered on 03-MAY-2021 11:20 for prophylactic vaccination. No concomitant medications were reported. On 03-MAY-2021 11:20, the subject experienced poor quality drug administered. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of poor quality drug administered was not reported. This report was non-serious. This case, from the same reporter is linked to 20210503927 and 20210504498.


VAERS ID: 1309197 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-05-03
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Fatigue, Headache, Injection site pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (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: Abstains from alcohol; Non-smoker
Preexisting Conditions: Comments: The patient had no known allergies and did not have any drug abuse/illicit drug use. The patient was not pregnant at the time of report.
Allergies:
Diagnostic Lab Data: Test Date: 20210503; Test Name: Body temperature; Result Unstructured Data: 99.6 F
CDC Split Type: USJNJFOC20210509153

Write-up: HEADACHE; INJECTION SITE PAIN; FEVER; TIREDNESS; This spontaneous report received from a patient concerned a 74 year old female. The patient''s weight was 160 pounds, and height was 167 centimeters. The patient''s concurrent conditions included abstains from alcohol, and non smoker, and other pre-existing medical conditions included the patient had no known allergies and did not have any drug abuse/illicit drug use. The patient was not pregnant at the time of report. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 205A21A and expiry: UNKNOWN) dose was not reported, administered on 03-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 03-MAY-2021, the subject experienced headache. On 03-MAY-2021, the subject experienced injection site pain. On 03-MAY-2021, the subject experienced fever. On 03-MAY-2021, the subject experienced tiredness. Laboratory data included: Body temperature (NR: not provided) 99, 6 F. Treatment medications (dates unspecified) included: paracetamol. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from fever on 03-MAY-2021, and was recovering from headache, injection site pain, and tiredness. This report was non-serious.


VAERS ID: 1309308 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C2LA / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Anxiety, Dyspnoea, Loss of consciousness, Nausea
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: FLUOXETINE
Current Illness:
Preexisting Conditions: Comments: No medical history was provided by the reporter.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20211

Write-up: passed out; Anxiety; right now she has trouble breathing; nauseous; This spontaneous case was reported by a non-health professional (subsequently medically confirmed) and describes the occurrence of LOSS OF CONSCIOUSNESS (passed out) in an 18-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 007C2LA) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No medical history was provided by the reporter. Concomitant products included FLUOXETINE for an unknown indication. On 03-May-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 03-May-2021, the patient experienced LOSS OF CONSCIOUSNESS (passed out) (seriousness criterion medically significant), ANXIETY (Anxiety), DYSPNOEA (right now she has trouble breathing) and NAUSEA (nauseous). On 03-May-2021, LOSS OF CONSCIOUSNESS (passed out) and NAUSEA (nauseous) had resolved. At the time of the report, ANXIETY (Anxiety) and DYSPNOEA (right now she has trouble breathing) had not resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Treatment of events at was reported as medic was about to give oxygen. The patient did not know if it was her oxygen or heart rate that was low but she became conscious. Patient is worry about taking second dose. She asked if something bad will happen if she stopped at first dose.


VAERS ID: 1309310 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-04-29
Onset:2021-05-03
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032B21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arthropod bite, Lyme disease
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: USMODERNATX, INC.MOD20211

Write-up: Lyme disease; She was bit by a tick; This spontaneous case was reported by a consumer and describes the occurrence of LYME DISEASE (Lyme disease) in a 73-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 032B21A and unknown) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 29-Apr-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 03-May-2021, the patient experienced LYME DISEASE (Lyme disease) (seriousness criterion medically significant) and ARTHROPOD BITE (She was bit by a tick). At the time of the report, LYME DISEASE (Lyme disease) and ARTHROPOD BITE (She was bit by a tick) outcome was unknown. Treatment included Doxycycline 200 mg. No relevant concomitant medications were reported. Action taken with mRNA-1273 in response to the events was not applicable. Company Comment: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.


VAERS ID: 1309428 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-04-05
Onset:2021-05-03
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Contusion, Flank pain, Hyperhidrosis, Pain, Pain in extremity, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Accidents and injuries (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: First shot, bruise on arm with pain, profuse sweating with fever. Side pain. Second shot, side ache, after about 5 days both arms were really sore like arthritis but I dont have arthritis in my elbows or wrists and my arms dont normally hurt. Took naproxen, tried Tylenol but got a side ache.


VAERS ID: 1309429 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-05-02
Onset:2021-05-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Petechiae, Rash
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Blood Work done on 5/10/2021
CDC Split Type:

Write-up: Developed severe skin rash throughout body. Went to Emergency Room and was diagnosed as Petechiae.


VAERS ID: 1309967 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-24
Onset:2021-05-03
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / UNK RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Hypertension, Renal failure, Renal function test
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Hypertension (narrow), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data: 5/3/2021 Kidney Function Blood Tests 5/8/2021 Kidney Function Blood Tests
CDC Split Type:

Write-up: Organ Failure following Second Shot - otherwise healthy person - Kidneys showed failure on 5/3/2021 at an ER visit- Blood Pressure became elevated- Kidneys have been failing since second shot


VAERS ID: 1310225 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-29
Onset:2021-05-03
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Clostridium difficile colitis, Clostridium test positive, Condition aggravated, Gastrointestinal haemorrhage, Haematochezia, Haemoglobin normal, Hypotension, Rectal examination abnormal, Rectal haemorrhage, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Abatacept Fluticasone Peppermint Oil Pravastatin Acetaminophen Omeprazole Ondansetron PreniSONE sucralfate traMADol hydrochlorothiazide
Current Illness: Rheumatoid arthritis - receiving abatacept infusions 1. Adenomatous duodenal polyp 2. History of colonic polyps
Preexisting Conditions: Palpitations Atherosclerosis of native artery of extremity with intermittent claudication (HCC) Mixed hyperlipidemia Essential hypertension, benign Supraventricular premature beats FH: CAD (coronary artery disease) Collagenous colitis Hemangioma of liver Adrenal insufficiency (HCC) Recurrent Salmonella septicemia (HCC) Rheumatoid arthritis involving multiple sites with positive rheumatoid factor (HCC) Gastroparesis POTS (postural orthostatic tachycardia syndrome) Tachycardia Juvenile rheumatoid arthritis (HCC) Hypokalemia Long term (current) use of systemic steroids Gastroesophageal reflux disease without esophagitis Osteopenia of multiple sites Encounter for long-term (current) use of high-risk medication History of lower leg fracture Macrocytic anemia Fatty liver Diabetes mellitus (HCC) Irritable bowel syndrome with diarrhea Vitamin B12 deficiency Iron deficiency anemia, unspecified Acquired calcaneovalgus deformity of both feet History of adenomatous polyp of colon Vitamin D deficiency Hyperparathyroidism , secondary, non-renal (HCC) Rectal bleeding Moderate protein-calorie malnutrition (HCC)
Allergies: nkda
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized for rectal bleeding DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Abdominal pain, unspecified abdominal location Gastrointestinal hemorrhage, unspecified gastrointestinal hemorrhage type COVID-19 virus not detected GI bleeding Rectal bleeding HOSPITAL COURSE: 44 yo female with h/o rheumatoid arthritis on immunomodulator therapy, adrenal insufficiency with chronic steroid use, duodenal and colonic polyposis, and irritable bowel syndrome, who presented on 5/3 with rectal bleeding. One day prior, she noted 2 small drops of blood on her underwear. On day of admission, she went to have a bowel movement and it was mostly blood and it saturated the water in the toilet bowel. She follows with GI Dr., and had EGD and colonoscopy on 2/1 again revealing multiple polyps. She had been referred to a geneticist to rule out familial polyposis syndrome. She came to the ED for evaluation. In the ED, she had one BP measurement that was low, 89/62, Hgb is 12.4, down from 14.5 from 3/3. ED performed a rectal exam that showed dried blood around the perineum. No large, palpable hemorrhoids. Pink jelly on exam finger. Possible small posterior anal fissure that was painful. She was given hydrocortisone 100mg IV, 1L IVF, and pantoprazole 80mg. She was admitted to the IM service with GI consulted, and Hgb remained stable on serial checks. Stool studies were sent, showing positive C diff PCR and she was started on oral vancomycin. Over the next few days, she showed gradual improvement of her presenting abdominal cramps and bleeding output. Her Hgb remained stable and she showed no evidence of uncontrolled infection. She was tolerating a diet and meeting nutritional requirements. She was evaluated on 5/7 and deemed stable for discharge. She is having scant bloody output with her stools still, but this was reviewed with GI on date of discharge and is expected for C diff colitis in ongoing recovery. She will be prescribed 12 more days of oral vancomycin therapy to complete a total 14-day course, given her history of immunodeficiency. She is recommended follow-up with her PCP within 1 week of discharge, and with the outpatient GI clinic as directed by their office. Condition specific return precautions were reviewed with her at length prior to discharge, and she vocalized full understanding of all given instructions and follow-up recommendations. CONSULTS / RECOMMENDATION: GI INPATIENT PROCEDURES: None


VAERS ID: 1310312 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-02
Onset:2021-05-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal discomfort, Abdominal distension, Abdominal pain upper, Angiogram cerebral normal, Chills, Computerised tomogram abdomen abnormal, Computerised tomogram head normal, Fatigue, Headache, Magnetic resonance imaging head normal, Pain, Pyrexia, Thrombosis, Venogram normal
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Thrombophlebitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Propecia, Probiotic, Multi-vitamin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: CT scan of the stomach given on May 3, 2021 revealing blood clots. CT scan, MRI, MRA, and an MRV of the head given May 3, 2021 to see if clots formed in that area. Test did not reflect clots in the head.
CDC Split Type:

Write-up: I felt tired the evening of the shot. The next morning I had fever and chills, body aches everywhere, severe headache, extreme fatigue, and very upset stomach. By the second day following the vaccination I have a very bloated stomach and extreme pain. These symptoms continued with the stomach and headache becoming worse. Entered the Emergency Room the evening of May 7th and admitted into the Hospital.


VAERS ID: 1310544 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-30
Onset:2021-05-03
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Myocarditis, Troponin increased
SMQs:, Myocardial infarction (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: troponin 5
CDC Split Type:

Write-up: myocarditis


VAERS ID: 1310576 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-02
Onset:2021-05-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Blood glucose normal, Carbon dioxide decreased, Chest pain, Cold sweat, Computerised tomogram head, Computerised tomogram neck, Dizziness, Dreamy state, Electrocardiogram normal, Fatigue, Hyperhidrosis, Hypoaesthesia, Influenza like illness, Lethargy, Loss of consciousness, Lymphocyte count normal, Mobility decreased, Musculoskeletal stiffness, Nasopharyngitis, Nausea, Neuropathy peripheral, Neutrophil count normal, Pain in extremity, Paraesthesia, Retching, Scan with contrast, Sleep disorder, Tremor, Vertigo, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Peripheral neuropathy (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune 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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lipitor, and Zoloft
Current Illness: None at time. Gallbladder removed in March
Preexisting Conditions: Hypoglycemia, and degenerated dics in back and neck
Allergies: Compazime
Diagnostic Lab Data: Blood, EKG and CT scans with and without contrast. Brain, and neck area.
CDC Split Type:

Write-up: First I got my 1st shot Sunday morning I sat in the observation, and for a brief period I got dizzy, and nauseated. It was brief. Day two sore arm of course, and tired felt like flu symptoms Day 3 extremely tired, and couldn''t keep my head up I was so lethargic. Felt like the Flu was coming on went to bed after work Thursday, Fri, and Sat my head was still feeling like I had a head cold. Fatigued still Sunday I was in dream state when I jolted from a spinning feeling in my sleep. I opened my eyes and I couldn''t even function. I couldn''t get out of bed nor move I was completely spinning. I tried to make it to the bathroom and threw up bile. Took a anti nausea pill Zofran, and didn''t work. Nothing was working. I fell asleep and woke up just constantly dry heaving. The vertigo was so bad I felt faint It was then at the point I was passing out when we called 911. I couldn''t move I was perspiring, and couldn''t keep liquids down. I was shaking, clamy, and my body turned numb. Thought I was having a stroke. In the ambulance narapathy started up, and down my arms and hands,, and my fingers locked up. Chest was on fireI, and my whole body tingled with fighting off whatever it was.. The hospital IV me with Zofran several times. Antivert and Ativan. EkG fine CT head Brain CT head neck. Ears were fine. No infection in ears. Blood Glucose was high 182 CO2 was slightly low 22 Lymphocytes low 21.6 low Neutrophils Absolute 7.7 high Nothing else to do but send me home to follow up with ENT and Nuero to make appts to follow up. I scheduled my primary qs well to look me over.


VAERS ID: 1310685 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-26
Onset:2021-05-03
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Diarrhoea, Dyspnoea, Gastrointestinal haemorrhage, Haematochezia, Myocardial ischaemia, Troponin increased
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Myocardial infarction (narrow), Pseudomembranous colitis (broad), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Noninfectious diarrhoea (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: diabetes, hypertension, hyperlipidemia, CAD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented to ED on 5/3/21 for shortness of breath, diarrhea, and bloody bowel movements, Patient does not occasional cough. Patient diagnosed with COVID -19 infection and GI bleed. Patient did have elevated troponins on admission attributed to demand ischemia from COVID-19 pneumonia and acute GI bleed. COVID-19 infection was treated with remdesivir, oxygen and steroids. Patient improved and was later discharged to home.


VAERS ID: 1310737 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-07
Onset:2021-05-03
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Deep vein thrombosis, Pain in extremity, Peripheral swelling, Thrombophlebitis superficial
SMQs:, Cardiac failure (broad), Angioedema (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament 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? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ? polyethylene glycol 3350 17 gram/dose oral powder (Miralax) ? famotidine 40 mg tablet (Pepcid) ? lansoprazole 30 mg capsule,delayed release (Prevacid) ? linaCLOtide 145 mcg capsule (Linzess) ? azelastine 137 mcg (0.1 %) nasal spra
Current Illness: G tube site cellulitis
Preexisting Conditions: AV canal s/p repair, gastric fisula at G tube site s/p repair, obesity, asthma, nocturnal enuresis, IBS, premature baby- had multiple central lines placed as an infant
Allergies: environmental
Diagnostic Lab Data: US doppler on 5/3/21
CDC Split Type:

Write-up: Deep venous thrombosis involving the common femoral vein and central portions of both superficial and deep femoral veins. Thrombus is also present within the saphenous vein. symptoms- leg swelling and pain since 5/2/21


VAERS ID: 1310844 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-04-06
Onset:2021-05-03
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: positive covid test
CDC Split Type:

Write-up: Breakthrough COVID requiring hospitalization. discharged home


VAERS ID: 1311099 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-12
Onset:2021-05-03
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chest pain, Computerised tomogram thorax abnormal, Dizziness, Dyspnoea, Electrocardiogram ST segment abnormal, Fibrin D dimer increased, Motor dysfunction, Paraesthesia, Pulmonary embolism, SARS-CoV-2 test negative, Sinus arrhythmia, Sinus bradycardia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Haemorrhage laboratory terms (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Disorders of sinus node function (narrow), Embolic and thrombotic events, venous (narrow), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zyrtec, Flonase, melatonin, L-theanine
Current Illness: None
Preexisting Conditions: Seasonal allergies - allergy related asthma
Allergies: No known medical or food allergies - just seasonal
Diagnostic Lab Data: COVID PCR test on 5/3: negative. EKG on 5/3: Sinus bradycardia with sinus arrhythmia Rightward axis, Nonspecific ST abnormality D-dimer on 5/5 = 554 ng/mL CTA scan on 5/5: Multiple sub-segmental pulmonary embolism in both lungs
CDC Split Type:

Write-up: Admitted to hospital on 5/3 with difficulty breathing, chest pain, light-headedness/dizziness, tingling in arms, and sloght loss of motor control of hands (clenching into fists uncontrollably). CT scan on 5/5 showed sub-sectional pulmonary emboli in both lungs. Released from hospital on 5/7 with treatment course including blood thinners.


VAERS ID: 1311150 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-04-23
Onset:2021-05-03
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Haematoma, Platelet count decreased, Thrombocytopenia
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (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? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None according to mother
Current Illness: NO
Preexisting Conditions: ASTHMA
Allergies: None
Diagnostic Lab Data: Platelets at 40,000
CDC Split Type:

Write-up: Hematomas on the body from the thrombocytopenia


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